Instructions for Using the Wayne Ambly-O-Trainer

The Wayne AMBLY-O-TRAINER was designed to permit the duplication of the research results obtained by Drs. Banks, Campbell, Hess & Watson as described in their report entitled "A New Treatment ot_ Amblyopia." (See attached report).

In their report, Banks, Campbell, Hess & Watson claimed exceptional results using their simplified equipment and techniques for the treatment of amblyopia. They reported successful treatment on a group of 40 young patients. The average treatment consisted of four sessions of seven minutes each duration. In one case cited, the "visual acuity for distance and near point improved from 20/300 to 20/20 after 10 treatment sessions spaced over a period of 21 days:'

A cursory survey of American doctors who acquired their own similar equipment indicated about 50% of the doctors were satisfied with the results of this new treatment procedure. The other doctors, who claimed lack of success stated that, assuming the report was valid, they encountered the following variables:

1. Selection of patients for treatment. The feeling was that not all cases of amblyopia respond to this type of therapy.
2. Selection of the most effective spatial frequency to use.
3. Higher contrast patterns were needed.
4. Difficulty in motivating patient to cooperate-partially due to the lack of self-directed activities and absence of immediate feedback.

The Wayne AMBLY-O-TRAINER was designed and engineered to optimize the above variables, thus resulting in an instrument which would be both functional and flexible.

The Wayne AMBLY-O-TRAINER has the following provisions:

1. Two rotating discs are used simultaneously. The right disc rotates at 1 rpm clockwise. The left disc can be driven at { rpm, 1 rpm, and 2 rpm clockwise or counter-clockwise.
2. The rotating discs are back illuminated for higher contrast and for greater spatial stimulus of the cortex.
3. A large work surface at 20� angle permits a variety of visual tracing tasks. (The Wayne TALKING PEN may be used with the AMBLY-0-TRAINER to increase patient motivation and attention span).
4. Patient can wear anaglyph glasses instead of an occluder.
5. Discs can be overlayed to produce a moire pattern made up of multiple spatial frequencies.
6. A near-point visual acuity disc is provided for dynamic near-point training.
7. Unit can be used as a light box for tracing, fusion training, etc., when discs are removed.

IMPORTANT: Before proceeding, be sure to read the enclosed research report "A New Treatment for Amblyopia."

The Wayne AMBLY-O-TRAINER is an instrument designed to help improve the acuity of the amblyopic eye which cannot be improved by standard optical correction. Treatment consists of viewing a high contrast grid which is slowly rotating behind a transparent cover on which visual tracing or drawing games are played to insure the patient's attention to the visual stimulus. The hypothesis upon which this is based is that cells in the visual area (cortex) of the brain respond best to a grating of a certain size (spatial frequencey) and orientation and that by stimulating these cells visual acuity can be enhanced. By using more than one frequency, the chance of hitting upon the most effective stimulation of the cortex cells for each individual is increased. By overlappinp, the disc oatterns, the moire pattern which is produced results in a multi-frequency stimulus.

First, and most important, test patient for visual acuity using acuity charts for distant and near point. The acuity of each eye should be recorded in addition to all other visual deviations.

Since the stimulus of the visual cortex is maximized when the spatial frequency patterns are imaged directly on the fovea, it is recommended that patients should first receive therapy for correcting the eccentric fixation, i.e., after-image technique, etc.

Start with Grid Disc #6 (widest lines). Place it on a dark back sheet in order to decrease contrast.

Position disc 14 inches in front of patinet.

Occlude patient's good eye.

Instruct patient to rotate the disc until the lines "go up and down" (vertical). Then rotate discs until lines are horizontal.

Repeat test using Disc #5, 4, 3 and 2 until patient is no longer able to correctly position lines properly. This last disc pattern should be placed on the left rotating spindle.

Select another grating that is one number lower or a factor of 1 octave finer. Place this disc on the right spindle.

The left spindle should be positioned per figure 2 for a 1 rpm rotation. (See section below on changing disc speeds).

Patient should be comfortably seated at a table with the Wayne AMBLY-0-TRAINER in front of him at reading distance. Occlude patient's better eye using a patch occluder or anaglyph glasses with a red filter placed over the work surface. With some patients it might be helpful to use plus lenses.

Instruct patient to trace the patterns on the overlay sheet using a crayon or china marker. (To increase the fun aspect of this activity, we suggest you use the Wayne TALKING PEN for tracing. The TALKING PEN will buzz if the visual tracking is not accurate. The Wayne AUDITORY MUSIC CONVERTER (AMC) may be used in conjunction with the TALKING PEN so that music from a radio or tape recorder will be heard only when patient is on track.)

At the conclusion of at least seven minutes of training, the patient should be re-tested for near and far acuity and the results recorded.

Each time the patient receives a treatment, repeat all of the above tests with a set of grid patterns which satisfy the new pre-test results.

The number of treatments needed will depend upon patient's rate of progress. To prevent regression, it is recommended that treatment be continued over an extended time period until acuity remains constant.

1. Buck shot approach. Change disc pattern size every two minutes during treatment period.
2. Pattern overlay-moire effect.
   
   When two grid patterns of identical frequency overlap, the result is a series of continual changing spatial frequencies. The grid discs can be placed closer together which will result in a larger disc overlay and thus a greater area of continuous changing spatial frequencies. To move grid discs closer together, see chart.
   
   Position the discs closer together (as shown in figure #4).
   
   Slow down one of the discs with your finger until the changing pattern is produced. This should motivate the patient and hold his attention for the maximum time period.
   
3. Variation of disc speeds.
   Since the speed of rotation of the left grid pattern can be increased to 2 rpm or decreased to { rpm, it is suggested that the speed of rotation be changed while noting the effect on patient's progress.

Patient can use a china marker and trace one of the grid lines and draw concentric spiral lines.

Game activities, i.e., saccadic dot patterns, when used with the TALKING PEN provide a fun task. Patient fixates directly on the overlapped area of the two discs and visually follows the changing moire patterns.

Place the near-point dynamic acuity disc on the left spindle and the selected grid pattern on the right spindle. Instruct patient to fixate on a given letter and follow the letter with his finger while it passes under the grid pattern.

The left spindle containing the near-point dynamic acuity disc can also be used alone for tracking etc.

The above treatment for amblyopes is relatively new. Standard office treatment procedures have not been established. Please share your experiences so that others may benefit.

The right pulley assembly and disc drive are connected directly to the motor and are not removeable.

The left pulley assembly is removeable and can be inserted into its bearing in one of two position, large pulley down or large pulley up.

The correct belt length must be used to change disc speed and position. Three belts are available. These are identified with a colored dot-pink, red, and white.