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 {1/2 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 and contrast 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.

1. Pattern overlay-moire effect.
   
   The selection of the optimum spatial frequency is critical for sucessful results. This would be difficult for a single selected frequency disk. To solve this problem two #1 frequency disks are provided. When two grid patterns of identical frequency overlap, the result is a series of continual changing spatial frequencies\The left spindle should be positioned per figure 2 for a 1 rpm rotation. Slow down one of the discs with your finger until the changing pattern is produced. This should motivate the patient and hold his/her attention for the maximum time period. For a rapidly changing frequency, change the speed of the second disk using the provided 2nd pulley belt.\\

(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. 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,test the acuity of the amblyopic eye, 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. Continue with your selected home treatments, ie, patching etc.

1. 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 correct belt length must be used to change disc speed and position. Two belts are provided. When selecting the proper belt, avoid over stretching.

Left Disc Speed	Right Disc Speed	Left Pulley Assembly Position	Bearing Hole Position	Belt Color	Figure
1 rpm	1 rpm	Larger pulley below smaller pulley	Left
2 rpm	1 rpm	Larger pulley above smaller pulley	Left
½ rpm	1 rpm	Larger pulley above smaller pulley	Left	1 rpm	1 rpm	Larger pulley below smaller pulley	Right