Key To Patching Successfully (Reducing Diopter Ratio)

From BackTo20/20, a worthwhile observation posted by David in the support forum:


I watch 15 minutes or so of a TV show with a patch daily, focusing on the subtitles.
It seems to be working.
I think that patching is also beneficial to the stronger eye(to both eyes…), but not sure, its just my intuition. It feels like the patched eye is resting (like after sleep) so maybe doing 5 minutes of patching can help ciliary spasm.


Thanks for sharing Jake!

It’s a good reminder to be patient when starting to reduce the ratio. It was difficult for me too the first times. It was like the brain was saying “Nope, don’t use this one, it can’t see well”. I think the brain is used to lean on the stronger eye to take the clearer image of the two eyes. But with constancy, it works, the non-dominant eye starts to improve and the brain stopps ignoring this eye. With my equalized prescription, I feel now less discomfort when I take my glasses off (less focal plane change?). What is terrible is that my dominant eye don’t stop improving just because of the patching…:upside_down_face:

Yeah reading subtitles on the TV while patching is great. I patch also sometimes when I go outside with my normalized, to have a really good distance stimulus.


In my case, patching is not uncomfortable if I do it outside, with distance vision. But when I try to do it in close-up, it doesn’t work as well! Anyone else who saw that kind of difference between both?


I’m a bit confused about the process of equalizing and so I am posting several questions here (hopefully not too many). My glasses - both normalized and differentials - have a difference of -0.75 diopters between the right and left eyes. At what point in the process should the difference between the two eyes be reduced, before or after starting to patch? If it’s before - so patching with my current diopters - and if my vision with those glasses is roughly the same in each eye, then is the goal of patching to make the weaker eye improve faster than the stronger eye? How do we know when to reduce the difference with new glasses? And would we need to reduce the difference in both differentials and normalized glasses at the same time? I’d be interested in hearing the experiences of others who have started out with this much difference, or more, between eyes and have successfully reduced the difference or equalized.


That’s a pretty long topic.

Main thing is to definitely take the time for both eyes to catch up to reductions, and not look at the dominant eye as the landmark of what the rate is (and consequently imagining that there is something wrong with the other eye). It’s when both eyes are caught up that the current diopter stimulus is complete.

Then there’s the matter of the relative ratio. 0.75 is much less with -10 diopters than it is with -2. If you’re high myopia there’s no need to address diopter ratio, unless you notice that the non-dominant eye is starting to show more improvement than the dominant eye.

And then if you do reduce the ratio, you should have at least 2 regular spherical reductions in between.

Patching usually starts before making the ratio reduction and then continues after. A little goes a long way, with patching.


Thanks. In retrospect it was perhaps too many technical questions for this platform but I appreciate you taking the time to respond!

1 Like

All good. Most of the time it’s questions that give me ideas for blog posts or videos. Ask away anytime. :slight_smile:


My situation is just the opposite. My dominant eye is -1.75 greater diopter than my non dominant eye. (normalized OD -3.25 OS -1.50) What might be going on here? I don’t that see that patching will help in this case. The diopter difference used to be smaller (about -0.75) before I started wearing progressives for presbyopia.

I’m not sure, but it is possible that with the arrival of presbyopia, the brain starts to use monovision, so one eye is used and adapted for close-up (the more myopic one) and the other for distance. It is one of the techniques used with Lasik for those who have myopia and presbyopia.
I think patching could still be useful to equalize the prescription and keep both eyes functional for distance and close-up. Usually you don’t want to patch before having some binocular reductions, but in your case, the ratio is really high, so maybe reducing the gap will be necessary before the less myopic eye improves too much. But I’m not an expert and I don’t have presbyopia (and don’t know how this can influence the situation), so interested to see what others say about this. :slightly_smiling_face:


So after changing your diopter ratio once, you should stick to that ratio for the next two reductions before attempting another diopter ratio to narrow the gap?


At the very least. Also more time between changes helps.


Another question with regard to patching. (I thought of this having just watched the pro-topic video on changing focal planes.) I usually change (reduce) my differential glasses at different times from my normalized glasses. Is it okay to reduce the diopter ratio in the differentials, use them for a few weeks, and then get normalized glasses with the same reduced diopter ratio as the differentials? Or would it be too confusing to the visual cortex to have the different ratios in the differentials and the normalized?

This is what I did - reduced my Diffz (they had 3 diopter difference between left and right) while my Normz had 3.5 diopter gap. Then reduced Normz to match once I was ready.


Hi dear all, i’m browsing through the information of Endmyopia for few days, i’m not asking for diopter advice, but wish to confirm with you so that i wont make a wrong decision,
I’m start to use endmyopia at Jan 2019 , with L: -6.5D, R: -6.75D
latest measurement is L: -5.5 D, R: -6.0 D
I’m using normalised glasses of both eye -5.25 D ,
I can see the Snellen chart with both eye clearly up to 20/25 with my normalised glasses, but not when i’m only using my right eye,

i’m thinking want to increase the power of right eye to -5.75D since my right eye with current normalised glasses is too blur to do active focus. or should i do patching until my weaker eye catch up before the next normalised glasses reduction?
your reply is highly appreciated. thank you so much.

Why did you drop your R power so much when your cm measurements said otherwise? Were you trying to equalize? If so, that’s probably not the best way to go about it. Trust your cm measurements and make gradual changes. Read more, watch more videos. That’s the best way to build the self confidence needed to make your own assessment. Of course, mistakes are a good way to learn too. You have already made some good progress, keep it up.


yes, my diopter difference was just -0.25D initially, so i decide to use the same power for both eye. but recently my left eye improve faster than right eye, i found out that right eye is too blur to do active focus with my normalised. i think i know what to do after browsing so much info here. since my right eye is difficult to do active focus, i will try to increase the power of right eye a little bit see what will happen. thank you so much for your reply. ^^


Sounds like a wise plan. The discussions on equalizing seem to involve people at a much lower diopter level than you and I – kind of like cleanup work after the big party. I started out with a 1 diopter difference, but my L has improved way faster. Suspect they were over- (L) and under- ® prescribed to begin with. Now equalized, but not holding my breath they will stay that way.


I’m in the same boat. My centimeters are about 25 left and 15 right. I just had my R contac increased because I was in monovision contacs before endmyo. Great to see this thread!

Edit 4 days later- I made a couple homemade patches and noticed 2 wins. First was, the other night when I took out my contacts after patching, before I put on my differentials, my right eye was ‘doing the looking’ which has not happened since the time it was the stronger eye. And the 2nd win this morning just brushing me teeth, the same thing happened. :slight_smile:


Shhhh, don’t tell anyone, but sometimes I patch one eye while driving, using a teabag under my glasses so that when I need to see with that eye I can get rid of it quickly. It does seem to be very stimulating to do when I have lots of long-distance vision to practice with and yes, with subtitles. BTW what kinds of materials are people using to patch with?