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Arnold, R. W., Armitage, M. D., Limstrom, S.A.. (2008). "Sutured protective occluder for severe amblyopia." Arch Ophthalmol 126(7): 891-895. OBJECTIVE: To investigate the feasibility, acceptability, efficacy, and cost of a newly developed translucent shield that can be fixed by sutures to the orbital rim for a month of amblyopia therapy. METHODS: In an institutional review board-approved protocol for patients with amblyopia who do not adhere to the use of conventional patching, shield occluders were fashioned from heat-moldable sturdy black or translucent (20/4000) plastic with holes drilled for attachment. Under brief general anesthesia, patients aged 5 to 10 years had a thorough examination before the shield occluder was sewn to the brow and cheek of the nonamblyopic eye with 3-0 monofilament polypropylene sutures. RESULTS: Ten children completed this protocol from December 1999 through January 2002. All tolerated the occluder for 12 to 36 days. The resultant skin scars were acceptable to parents, patients, and investigators. The amblyopic eyes improved from a mean (SD) of 0.77 (0.30) logMAR (Snellen equivalent, 20/119) to 0.45 (0.29) logMAR (Snellen equivalent, 20/57), a change of 0.32 (0.16) logMAR lines. There was no damage to the sound (occluded) eye. CONCLUSION: Sew-on occluder shields are an alternative when adherence to the use of other types of patching (often referred to as compliance with patching) is not satisfactory.

Other options for blurring: Bangerter filters (Agervi, P., U. Kugelberg, et al. (2009). "Treatment of anisometropic amblyopia with spectacles or in combination with translucent Bangerter filters." Ophthalmology 116(8): 1475-80.)

Other methods for increasing patch compliance: Superglue Patch: Rubab, S., D. French, Levin, A.V. (2008). "Glued patches for children resistant to amblyopia occlusion therapy." Arch Ophthalmol 126(1): 133-4.

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