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What eye patching is, how you can help a pupil who wears a patch, activities the pupil can do while patched.
What eye patching is
Patching, also known as occlusion therapy, is a common way to try to improve the vision in a weaker eye when a child has a lazy eye (also known as amblyopia).
The child wears the patch on the better seeing eye for a few hours each day, depending on the difference in the vision in each eye. Some children may need to wear a patch to improve vision in an eye that’s only slightly weaker than their better eye. Other children may need to wear a patch to improve vision of an eye that is much weaker than their better eye.
If a child can use both eyes together, this helps them know where objects are in space, also known as depth perception.
Children who only use one eye are likely to find it difficult to:
- judge the height of steps
- reach accurately for objects
- judge the speed that something is travelling at
- judge how far away an object is
With experience, these children tend to:
- adapt and learn where things are in space
- become more confident in familiar settings, for example the home or nursery
However, when they go into unfamiliar places, they may show these difficulties again and are more likely to bump into things or fall.
Patching can be required for a short period of time (for example 1 hour per day) or several hours per day. The level of vision and the amount of time patching is required, and the need to continue patching treatment will be reviewed regularly.
What you can do to help a child wearing a patch
Whatever the child is doing, they’re stimulating the vision in their weaker eye. Distraction is a useful strategy to encourage the child to wear a patch.
It may be easier to patch when the child can focus on stimulating fun activities rather than learning something new that requires a high level of concentration and effort.
To help a child wearing a patch, you can:
- use a reward system with attainable short-term goals
- help the child understand why they need to wear a patch
- help other children understand why a child needs to wear a patch, you can also help the child explain to others if they’re asked
- give the child time to explore their environment including steps and heights keep furniture in a consistent layout as much as possible
- allow the child to bring objects close to them or to get close to objects or books
- encourage the child to engage in fun activities while being patched
- provide extra supervision when in unfamiliar environments
- establish a routine:
- think carefully when the best time would be to patch, so that the child can engage in activities
- start with fun activities and once the child is more confident wearing the patch, you can try to have them wear the patch as much as possible whatever they’re doing
If vision in the weaker eye is very poor:
- provide books with larger print or enlarge some materials and books: books for young children often have large print and it’s useful to have an example of font size the child can see (check with the child’s orthoptist)
- make sure the child is sitting close enough to the teaching focus to be able to see it, for example closer to the interactive white board or to the shared story book
Examples of activities while a pupil is patched
Activities a pupil can engage in while patched include:
- games that involve drawing a line in between lines, like in mazes to find your way out
- dominoes where you match patterns or colours
- peekaboo games: find a picture hiding under flaps or somewhere on a page
- share a story book: if vision is very poor in the weaker eye, choose books with large bold pictures
- drawing, colouring and painting are great activities
- watching a video
- playing computer or video games or an iPad game
Transition between settings
At transition times between setting, for example from nursery to school:
- make sure staff in the new setting are informed about strategies in place in the current setting
- make sure you share any information and advice provided about the level of vision with new setting
- make sure staff have contact details of the pupil’s orthoptist
- establish a routine for patching that will work the new setting
Instructions on how to create a mandatory or roaming login profile for a pupil.
To create a login profile for a pupil, you need to use the pupil’s active directory username.
The account must have one of the following profile options:
- roaming profile (recommended option): if the school uses roaming profile, the pupil can modify and set their profile according to their needs
- mandatory profile: if the school uses mandatory profile, the pupil and teacher will liaise with the School IT Officer and agree on the accessibility options
The pupil won't be able to modify this profile later on.
Read instructions on:
What Quality First teaching is, strategies to teach pupils with vision impairment.
What Quality First Teaching is
Quality First Teaching refers to the style of teaching adopted to promote inclusion.
It includes differentiated learning and strategies that are expected to be implemented by class and subject teachers, to meet the needs of children and young people with special educational needs and disabilities.
Quality first teaching and a graduated response are embedded in the SEND Code of Practice.
Environment strategies
Make sure the classroom is well organised and labelled, with good acoustics. Keep background noise to a minimum.
Make sure the seating position enhances and optimises use of vision to access:
- interactive whiteboard
- flipchart
- screens
- smartboards
- any demonstrations
Check lighting levels to make sure there’s appropriate and comfortable light for the pupil, including use of blinds.
Where possible, pupils should be seated:
- with their back to the windows
- so shadows are not cast over them and their work
Highlight steps and key features within the school and playgrounds or outside space. Carry out an environmental audit as advised, in liaison with a Qualified Teacher for the Visually Impaired (QTVI).
Interacting with the child or young person
Make sure the child or young person:
- is included in the classroom
- gets opportunities to work with a variety of peers at different times
Praise should be specific and clear, giving the pupil a realistic sense of themselves.
The child or young person should be clear on:
- what is expected
- the volume of work they should complete in the time available
Help the pupil access good examples of peers’ work.
Give the pupil opportunities to have real first-hand experiences, for example use real objects.
Strategies for teachers and staff
Delivering lessons
PowerPoints should have clearly numbered slides, so that students using personal copies of the presentation can easily follow in the lesson.
Give clear verbal explanations when giving a demonstration. Verbalise what you write on a board.
Say the pupil’s name before talking to them so they know who you’re directing the request or instruction to. Remember that children and young people with a VI are unlikely to follow non-verbal communication
Do not stand against a window, as your face becomes difficult to see.
Supporting vision
Encourage pupils to:
- use aids, for example writing slopes, glass or hand magnifiers
- keep glasses clean, if applicable, as advised by QTVI
Provide rest periods or alternate activities to reduce visual effort. For example, use audio books or a practical activity. Reduce unnecessary visual information from materials or copying from board.
Colour contrast
Make sure there’s good contrast between print and background colours, when making either paper copies or electronic presentations.
Adults should use pens that provide good contrast when writing on a board or pupil’s books, for example when giving feedback.
Resources
Provide a range of resources that support visual access, so the pupil can choose the most appropriate resource for an activity.
For example:
- different types of pens and pencils
- high visibility rulers
- soft pencils 2B and 4B
- wet ink handwriting pens
- thick lined or wide spaced writing books
Use resources that facilitate visual access across the curriculum, for example:
- coloured balls in PE
- accessible science equipment
A QTVI can discuss these and advise regarding purchase.
Learning materials
Use matt surfaces, including laminated materials, to reduce glare.
Provide materials with font style and size appropriate to the pupil, as advised by QTVI.
Give pupils their own copy of materials. Avoid sharing books or monitors so the pupil can position themselves in the best angle or distance, unless sharing is needed for social reasons.
Where enlargement is needed use A4 paper. Print landscape if the level of enlargement makes it more manageable. Number pages in the same place on the sheets.
Photocopies should be good quality, strong contrast, and colour where possible.
Activities
Consider:
- arrangements for break and lunchtime activities
- the child’s participation and inclusion in these
- finding and accessing peers before these activities take place
Consider using a classroom tablet computer to take photos and enlarge images to help with access, as advised and discussed with QTVI regarding purchase.
Consider access to assemblies and information:
- give the pupil their own copies of materials or a laptop or tablet displaying information
- consider the pupil’s seating position
- arrange access to staff to give additional verbal descriptions or information
- make sure the pupil has an evacuation plan and risk assessment in liaison with QTVI
Additional resources and information
RNIB
Links to useful resources and a document listing teacher-reviewed resources for blind and partially-sighted learners.
Book Share (previously Load2Learn)
Accessible online library for people with print disabilities. Useful for a range of needs
Seeing Ear Library
Accessible online library for large print.
RNIB Lending Library
Large print and Braille books.
Sources or causes of potential hazard for pupils with vision impairment and measures you can take to eliminate the hazards.
When compiling your school risk assessment, choose the risk assessment recommendations that are appropriate to:
- your school
- the pupil’s vision impairment
Hazard
Safe access to, and participation in school visits.
Cause or source of hazard
Lack of familiarity with environment and activity.
Possible lack of background experience.
Inadequate mobility and independence skills.
Measures to eliminate or control risks
Carefully consider the needs of the visually impaired pupil.
Consult with the Qualified Teacher of Vision Impaired (QTVI) and the pupil’s parents or carers to check experiences. Build in pre-tutoring, if necessary.
Allocate support staff to offer the level of support agreed for the pupil. Consider comfort breaks for staff and times during the visit when you need to increase or decrease support, depending on the student and activity.
Support staff need to be fully trained in the mobility needs of the student they’re supporting, for example, cane use, sighted guide techniques.
Alert staff at the venue of the needs of the pupil.
By whom
Select from following as appropriate:
- education mobility personnel
- QTVI
- Teaching Assistant
- pupil
- school staff and support staff
- venue staff
- parents
Getting the pupil’s attention, materials and positioning, helping concentration.
General things to consider
Consider the following for each pupil:
- what their eye condition and visual needs are
- if they have some useful vision
- if they have an unusual head position for looking
- if they have a visual preference, right or left, central
- how they use their vision, for example at what distance they can see facial expressions, Makaton signs and resources
Pupils need lots of opportunities to use their vision. Develop their interest in looking by ringing in the changes, for example:
- use of sensory rooms
- UV fluorescent materials
- ICT
- eye gaze technology
- autumn colours walking under the trees
Getting the pupil’s attention
Approach the pupil from in front and gain their visual attention.
Make sure you attract the pupil’s attention by getting down to their level, in line of their vision and call or sign their name.
Materials and positioning
Find the best working position to present things, for example at eye level, as the pupil may find it difficult to look at objects placed on their trays.
Consider:
- the size of materials
- the distance they’re presented to the pupil
- using a tilted work desk or an easel
- using a CCTV to enlarge and present materials on a monitor at the pupil’s eye level
They may need their own educational materials.
Make sure teaching materials stand out clearly from the background:
- use good colour contrast
- reduce visual clutter for ease of access, for example maxess black felt boards
Make sure there’s good, even level of lighting, with glare reduced:
- position the pupil with their back to the light source
- use blinds or curtains
- use resources with matt surfaces
Helping concentration
Give the pupil time to look and respond.
Reduce the background noise and visual clutter so the pupil can concentrate on using their vision
Allow time for the pupil to rest. It’s hard work to coordinate looking, listening and making a physical response.
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