Download the Flower program:
1. Purpose of the “FLOWER” program.
The “FLOWER” program is intended to diagnose disorders of binocular vision (strabismus, amblyopia), restore and develop binocular vision, and treat mild and moderate amblyopia and myopia (nearsightedness). The first stage can also be used to treat severe amblyopia.
2. General description of the program
The “FLOWER” program is an interactive training program with a game-like format. It offers the patient a series of increasingly difficult but similar visual exercises involving the search for a specified object among several objects displayed on the petals of a flower. The exercises are divided into 4 levels according to difficulty; within each level, only the image sizes vary (5 gradations). At the first level, objects of different sizes are presented individually; at the second, in groups of 4; at the third, in groups of 7; and at the fourth, in groups of 10.
3. Rules for using the program
After launching the program, a window will appear containing fields for registering a patient or selecting one from the existing list, as well as 4 buttons and a sound-control switch. Initially, the registration field contains the sequential number of a new patient. If the patient is genuinely new, meaning they have not yet used this program, enter their surname and first name in the “New patient” field using the keyboard. If the patient is training for the first time, view the patient list by displaying it in the standard way and click the required surname. The patient’s details should then appear in the registration field.
If necessary, before starting training you can view the results obtained in previous sessions by clicking the “View results” button. In addition, taking the patient’s characteristics and results into account, you can change the training parameters by clicking the “Settings” button. A window will open with the proposed procedure parameters, operating modes, and object types. Five types of objects are available: Russian letters, Latin letters, outline images of simple objects, silhouette images of similar objects, and silhouette images of animals. The table on the left shows how many times objects are presented individually and in groups, and how much time (in seconds) is allowed to search for objects under different conditions. The possible object sizes (5 gradations) are shown below the table. By checking the appropriate boxes, you can select only large or only small objects, or leave all sizes selected.
By default, under all conditions, test objects of each size are presented 5 times; 5 seconds are allowed to search for individual objects, 10 seconds to search for letters in groups of 4, 15 seconds in groups of 7, and 20 seconds in groups of 10. All these parameters can be changed according to the characteristics of the patient’s vision and restored to their original values by clicking the “Default” button. To use individually selected parameters in subsequent training sessions, click the “Patient profile” button. For patients with severely impaired vision or slowed reactions, “Adaptive mode” can be enabled. In this mode, the program automatically increases the presentation time for objects if the patient does not have enough time to find them, and stops presenting small objects if the patient makes frequent errors.
To start training, click the “Next” button. The “Training conditions” window will appear.
If you are training one eye, cover the other with an occluder (preferably matte and translucent) and click the appropriate line. This information will be taken into account when recording the test results.
Then click the “Start game” button. First, a sample test image will appear on the screen: a schematic flower with a center and six petals shaped as regular hexagons. One object will be shown on each petal and in the center. This frame may remain on the screen indefinitely; it is displayed to explain the task. If the patient is already familiar with the program, they can press any key to proceed to the first task.
At this moment, the time allotted for completing the task begins to count down. To encourage the patient, a growing red bar will appear along the left edge of the screen at the same time, symbolizing the passage of time. The bar grows at a speed selected so that by the end of the time interval allotted for the task, it reaches the top edge of the screen.
The object shown in the center of the flower is the reference object, which must be found among all the objects shown on the petals. The patient’s task is to use the mouse to place the pointer (arrow) as quickly as possible on the petal containing the required reference object, without trying to click the object itself precisely, and press the left mouse button. A “success” signal should sound if the petal was selected correctly, and a “failure” signal if an error was made. If the patient does not complete the task within the allotted time, a “time is up” signal should sound. The result will be saved automatically in the computer’s memory, and a new exercise will begin. By default, objects of each size are presented 5 times.
After completing the series of first-level exercises, which by default consists of 25 tasks (5 object sizes × 5 presentations), the score achieved appears on the screen, along with a “Next” button. Clicking it launches the second-level exercises.
The second-level exercises follow the same pattern as the first-level exercises, except that the objects on the petals appear not individually but in compact groups of 4. The required object may occupy either the central or any other position in the group. The time allowed to search for the required object at this level is increased to 10 seconds by default. After completing the second-level exercises, the total score accumulated over the two stages is displayed, and the patient can launch the third-level exercises by clicking “Next.”
The third-level exercises differ from the second-level exercises only in the number of objects in each group, which is now seven, and the time allowed for each task, which is increased to 15 seconds by default. After the third-level exercises, the program automatically proceeds to the fourth-level exercises, where the number of objects in each group is increased to ten and the time allowed for each task to 20 seconds.
The patient’s results are displayed on the screen either after completing the fourth-level exercises or earlier if the patient stopped working at a lower level.
4. Results recording format
The complete results table contains 4 columns corresponding to the levels and 5 rows corresponding to the size gradations. The 20 cells record the time spent completing all exercises and the number of erroneous clicks (on petals with incorrectly selected objects) within the allotted time. An additional row records the average time spent searching for individual objects and objects in groups across all sizes.
In addition, the number of points scored after completing one, two, and three training stages should be indicated, along with the crowding coefficients K1 and K2 (the ratios of the time spent completing the second- and third-level exercises to the time spent completing the first-level exercises).
Below the table, the question “Save results?” (Yes/No) will appear. If the answer is affirmative, the entire table will be saved in memory; in addition, the corresponding points will be plotted on 3 graphs showing the progress of treatment. These graphs can be viewed by returning to the beginning and clicking the “View results” button. After the results table, the screen will display the buttons “Next, return to beginning,” “New patient, return to beginning,” and “Exit.” The “Exit” button always allows you to leave the program immediately. The two buttons that return to the beginning differ in that the first implies continuing training with the same patient, who does not need to be registered again.
When the “View results” button is clicked, graphs appear showing changes during training in the average search time for individual objects and in coefficients K1 and K2. Results obtained for each eye and for both eyes correspond to points and lines in different colors. As the number of training sessions increases, the time axis progressively contracts. The training date can be displayed by placing the cursor on the corresponding point; the date appears in the middle of the screen.v
At the top right of the graph page there are 2 buttons: “Return to beginning” and “Tables.” The first button allows you to repeat the training or continue under new conditions, while the second allows you to view the results tables for the entire training period.
For technical reasons, in the current version of the program, the results of fourth-level tasks (with groups of 10 objects) are displayed only at the end of the current session and are not saved in memory, so they must be recorded manually if necessary. A new version of the program is being prepared in which this limitation will be removed.
