Amblyopia Home Therapy

By Jeffery Cooper MS, OD, F.A.A.O. & Rodney K. Bortel

DOCTORS MANUAL

Copyright 2006 by HTS, Inc. All rights reserved

HTS, Inc. 5301 S. Superstition Mtn. Dr. PMB 483 Suite 104 Gold Canyon, AZ 85218

Phone (480) 983-0857 / (800) 346-4925 Fax (480) 983-6005 Email: hometherapyinc@att.net

________________________________________________________Amblyopia Home Therapy ____________________________________________________________________CONTENTS

1 1.1 2

WELCOME TO AMBLYOPIA HOME THERAPY ASSIGNING THERAPY RUNNING AMBP INET CUSTOMIZE AUTO MODE MANUAL MODE RUN PROGRAM AUTO RUN PROGRAM MANUAL PERFORMANCE BACKUP/COPY RESULTS DATA UPDATE RESULTS DATA

1.1 1.3 2.1 2.4 2.4 2.6 2.7 2.8 2.9 2.10 2.11 3.1 3.4 3.6 3.8 3.10 3.12 3.14 3.16 3.18 3.20 3.22 3.24 3.26 4.4 4.4 4.5 4.6 4.5 4.4 4.4 4.1

2.1 2.1.1 2.1.2 2.1.3 2.1.4 2.2 2.3 2.4 3

PROCEDURES FOLLOW THE LETTER LETTER JUMP FIND THE TARGET CONCENTRATION SPACE BALL CAPTURE THE TARGET LASER BALL BUTTERFLY HUNT TRAFFIC JAM PENGUIN PEEK CHIPMUNK CHASE SKIING

3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 3.12 4

USING THE AMBLYOPIA INET TOOLS PROGRAMS DEMONSTRATING AMBP INET MODIFYING OR CONFIGURING THE PATIENTS PROGRAM NEW PATIENTS EXISTING PATIENT MOVING USERS REVIEW MODIFY EXISTING PATIENTS

4.1 4.2 4.2.1 4.2.2 4.3 4.4 4.5

Welcome to Amblyopia Home Therapy

This manual provides the essentials you need to successfully operate Amblyopia Home Therapy and integrate this valuable program into your practice. Section 1 describes the features of Amblyopia Home Therapy and how to incorporate the program into your practice. Section 2 leads you step-by-step through Amblyopia Home Therapy using your Doctors Practice program. In Section 3 you will find a detailed description of the twelve Amblyopia Home Therapy procedures. In Section 4 you will be shown how to use the special Tools program that allows you to demonstrate Amblyopia Home Therapy to your patients. You will also learn how to modify a Patients Program and track their therapy results. Amblyopia, a reduction in visual acuity due to inappropriate visual stimulation during the critical period of time, causes more visual acuity loss in the under 40 group than all the other ocular diseases combined. This condition which afflicts approximately 3% of the population can be detected with appropriate visual screening which includes: visual acuity testing, cycloplegic refraction, and measurement of fixation (visuoscopy). We suggest that you use the streak of your ophthalmoscope in young children to determine the presence or absence of eccentric fixations. Children are reflex bound and will look at the light. Thus, when viewing the normal eye young children will fixate the light, i.e. the streak will be coincident with the fovea; with eccentric fixation the streak will not be coincident with the fovea. Stereopsis evaluation with random dot stereograms will aid in the diagnosis. All strabismics including microtropes will fail to perceive a random dot stereogram while some anisometropic amblyopes will perceive a random dot stereogram. Amblyopia is a result of amblyogenic factors, e.g., anisometropia, strabismus, high isometropia, microtropia, congenital cataract, ptosis. Idiopathic amblyopia though rare can occur and rapidly responds to conventional patching therapy. Recent NIH sponsored studies for young children have shown that mild to moderate amblyopia responds well to 2 hrs of patching and/or atropine; and 6 hrs of patching and/or atropine for moderate to advanced amblyopia. Recent studies have shown that the above regiment combined with hand eye coordination tasks in amblyopic patients 7-17 yrs results in successful remediation of amblyopia. Though, no clinical trials have been employed in children under seven years of age having their patching augmented with hand-eye coordination tasks, it is intuitive that if hand eye tasks improve amblyopia treatment in the older population it should work in the younger children. From these studies we conclude that amblyopia should be aggressively treated with the appropriate use of patching, and/or atropine, in combination with hand-eye coordination tasks. HTS has therefore created an amblyopia hand-eye coordination program which uses principles of operant conditioning and behavior modification to appropriately alter stimuli characteristics to improve visual acuity. The new Amblyopia Home Therapy program automatically begins at a level where the amblyopic eye can easily see and perform the tasks. As therapy progresses, the stimuli become progressively smaller. The stimuli have been intentionally designed to require fine discrimination, improve hand-eye coordination, and maintain the interest of your patient Correct responses are audiotorally reinforced with a subsequent reduction in the size of the stimuli. Therapy is directed to improve resolving ability with concomitant use of hand-eye coordination tasks. Therapy can be

preformed monocularly or monocularly in a binocular field. The Amblyopia Home Therapy program is designed to be prescribed requiring a minimum of doctor intervention. Each session consists of six different tasks of five minutes of duration. We suggest that that therapy be performed five days per week. The patient is instructed to patch the good eye and perform the prescribed tasks. Improved performance is noted at the end of the session with the accumulation of stars. If a patient obtains all the stars then the acuity has improved to 20/20 for that procedure. Performance may also be monitored by viewing performance graphs.

1.1

Assigning Therapy

The Amblyopia Home Therapy program may be prescribed in one of two modes, Auto or Manual. Auto Mode is the default setting for the Amblyopia Home Therapy program. The Auto Mode will sequentially advance a patient through the acuity levels as their performance improves. All twelve activities are performed weekly; 6 each day. Each days procedures begin at a level previously determined in the last session by the amblyopic eye. The initial acuity of the amblyopic eye and designated eye (RE or LE) should be recorded in the area printed on the back of the patients kit box so that the patient may enter that information into their program. The program will start two lines of resolution larger than the recorded acuity level. Therapy is assigned for approximately thirty minutes per day, five days per week. Each day the patient will perform six of the twelve activities. The Manual Mode allows you to specify a custom therapy protocol by assigning specific procedures. In the Manual Mode, you will have the ability to select the starting acuity level as well as the duration for each procedure. Therapy may be assigned in one of two modes, either monocular with patching or monocular in a binocular field. Monocular in a binocular field may be prescribed only by the doctor. (The doctor should use this mode only if there is no concern of irretractable diplopia.) The default is monocular with patching. An eye patch is supplied with the Amblyopia Home Therapy kit. If you wish to assign therapy in the monocular in a binocular field mode, you will need to supply the filtering eye patch to the patient and change the settings via the Customize button on the Main Menu. This should not be used unless fusion can be demonstrated such as in anisometropic amblyopia. It has been our experience that consistency is the essence of the Amblyopia Home Therapy program. It is very important that patients perform therapy the assigned number of days per week. The patients manual instructs the patient to contact the Amblyopia Home Therapy help line if they experience any difficulties loading or running the program. You should reinforce this at the time of dispensing. We will be able to address most problems on the telephone. If your patient has clinical questions, we will refer them back to you for assistance.

RUNNING AmbP iNet

Load the AmbP iNet Tools Program by following the instructions in the Getting Started Guide. Launch the program by clicking on the AmbP Tools iNet icon on your desktop, then select Sample Patients Program from the menu.

Note: A patient launches the program by clicking on the AmbP iNet icon on their computers desktop. This will take them directly to the Main Menu screen as shown above.

The very first time your patient runs the AmbP iNet Program; they will be prompted to type in their name, starting Visual Acuity level and Amblyopic Eye. This is the only opportunity they will have to do this. This information determines the beginning acuity level in the Auto Mode, so its very important that they input this data correctly (see below). Note, that we have designed an area on the back of Patients Kit Box for you to record this information.

The Main Menu screen looks like this:

Notice the Runs Remaining in the lower center of the screen. The patients AmbP iNet program has 150 runs. A run consists of entering and exiting the AmbP iNet Program. Therefore, it is important to instruct your patient to finish their entire daily assignment before exiting the AmbP iNet program. Note that the status of the program, either Monocular (Patching) or Monocular in a Binocular Field, (blue targets) as well as the Amblyopic Eye (L or R) is displayed beside Mode:" When reviewing the patient's data check this information to assure that they have entered the information correctly. Note: If at any time you have questions about what you see on any screen, click on the Help button to bring up the Help menu.

2.1 2.1.1 Auto Mode

Customize

The Customize feature allows you to select either Auto or Manual Mode therapy. Note that you will select Customize only if you wish to modify the Auto Mode or change the program to the Manual Mode. Clicking on Customize will display a password requestor screen. This is designed to prevent a patient from modifying their program without your authorization. The password is 2020. Once the password is entered the program will display the Customize screen.

This screen allows you to modify the Auto Mode settings. You may change the duration for any procedure from 1 to 60 minutes. The default setting is 5 minutes.

You may remove any procedure from the Auto Mode protocol by deselecting the Use check box for that procedure.

Finally, you may select Monocular with Patching or Monocular in a Binocular Field with filtering eye patch, by clicking on the Amblyopic Eye button. The Amblyopic Eye button is password protected, the password is 99. This button allows you to reset the Amblyopic Eye setting if a mistake was made when the patient initially set up their program.

Filtering Eye Patch If you assign the program in the Monocular Binocular Field mode the patient will need to use the optional filtering eye patch. This eye patch is not included with the Amblyopia Home Therapy Kit, they must be dispensed separately.

2.1.2

Manual Mode

Clicking on Manual will change the program to the Manual Mode and display a new screen.

The Manual Mode allows you to select the Duration for each procedure. You may also select which procedures will be offered. The Manual Mode does not present procedures on a predetermined daily basis. The patient will select, one at a time, the procedures you have assigned.

2.1.3

Run Program Auto

Clicking on Run Program while in the Auto Mode will display the following screen.

The patient will see the procedures assigned for that day. It is important that the patient completes the entire daily assignment before they exit the program. The patient will perform six different procedures for 5 minutes each day.

2.1.4

Run Program Manual

Clicking on Run Program while in the Manual Mode will display the following screen.

The patient is instructed to select one at a time the procedures you have assigned.

2.2

Performance

Clicking on Performance from the Main Menu will display a graph and numerical data for each procedures results. Each daily sessions results are plotted. Clicking the yellow arrow will advance the program to the next procedure. If desired, the results may be printed.

2.3

Backup/Copy Results Data

Backup/Copy Results Data is used only if your patient is not an internet user or if they are a dial-up internet user and the program prompts them to backup, or if they are an internet user but are moving their program to a non-internet connected computer, or if they do not have internet access and you have requested them to supply you data on a diskette or CD. If your patient is not an internet user, it is important that they use the Backup Results Data feature before returning to your office for a progress evaluation. They should simply click on the Backup Results Button and then choose Backup to Data Disk, then select the type of device they wish to backup to. They do not need to backup every day, but they should perform a Backup Results Data every few weeks so that they have a copy of their results in case of a hard drive failure. If their computer will not successfully backup to a diskette, it may be due to a damaged diskette. They may substitute any blank diskette for a Data Disk. Macintosh users must format the new diskette as a PC diskette.

2.4

Update Results Data

If you make changes or modify your patients program during a progress evaluation and they are a non-internet user they may use the Update Results Data feature and a Data Diskette to incorporate those changes in to their AmbP iNet program. Before going to a progress evaluation they must perform a Backup Results Data to a diskette, CD or Flash Drive, and take it with them to your office. After returning from a progress evaluation and before beginning therapy they must insert the Data Disk, CD, or Flash Drive into their computer and click on Update Results Data. NOTE: The patient should never use the Update Results Data feature if you have not made changes to their program. Tell them to be very careful to not confuse the Backup and Update features, as Update will replace all of the results on their hard drive with the results from the Data Disk. If a child is using the AmbP program we recommend that a parent perform the Backup and Update functions. If your patient is a broadband internet user, the AmbP iNet program will automatically Update each time they launch the program. If your patient is a dial up internet user, they will need to Update if you modify their program via the internet. If you contact your patient and indicate that modifications have been made to their program, they must select Update Results Data from the Main Menu and then Update Data From Internet before beginning another therapy session. Your patient will also use the Update Results Data feature if they are a non internet user and are transferring their program to another computer. Notes The Notes filed contains an archive of all notes that you have sent to your patient. It also contains a copy of their UserID and Passcode information.

3
Preview Screen Features

Procedures

When a patient clicks on Run Program from the Auto Mode they will see a screen listing that days activities. After clicking on Start, they will see the introduction screen for that days first procedure.

The introduction screen for each procedure will always provide the following information: Session This represents the number of times the patient has performed a procedure. Level The total number of Acuity Levels for a procedure will be shown within the grid. To advance from one acuity level to the next, the patient must meet or exceed the goal(s) in that therapy session. When they do, they will receive a gold star. The program will then advance to the next level.

Back Clicking in the Back arrow will allow the patient to set the procedure back 1/2 acuity level. Dialog Box The text box below the Levels Grid lists the stimuli that the patient must respond to and the acuity level for that stimulus. Duration This indicates how long the procedure will run. Note that if a patient exits a procedure before the assigned time expires, no results will be scored or recorded. Viewing Distance It is critical that the patient maintains the assigned 16 viewing distance. Start Procedure Clicking Start Procedure will begin the procedure. Help Clicking Help will display a summary of the response methods for a procedure and a listing of that procedures goals. AUDITORY REINFORCEMENT For each procedure the computer will present the patient with verbal reinforcements depending upon their responses.

Sessions Results At the end of the assigned duration for a procedure the program will display the results for this session as well the results for the previous session. If the patient has met or exceed criteria, they will receive a Gold Star and advance acuity level.

The following section of this manual presents a detailed description of each procedure.

3.1 Follow The Letter

The Follow The Letter procedure is designed to help improve both pursuits and visual acuity in the amblyopic eye.

FOLLOW THE LETTER PROCEDURE The Follow The Letter procedure requires the patient to identify the direction that the stimulus is facing as it moves around the screen. They will press the arrow keys on the keyboard that corresponds to the direction the stimuli is facing. There are three variables in this procedure: Stimuli Type There are two types of stimuli utilized in this procedure. 1. The Letter E 2. The Letter C Presentation Speed there are two speeds Slow and Medium. Stimuli Size The size of the stimuli decrease as the levels increase.

SESSION GOALS To advance to the next level of resolution the patient must meet or exceed the session goals as follows: 80% correct responses or better for the assigned duration will result in an advancement of one level of resolution.

3.2 Letter Jump

The Letter Jump procedure is designed to help improve saccadic fixation and visual acuity in the amblyopic eye.

LETTER JUMP PROCEDURE The Letter Jump procedure requires the patient to identify the direction that the stimulus is facing as it jumps around the screen. They will press the arrow keys on the keyboard that corresponds to the direction the stimulus is facing. For example, if the stimulus points to the left press the left arrow key, if the stimuli points down, press the down arrow key. There are three variables in this procedure: Stimuli Type There are two types of stimuli utilized in this procedure. 1. The Letter E 2. The Letter C Stimuli Size The size of the stimuli decreases as the levels increase.

SESSION GOALS To advance to the next level of resolution the patient must meet or exceed the session goals as follows: 80% correct responses or better for the assigned duration will result in an advancement of one level of resolution.

3.3 Find The Target

The Find The Target procedure is designed to help improve visual acuity and crowding phenomenon associated with amblyopia. Find The Target may also improve eye hand coordination activity.

FIND THE TARGET PROCEDURE The Find The Target procedure requires patients to identify specific stimuli from among random characters. A stimuli type is presented at the top of the screen. The patient should use the mouse to click on all the characters of this type. When all of the stimuli have been located a new screen and series will be presented.

There are four variables in this procedure: 1. Stimuli Type There are four types of stimuli utilized in the procedure. a. Numbers Ten digits from 0 9. b. Upper Case Letters All the letters of the alphabet A Z. c. Symbols Various symbols such as ?,/, and <. d. Codes A combination of letters and symbols. 2. Number of Stimuli The number of stimuli to be found increase as the level increases. 3. Number of Stimuli The number of stimuli on the screen increases as the level increases 4. Stimuli Size The size of the stimuli decreases as the levels increase. SESSION GOALS To advance to the next level of resolution the patient must meet or exceed the session goals as follows: 80% correct responses or better for the assigned duration will result in an advancement of one level of resolution.

3.4 Concentration
The Concentration procedure is designed to help improve visual acuity and hand-eye coordination in the amblyopic eye.

CONCENTRATION PROCEDURE The Concentration procedure requires the patient to identify the stimuli of increasing resolution that are flashed on the screen. The computer will flash a series of stimuli on the screen. It will then present a list of stimuli. The patient should click on the stimulus that exactly matches the stimuli that were flashed on the screen.

There are three variables in this procedure: 1. Stimuli Type There are four types of stimuli utilized in the program. a. Numbers b. Upper Case or Lower Case Letters c. Symbols d. Codes 2. Stimuli Size - The size of the stimuli decreases as the levels increase. 3. Stimuli Length 2 to 4 characters. SESSION GOALS To advance to the next level of resolution the patient must meet or exceed the session goals as follows: 80% correct responses or better for the assigned duration will result in an advancement of one level of resolution.

3.5 Space Ball

The Space Ball procedure serves as an eye hand coordination activity.

SPACE BALL PROCEDURE The object of the Space Ball procedure is to keep the space ball on the playing field. The patient will use their mouse to move the paddles (on the top, bottom, left and right sides of the screen) to hit the ball to prevent it from leaving the screen. There are two variables in this procedure: 1. Stimuli Size - The size of the stimuli decreases as the levels increase. 2. Presentation Speed Slow, Medium and Fast

SESSION GOALS To advance to the next level of resolution the patient must meet or exceed the session goals as follows: Average less than 2 missed for every 10 possible hits will result in an advancement of one level of resolution.

3.6 Capture The Target

The Capture The Target procedure is designed to help improve visual acuity in the amblyopic eye. Capture The Target also serves as an eye hand coordination activity.

CAPTURE THE TARET PROCEDURE The Capture The Target procedure requires the patient to identify and capture a moving stimulus. Their mouse pointer will be replaced by a number, letter, or symbol. They will find the stimulus moving on the screen that matches their mouse pointer, and then click on it. There are three variables in this procedure. 1. Stimuli Type Numbers, Upper or Lower Case Letters and Symbols. 2. Stimuli Size - The size of the stimuli decreases as the levels increase. 3. Presentation Speed Slow and Medium.

SESSION GOALS To advance to the next level of resolution the patient must meet or exceed the session goals as follows: Less than 20% incorrect choices (incorrect or missed stimulus) for the assigned duration will result in an advancement of one level of resolution.

3.7 Laser Ball

The Laser Ball procedure is designed to help improve visual acuity in the amblyopic eye. Laser Ball also serves as an eye hand coordination activity.

LASER BALL PROCDURE The Laser Ball procedure requires the patient to identify a stimulus of increasing resolution. They will use their mouse to move the laser ball at the bottom of the screen, and find the stimulus in the upper half of the screen that matches the one below the laser ball. They will move their mouse directly below the matching stimulus, and then click the mouse button to launch the laser ball. There are two variables in this procedure. 1. Stimuli Type Arrows, E or C 2. Stimuli Size The size of the stimuli decreases as the levels increase.

SESSION GOALS To advance to the next level of resolution the patient must meet or exceed the session goals as follows: Less than 20% incorrect choices (incorrect or missed stimuli) for the assigned duration will result in an advancement of one level of resolution.

3.8 Butterfly Hunt

The Butterfly Hunt procedure is designed to help improve visual acuity in the amblyopic eye. Butterfly Hunt also serves as an eye hand coordination activity.

BUTTERFLY HUNT PROCEDURE The Butterfly Hunt procedure requires the patient to identify and capture a target of increasing resolution. They will move their mouse to keep the camera's finder (purple rectangle) directly on top of the moving butterfly. When the finder is above the butterfly, the computer will sound a tone. There are two variables in this procedure. 1. Stimulus Size The size of the stimulus decreases as the levels increase. 2. Presentation Speed Slow, Medium and Fast

SESSION GOALS To advance to the next level of resolution the patient must meet or exceed the session goals as follows: On stimulus for 80% for the assigned duration will result in an advancement of one level of resolution.

3.9 Traffic Jam

The Traffic Jam procedure is designed to help improve visual acuity in the amblyopic eye.

TRAFFIC JAM PROCEDURE The Traffic Jam procedure requires the patient to identify a stimulus of increasing resolution. At the bottom of the screen is a set of stimuli (Arrow, E or C). The patients will click on the stimuli at the bottom of the screen that matches the stimulus on the car or truck in front of their car in order to bump it out of their way. They should proceed left to right across the screen. There are two variables in this procedure. 1. Stimuli Type Arrows, E or C 2. Stimuli Size The size of the stimuli decreases as the levels increase.

SESSION GOALS To advance to the next level of resolution the patient must meet or exceed the session goals as follows: 80% correct responses for the assigned duration will result in an advancement of one level of resolution.

3.10 Penguin Peek

The Penguin Peek procedure is designed to help improve visual acuity in the amblyopic eye.

PENGUIN PEEK PROCEDURE The Penguin Peek procedure requires the patient to identify stimuli of increasing resolution. Several penguins will be shown holding cards with a target (Shapes, E or C). For each penguin, there will be another penguin holding a card with a matching stimulus. Using their mouse, the patient will click on a penguin and then click on another penguin holding a matching stimulus. (Note: To deselect the first penguin, click on it a second time.) There are two variables in this procedure. 1. Stimuli Type Shapes, E or C 2. Stimuli Size The size of the stimuli decreases as the levels increase

SESSION GOALS To advance to the next level of resolution the patient must meet or exceed the session goals as follows: 80% correct responses for the assigned duration will result in an advancement of one level of resolution.

3.11 Chipmunk Chase

The Chipmunk Chase procedure is designed to help improve visual acuity in the amblyopic eye.

CHIPMUNK CHASE PROCEDURE The Chipmunk Chase procedure requires the patient to identify a stimulus of increasing resolution. The patient will press the arrow key that corresponds to the direction of the target (Arrow, E or C) that each chipmunk will show them. For example, if the stimulus points to the left press the left arrow key, if the stimulus points down, press the down arrow key. There are two variables in this procedure. 1. Stimuli Type Arrows, E or C 2. Stimuli Size The size of the stimuli decreases as the levels increase

SESSION GOALS To advance to the next level of resolution the patient must meet or exceed the session goals as follows: 80% correct responses for the assigned duration will result in an advancement of one level of resolution.

3.12 Skiing
The Skiing procedure is designed to help improve visual acuity in the amblyopic eye. Skiing also serves as an eye hand coordination activity.

SKIING PROCEDURE The Skiing procedure requires your patient to use their mouse to move and align the skier between each set of advancing poles without touching the poles. There are two variables in this procedure: 1. Stimulus Size The size of the skier and the distance between decreases as the levels increase. 2. Speed Slow and Medium

SESSION GOALS To advance to the next level of resolution the patient must meet or exceed the session goals as follows: The patient must avoid touching 80% of the polls in order to advance of one level of resolution.

Remember, if you have any questions, at any time; please contact us at 1.888.810.3937 or 480.983.0857 or email hometherapyinc@att.net

Using the Amblyopia iNet Tools Programs

4.1 Demonstrating AmbP iNet

Click on the AmbP iNet Tools icon on your desktop. At the Main Menu, select the Demo button.

The Demo program is very useful in that it allows you to demonstrate the AmbP iNet program to patients in your office on your PC. There is no limit to the number of times you may run Demo. After launching Demo, click on Run Program to show the patient how to run the AmbP iNet program and how to respond to the stimuli presented in each procedure. You will be able to demonstrate each procedure at any difficulty level by using the + / keys on your keyboard to increase or decrease the difficulty levels. The stars displayed in the difficulty level grid will indicate which level will be demonstrated. In the Demo program no results are recorded and the duration is set at 1 minute.

4.2

Modifying or Configuring the Patients Program

Start by clicking on Tools. The menu displays New Patients and Existing Patients.

Note: You will never need to insert a patients Installation CD into your computer; all modifications are made with the UserID and Passcode that is on the CD case of the patients installation CD.

4.2.1

New Patients

If you wish to modify a patients AmbP iNet program before you dispense, select New Patients.

If your Tools computer has internet access, select Internet. You will now be prompted to enter the patients User ID and their User Passcode. These will be displayed on the CD case inside the patients program kit.

After you type in the patients UserID and Passcode, the Tools program will load the patients data file from our server allowing you to make modifications to their program. A sample data file for Sara McDowell is shown below.

You may then choose Customize and type the password 2020. From the new screen, you will be able to change from Auto Mode to Manual Mode, remove procedures from the protocol and change the duration of any procedure.

Before you exit be sure to select Note to Patient and type a memo indication that you have made modifications. This will allow the HTS Inc. staff to make those changes for patients who are not internet users when they call HTS Inc. for an activation code. Once you have completed the memo simply exit Tools and dispense the kit to your patient. When your patient loads and launches the AmbP iNet program, the changes you have made will automatically incorporate into their program if they are connected to the internet. If your patient does not have internet access, they will be prompted to contact HTS Inc. for an Activation Code and we will manually make the modifications to their program at that time. If your Tools program is on a non-internet accessible computer, you will need to give your patients a written copy of your desired modifications and instruct them to call HTS Inc. at 888-810-3937 or 480-983-0857. We will manually make those changes when the patient calls. You can also instruct the patient to choose Customize from their Main Menu, enter the 2020 password, and then make the appropriate changes themselves.

4.2.2

Existing Patient

If you wish to modify or view the results of a patients program after you have dispensed, and you are on an internet accessible computer, select Existing Patient and then Internet. You will see a screen with a list of all of your patients who have the AmbP iNet program. The list displays the patients name and the Days Since Last Use. This allows you to quickly determine if any patients are not using the program as assigned. You may sort this list by clicking on the header. Clicking on Show Patients Run Count will display the remaining runs for each patient.

The letter D beside a patient name means that they are on a Dial-Up internet connection. These patients will have their data uploaded to the internet every 5 uses. Therefore, their Date of Last Use may not be current.

4.3

Moving Users

On the right side of the screen, you will see Move Users to Inactive List and Move Users to Maintenance List. These buttons allow you to create sub-categories of patients who are either no longer actively using the program or are just using it periodically for maintenance therapy. The yellow arrows at the bottom of the screen allow you to scroll between lists. Note that one sub category is Disk Users. These are patients who are not using the program on an internet accessible computer and therefore will not have data available. These patients must first perform a Backup/Copy Data Results at home and then bring their Data Disk to your office in order for you to review their results or modify their program. To do so, you will launch your Tools programs and select Tools, then Existing Patients and then Disk.

4.4

Review

To review an individual patients results or to modify their program, first select their name from a list and then select Review. You will see the Main Menu of their program. You will see three selections that you may wish to use. They are Calendar, Performance Review, and Note to Patient. Please note that the Amblyopia Home Therapy Program stores the results data for Monocular and Monocular in Binocular Filed separately. You will not be able to see the data for both modes at the same time. If your patient started the program in the Monocular Mode and at some point changed to Monocular in Binocular Field, only that data will display. If you need to review the old results data for Monocular, you must change the Program Mode back to Monocular. Be sure to remember to change the program mode back to Monocular in Binocular Filed before exiting the Tools program.

Calendar The calendar will mark in red, each day that your patient has performed therapy over the last four months. This is a very easy way to determine if your patient is performing therapy as assigned.

Note to Patient This feature allows you to send text messages to your patients, to either reward or sanction them, depending how well they are complying and progressing.

Performance Performance allows you to review your patients therapy results.

The graph at the top of the screen plots the Acuity Levels and number of Sessions performed. At the left side of the graph you will see the assigned Ending Level and the patients age. The patients name, therapy mode, (either Auto or Manual) and status (either working or complete) are displayed below the graph. In the Auto Mode, after a patient has mastered the assigned Ending Level, the Status will display Complete and that procedure will no longer be presented in the daily assignment. At the bottom of the Performance screen you will see the appropriate data for that procedure. Each session number, the date and time of day are recorded. The level for that session and duration are recorded. Also displayed is the patients results, the goal for that procedure and number of trials completed within that session. Clicking on the arrows beside the procedures name at the bottom of the screen will display the next procedure. Clicking Print will send the displayed information to your printer.

The purpose of viewing performance is to assure that your patient is performing their therapy, as well as verifying their progress. It is important for your patient to see their results and for you to reinforce your patients success. If you want your patient to monitor their performance section at home, instruct them to select Performance from the Main Menu.

4.5

Modify Existing Patients

If you wish to modify a patients program, after you have dispensed, and you are on an internet accessible computer, select Existing Patients and then Internet. Select the patients name from the list and choose Review. From the Main Menu, choose Customize and type the password 2020. From the new screen, you will be able to change from Auto to Manual, change Starting or Ending levels, remove activities from the protocol and change the duration of any procedure. Existing Patients who do not have Internet Access If either you or your patients are not using an internet accessible computer, you will need to review or make modifications from your patients Data Disk, CD-ROM Disk, or USB Flash Drive. Your patient must first perform a Backup/Copy Results Data at home and bring their Data Disk, CD-ROM Disk, or USB Flash Drive to your office. You will select Tools, Existing Patients, and then Disk. It is very important that your patients perform an Update Results Data before continuing therapy when they return home, in order to incorporate your modifications into their program. If you have any questions or need assistance using your AmbP iNet Tools program, please contact us at 888-810-3937 or 480-983-0857. We will be able to review the program with you and answer any questions or resolve any issues. Reviewing a Patients Results The Performance program is a valuable tool that allows you to verify and document when and how well your patients have performed home therapy. Remind your patients that they must perform a Backup/Copy Results Data and bring their disks with them to their appointments so that you can evaluate their progress. To view a patients performance, click on the AmbP iNet Tools iNet icon on your desktop, and then select Tools from the menu. On the Tools menu screen, select Performance to start the Performance program. With the patients Data Disk, CD-ROM Disk, or USB Flash Drive inserted in your computer, select the Performance screen.