Vision Correction: Taking a Look at What's New

12 Pages·2002·1 MB·English

by  by Carol Lewis

'-1V5330 Carol Lewis
.L4 VISION CORRECTION
2002
i4VS"."^0 CarolLewis
CORBECTSO^
VISION
4
2002
Correction
Vision
A New
Taking Look At What's
By CarolLewis
VISION
correction has come a long way since the 13th
century when the first pairofspectacles was made by riveting together the handles
oftwo magnifying lenses. Today, surgical developments in vision correction, as
well as advances in traditional eyeglasses and contact lenses, can potentially im-
prove aperson's vision to betterthan the optimal range of"20/20."
It's no surprise, then, thatpeople dependent on glasses orcontact lenses are vis-
iting theireye-care specialists, hoping to find a quick fix for some age-old vision
problems among the array ofnew techniques, products and technologies. Learning
AReprintFrom FDA ConsumerMagazine
—
about some ofthe common disorders Refractive errors usually occurinoth- pendency on glasses orcontactlenses.
thatcan threaten vision and how the eye erwise healthy eyes. They are caused Laser surgery can provide vision correc-
"sees" can help you determine the best mostly by an imperfectly shapedeye- tion similarto what would be obtained
treatmentto correctyourvision. It's also ball, corneaorlens. There are fourbasic with glasses orcontact lenses. People
important to understand the advantages, types oferrors: underthe impression that surgery can
—
disadvantages, and limitations thatcome Myopiaornearsightedness Close ob- improvetheirvisionbeyondwhatthey
with visioncorrectionprocedures and jects appear sharp butthose in the dis- can see with glasses orcontactlenses,
aids. tanceareblurred.Theeyeballislonger however, likely willbedisappointed.
thannormalfromfronttoback, soimages By far, the largest increase in lasereye
How the Eye Sees focusinfrontoftheretinainst—eadofonit. surgery interestrecently has been in a
Having 20/20 visionmeans seeing at Hyperopia orfarsightedness Distant procedure called "laser in situ
20 feet what aperson with normal vision objects can be seen clearly but objects keratomileusis,"popularlyknownas
sees at 20 feet. Aperson who has 20/40 up close are blurred. The eyeball is LASIK. Advertising forthis technique
vision can see at 20 feet what the person shorterthan normal, so images focus be- appears prominently on broadcastout-
with normal vision sees at40 feet. And hind the retina. lets, including the Internet and in news-
—
so on. Astigmatism Objects are blurred at papers and magazines. Fortunately, says
The eye does not actually "see" ob- any distance. The cornea, lens, orboth Terrence P. O'Brien, M.D., a spokesman
jects. Instead, it sees the light that ob- are shaped so that images aren't focused fortheAmericanAcademy ofOphthal-
jects reflect. To see clearly, light striking sharply on the retina. mology (AAO), most surgeons and
—
the eye must be bent or"refracted" Presbyopia oraging eye The eye medical centers are doing a goodjob of
—
through the cornea the clearwindow at loses its ability to change focus due to educating the public about the risks and
thefrontofthe eye thatprovides mostof the natural aging process. This usually benefits ofLASIK. "But patients need to
the focusing power. Light then travels occurs between ages 40 and 50. be very well-informed in advance," he
through the lens, where it is fine-tuned Glasses, contact lenses, and lasereye says.
to focus properly on the—nerve layerthat surgery attemptto reduce refractive er- LASIKpermanently changes the
lines the back ofthe eye the retina rors by making lightrays focus properly shape ofthe cornea, and is performed
and sent to the brain viathe optic nerve. on the retina. for varying degrees ofnearsightedness,
The retina acts like the film in acamera, farsightedness, and astigmatism. Asur-
—
andclear vision is achieved only iflight LaserEyeSurgery APopular gical knife, called a microkeratome, is
from an object is precisely focused on it. Alternative used to cut a flap in the cornea, leaving a
Ifnot, the image you see is blurred. This Lasereye surgery is intended for hinge at one end ofthe flap. The flap is
is called arefractiveerror. people who wantto minimize theirde- thenfoldedbacktoreveal themiddle
HowWeSeelt
Myopia, ornearsightedness, occurs
wheneitherthecorneaistoosteep
and/ortheeye istoo long,andlightis
focused infrontofthe retina.Close
objectsappearclearandfarobjects
areblurry.
Hyperopia, orfarsightedness, occurs
wheneitherthecorneaistooflatand/or
theeyeistooshort, and lightisfocused
behindthe retina.Distantobjectsappear
clearandcloseobjectsappearblurry.
Astigmatism occurswhenthesurface |
Thecorneaandthe lensare respon- ofthecorneaisoval-shaped, ratherthan ^
sibleforfocusing lightontheretina. round.Lightrayshave morethanone -|
With normalvision, lightstrikingthe focal pointandcanfocusondifferent ^
corneaisfocuseddirectlyonthe areasofthe retina.Astigmatismcreates ^
central regionofthe retina. double, distortedorblurryvision. "|-
layerofthe cornea, called the stroma. beinginfluencedby friends who have
Pulses from acomputer-controlled hadLASIK surgery ordoctors who en-
excimer laser vaporize aportion ofthe couragepatients to do so.
stroma and the flap is then replaced. By
removing this tissue, the shape ofthe Formore on LASIK, such as what
central cornea is changed, andthe re- to expect before, duringand after
fractive errorisreduced. surgery, and how to find the right
O'Brien, who is also directorofre- doctor, visit the FDA's special
fractive surgery at the WilmerEye Insti- LASIK Web site at www.fda.gov/
tute atJohns Hopkins University in Bal- cdrh/lasik/.
timore, has performedover 10,000eye
surgeries. Still, he warns that people A secondlaserprocedure used today
considering LASIK need to be wary of as an alternative to LASIK is
ads that make excessive promises. photorefractivekeratectomy, orPRK.
"Price should not be the first factor" Although O'Brien says that less than 5
in considering to have delicate eye sur- percent ofpeople undergo PRK, itis still
gery, he says. "People fearblindness the procedure ofchoiceforcertaineye
second only tocancer, andjust as they conditions. This type ofrefractive sur-
wouldn't consider adiscount open heart gery gently reshapes the cornea by re-
operation orbudget brain surgery, they moving microscopic amounts oftissue
shouldn't take a chance with theireyes." from the outer surface with a cool, com-
Thereal struggle, he says, is in training puter-controlled ultraviolet beamof
doctors. "The most advanced technology light. Itdoes not, however, involvecut-
andprecise laserwill give poorresults if ing conditions. The risks are doubled ting. The procedure takes only afew
you don't have an experienced, capable when both eyes are treated at the same minutes, andpatients are typically back
surgeon." time. to daily routines infive to seven days.
This latest hype aboutLASIK's now- Also, LASIK is not reversible. That's Clinical studies indicate that about 5
more-affordable advantage, coupled why in Polazzo's case, O'Brien inten- percent ofPRKrecipients continued to
with some pretty appealing results, tionally undercorrected herdistance eye. need glasses fordistance vision follow-
makes surgery one ofthe mostexciting "We were aiming formodified mono- ing the surgery, and up to 15 percent
vision correction options available. Doc- vision," he explains, which means that need glasses occasionally, such as when
tors say that LASIK gives arapid visual one eye would see close up while the driving. In addition, many people expe-
recovery, with minimal pain, andlittle or otherwould be corrected to see dis- rienced mildcorneal haze following sur-
no post-operative discomfort. In fact, tances. But Polazzo experienc—ed some gery, which is part ofthe normal healing
most people w—ho undergo LASIK, like regression in herdistance eye that is, process. Thehaze appearedtohave little
Beth P—olazzo one ofO'Brien's pa- herdistance vision began to wor—sen as orno effect on final vision, and could
tients can see well enough to drive im- she returnedto nearsightedness some only be seen by a doctorunderamicro-
mediately after surgery, and usually weeks following surgery. However, be- scope. Forabout 5 percent ofPRK pa-
have excellent vision within a week. cause ofthe initial undercorrection, tients, best-corrected vision without cor-
"I had good vision immediately," says O'Brien was able to fix the problem.
the 54-year-old Brooklyn, N.Y., resident, A. Ralph Rosenthal, M.D., directorof
Eye Tips
even though eventually one eyehadto the Food and DrugAdministration's di-
be retreated. "This is the best I've seen vision ofophthalmic and ear, nose and While you can't do anything about
since I was seven years old."The laser throatdevices in the CenterforDevices age orgenetic makeup, you caneata
does its workon each eye in less than a and Radiological Health, says that no balanceddiet, wear sunglasses that
minute, and patients are typically back one knows the long-term effects oflaser blockultravioletlight, and getregu-
to work ornormal activities within three eye surgery. "Wejust can'tknow that lareye exams to help maintain good
days. yet," he says, so when people call look- vision. Regulareye exams are im-
While mostpeople arepleasedwith ing foraguarantee in years forthe suc- portantbecause they can detectearly
theresults oftheir surgery, O'Brien says cess oftheprocedure, "I can't give them signs ofdisease longbefore thedis-
that, as with any medical procedure, one." ease leads to vision loss. Doctors
there are risks involved. Some include: Before undergoing LASIK, Rosenthal recommendthat everyone have an
over- or under-treatment; the inability to says people should carefully weigh the eye exam shortly afterbirth, and at
wearcontactlenses; permanent loss of risks andbenefits based on what's im- least every few years until age 40.
vision; reduction in the quality ofvision portant to them, and potential side ef- Afterthat, the eyes shouldberou-
including the developmentofglare, ha- fects, including the pros and cons of tinely checked every 2 or 3 years.
los, and starbursts; difficulty with night- having one orboth eyes done on the —C.L.
driving; andreduced vision in dimlight- same day. It's also importantto avoid
rective lenses was slightly worse after tute, says people satisfied with their vi-
surgery than before. These conditions, sion correction may not needto look
however, improved ordisappeared in very far. "Ifyou are already a satisfied
mostpeople in six months. contact wearer," he says, "you may not
Anothernew, less-invasivelaserpro- considerother options worthwhile when
—
cedure indicated fortemporarily re- you're wearing yourcontacts as well as
—
ducing hyperopia is being aimed ex- you are." Satisfied wearers typically
clusively atpeople over40. Laser have no allergies andhave not devel-
thermal keratoplasty, orLTK, involves oped an intolerance to contactlenses.
zapping 16 spots onthe outerpart ofthe The bottom line: Ifcontact lenses are
cornea to shrink the tissue. People usu- For More working for you, Balyeat says, it's hard
ally can leave 30 minutes afterthe pro- tojustify otheroptions, such as perma-
cedure and resume normal activities the Information nent laser alteration ofotherwise healthy
following day. The advantage ofLTK is eyes.
FDA
that it's a "no touch" procedure, mean- Balyeat cites his wife, Marilyn, as an
ing there's little chance ofinfection or Division ofSmall Manufacturers, example. Although she was a good can-
loss ofvision. The disadvantage is that International, and Consumer didate forthe LASIK surgery, she opted
—
the procedure is considered temporary Assistance formonovision contacts one lens fo-
—
since the treatment effectregresses for ConsumerAssistance Staff(HFZ-2I0) cuses close up while the otherlens cor-
many people, about halfofthe correc- 1350 Piccard Drive rects fordistance vision. "At 60," she
MD
tion is gone within two years. Another Rockville, 20850 says, "Ican stillreadwithout glasses."
drawback is that people may become 1-888-INFO-FDA(1-888-463-6332) And that, says herhusband, is the single
nearsighted in the first six weeks, (follow touch-tone prompts to get most importantfactor: "Ifyou like being
enough to require glasses fordriving, information aboutmedical devices) able to take out yourcontacts and still
and their vision can fluctuate for weeks www.fda.gov/cdrh/corisiimer/index.shtml see up close, surgery is not a worthwhile
after surgery. National Eye Institute trade-off." Balyeatadds thatmany
Rosenthal wants people considering National Institutes ofHealth people don't realize that laser surgery,
laser surgery to know and carefully 31 CenterDrive, MSC 2510 performedonpeopleover40, won'tlet
weighthe pros andcons. "FDA man- Bethesda, MD 20892-2510 you seeupclosewithoutglassesorcon-
dated that manufacturers ofall excimer 301-496-5248 tacts unlessyouoptformonovision
lasers make available to people a patient www.nei.nih.gov LASIK.
information booklet," he says, that spells Contact lens quality continues to im-
out this information. Ifthedoctorfails to AmericanAcademy ofOphthal- prove. Soft contacts contain from 25
offer one, Rosenthal says that you mology percent to 79 percent water, are easy to
should ask forit. PO. Box 7424 adjustto, and are more comfortable than
Experts say that the reliability oflaser San Francisco, CA 94120-7424 rigid gas permeable (RGP) lenses,
vision correction is quite good in mild to www.aao.org thanks to their ability to conform to the
moderate levels ofrefractive errors. But American OptometricAssociation eye and absorb water. Soft lenses aren't
people desperate forclear vision need to 243 N. Lindbergh Boulevard likely to pop out orcapture foreign ma-
understand the dangers. The most satis- St. Louis, MO 63141 terial such as dustunderneath, as hard
fied laser surgery patient is one who has www.aoanet.org lenses are. Extra-thin soft lenses are
realistic expectations and a thorough un- available for very sensitive eyes.
derstanding ofthe risks and possible While the ability to hold water in-
complications ofrefractive surgery. creases oxygen permeability ofsoft
— ofplastic, and offernumerous options. lenses, it also makes them more fragile.
Contact Lenses More Choices With daily wear orextended wear (over- And soft lenses are more likely to ab-
Whether you're interested in wearing night) lenses, the options include fre- sorb chemicals andresidues on the
contact lenses forthe first time, or are quent- orplanned-replacements, wearer's hands.
considering an upgrade forcomfort and disposables, bifocals, UV-blocking con- RGP lenses are more durable and re-
convenience, discussing the latest inno- tacts, and more. There are clear, tinted, sistant to deposit buildup, and they gen-
vations with youreye-care practitioner opaque, spherical and rounded lenses. erally give clearer, crisper vision. They
will help make yourchoices easier and So where does someone start when de- tend to be less expensive overthe life of
minimize the risks. Advances in materi- ciding ifcontact lenses are the right the lens, but the initial cost often is
als forprecision lenses have made soft choice for vision correction, and what to higher. RGPcontacts last several years,
—
and rigid gas permeable contacts the choose? while soft contacts, depending on the
—
two main contact lens groups an op- Hal Balyeat, M.D., professorofoph- type, are meant to be replaced afterperi-
tion formorepeople. These medical de- thalmology at the University of ods ranging from aday to about a year.
vices are made ofmany different types Oklahoma's DeanA. McGee Eye Insti- In addition, RGP lenses can be marked
—
I
Constance Dicembre waits for the countdown that
prompts the loser application. A lid speculum is
placed between her eyelids to prevent her from
blinking.
Terrence O'Brien, M.D., (left) performs LASIK eye
surgery atJohns fHopkins University's Wilmer Eye
Institute in Baltimore. O'Brien first surgically creates
a flap of corneal tissue less than the thickness of a
human hair and lifts it to one side. Assisted by
associate Marc Winnick, M.D., O'Brien then
applies laser energy to reshape the cornea
according to carefully calculated measurements.
The monitor on the wall shows the precise location
of the laser beam on the cornea. Finally, the flap,
which serves as a naturally adhering bandage, is
repositioned.
to show which lens is for .i ich eye, and vices branch in the FDA. "And ifyou that in some cases, rubbing is still neces-
they're less likely to tearorrip. making reuse yourlenses, you need to do some- sary to keep theirlenses clean.
them easierto handle. However, it often thing more than store them in saline so- A new generation oflens materials is
takes several weeks to getused to wear- lution."The FDAapprovedin 2000 the being studied. Lenses made ofthese ma-
ing rigidlenses, compared with several first "no-rub" cleaning solution forcon- terials provide a greateramount ofoxy-
days for soft. tact lenses. The solution adds a safe- gen permeability, says Saviola. Two
Many changes are occurring in the guard forpeople who do notrub their types already havereceivedFDAap-
— —
world ofdisposable (defined by the FDA lenses but should when cleaning. proval, one forseven days ofcontinuous
as used once and discarded) and fre- The no-rub directions forthis first solu- wear, the otherfor 30 days.
quent- orplanned-replacement contacts. tion initially applied to lenses replaced The most serious safety concerns with
The latest innovations include daily within a month or less. Now, it has been any contact lens deal with overnight use,
disposables, bifocals andtoric contacts expanded to include lenses that are re- orextended-wear. Rigid or soft, wearing
forastigmatism. placed after a month or more. Other these types ofcontacts overnight in-
"It's heahhier to replace lenses more products also are available that have no- creases the risk ofcorneal ulcers
often," says James Saviola, O.D., chief rub directions forlenses replaced within infection-caused eruptions on the cornea
ofthe vitreoretinal andextraocularde- a month. But Saviolareminds people that can lead to blindness. Symptoms in-
PHOTOGRAPHS BY NORMAN WATKINS
elude vision ehanges, eye redness, eye low amounts ofnearsightedness or
discomfort, and excessive tearing. Ex- astigmatism. The goal is to bring the
tended-wearrigid lenses also can cause person's vision to at least 20/40. But for
unexpected, sometimes undesirable re- some, Ortho-K will provide 20/20 vi-
shaping ofthe cornea. Saviola advises sion.
that keeping lenses clean, replacing
them often, and wearing them as pre- Corneal Ring Segments
scribed by youreye-care specialist in- In 1999, the FDA approved anon-la-
creases the safety ofwearing contacts. ser surgical procedure forcorrecting
People should not wearcontact lenses small amounts ofnearsightedness. Cor-
longerthan the time prescribed by their neal ring segments are tiny, clearcres-
eye-care practitioner. But whateverhe or cent-shaped pieces ofplastic polymer
she prescribes, be sure to ask for written that are implanted in the cornea. The
instructions and follow them carefully. ring segments reshape the cornea so that
Patientpackage inserts usuallyaccompany it becomes flatter, allowing itto focus
contactlenses, andSaviolaemphasizes light rays onto the retina and producing
thatpeople who arenotofferedthisinfor- sharp vision. The procedure takes about
mationbytheirdoctors shouldaskforit. 15 minutes and is done on an outpatient
Forthose who haven't been able to basis. Before surgery, anesthetizing
wearcontacts, implantable lenses may drops are placed in the eyes. perched on his nose. Like a scarthat
be an option in the future. Corneal rings are still being studied to neverfades, Trossevin's glasses have
treat mild hyperopia and astigmatism, been withhim every day since he was 4
Orthokeratology although these uses have not been ap- years old. Now 35, he says, "There was
Orthokeratology, or Ortho-K, is a pro- proved by the FDA. Several other in- atime when I'd have done anything to
cedure that uses RGP contact lenses to traocular and corneal implants, from getrid ofmy glasses." Or so he thought.
change the curvature ofthe corneato several companies, also are in various Although he could neverwearcontact
improve its ability to refract light and stages ofclinical study. lenses because ofthe severe flatness of
successfully focus on objects. Unlike his cornea, Trossevin was acandidate
—
regularRGPs, Ortho-K RGPs have ade- Eyeglasses The Old Standby forlasereye surgery. But the one thing
sign that can reshape the curvature of In some cases, modern technology can he was unable to obtain from any doctor
the cornea. This method, however, does provide the best vision correction op- was aguarantee that aftersurgery he
not produce apermanent result. tion. In those cases in which it can't, would—n't see starbursts and halos around
With conventional Ortho-K, the lenses eyeglasses can often help. Glasses cor- lights abig concern since he drives a
are worn about eighthours a day. After rect refractive errors by adding or sub- goodpart ofthe day and plays baseball
the corneahas achievedthe best shape tracting focusing powerto the cornea at night. "The guarantee was every-
foroptimal vision, the lenses are worn and lens. The power needed to focus im- thing," he says. "When he couldn't give
less frequently—perhaps for afew hours ages directly on the retina is measured in me that, sudde—nly my glasses took on
every two orthree days. Ifsomeone diopters. This measurement is also your new meaning a guarantee ofthe good
starts and then discontinues Ortho-K, eyeglass prescription. eyesightthey have given me forover 30
says Saviola, the corneas will eventually Like contact lenses, glasses come in years."
returnto theirnatural state. People all shapes and sizes, offering an array of
choose Ortho-K overrefractive surgery choices forboth function and fashion. LookingAhead
because Ortho-K's effects are not per- Eyeglass frames, for example, are more Among some ofthe more intriguing
manent. durable andtout materials such as tita- developments in the vision-correction
One disadvantage ofOrtho-K is that nium and new "memory metals." Lenses pipeline is an alternative to LASIK,
clear vision may fluctuate during the are thinner, strongerand lighter. Lens called LASEK, a new avenue forrefrac-
day. Also, Ortho-Kmay take many options include antireflectivecoating, tive surgeons that disturbs less corneal
months to change aperson's vision. A light-changing tints, progressive (line- tissue than its sound-alike counterpart.
more advanced technique known as free) bifocal lenses, andpolycarbon- There's also talk ofinvestigational de-
—
"accelerated Ortho-K" takes less time, ate the most impact-resistantlens ma- vices that could be placed inside the eye
and may be recommended to achieve a terialavailable. to correct refractive errors. Over the
rapideffect. Perhaps the greatest troubling aspect next decade, there are sure to be im-
Since 1998, Saviola says the FDA has foreyeglass wearers is the constant feel provements in current techniques and
cleared a number ofdaily wearOrtho-K ofsomething sitting on the nose, despite technologies, in addition to new proce-
lenses, but overnight Ortho-K lenses such advances as featherweight glasses. dures.
have not been approved. Paul Trossevin ofFallingWaters, W.Va.,
The best candidates forprescription knows all too well the uncomfortable CarolLewis is a stajfwriterforFDA
Ortho-K are people ofany age who have feeling ofsomething permanently Consumer.
Buying Contact Lenses
by Phone, Mail or tiie
internet
—
Ifyou buy contact lenses an FDA- expiration date is
—
regulated product on the Internet, over currently setby each
the phone, orby mail, the agency wants state. Some states
you to be well-informed. While such require one- ortwo-
purchases are often aconvenient and yearexpiration
economical way to get yourlenses, con- dates, while other
sumers need to exercise caution when states leave itto eye
using alternatives to aprescription from care-specialists to
aneye-care specialist, orreputable phar- decide. Neverorder
macy. The following information and lenses using apre-
tips can help: scription that has
expired.
Health-Related Information • Be sure the lenses
• Getregulareye exams. You may have the company sends
problems with youreyes that you are not matches yourpre-
aware of, and yourcontacts may not cor- scription exactly.
rect yourvision properly. Some un- Check that you have
treated infections can lead to blindness. the brand and lens
• Have an eye-care specialist checkto name you ordered,
make sure that yourcontact lenses fit and that the num-
properly andthat the contact lens pre- bers indicating
scription was filled properly. Failure to power, sphere, cyl-
do so couldcause discomfort ordamage inder and axis (if
to youreyes. any), diameter, and
• Beware ofattempts to substitute adif- base curve are the same as on yourpre- is selling you a prescription device as if
ferent brand than what you normally scription. This information is required to it were an over-the-counterdevice. This
wear. There are differences in watercon- appearon the contact lens package or violates federal regulation. Be wary
tent and shape between brands. The container. when companies tell you they will
choice ofwhich lens is right foryou • Ifyou think you have received an in- checkwith yourdoctorto confirm the
should be made only based on examina- correct lens, check with yourdoctor. prescription. They don't always check.
tion by youreye-care specialist, not over Don't accept substitutes for any contact
the phone orthe Internet. lens unless yourdoctorapproves. Problems Relating to Purchases
• Requestthe manufacturer's written • Some Internet sites ask for informa- • Report serious eye problems associ-
patient information foryourcontact tion about yourdoctor so that they can ated with yourlenses to the FDA's
lenses. It will give you important infor- check the prescription. Ifthey do check MedWatch reporting program at
mation, as well as instructions for use. andreceive a verbal OK, then they have www.fda.gov/medwatch/ Also, contact
.
complied with the Federal prescription yourhealth professional for medical ad-
Prescription-Related Information deviceregulation. Ifthecompanydoesnot vice.
• The minimum elements contained on check, theyhavenotobtainedavalidpre- • Report problems involving contact
a valid contactlens prescription should scription. Some state lawsrequirethata lens sales by Web sites by sending an e-
include yourname, doctor's name, con- writtenprescriptionbepresented. [email protected].
tact lens brand name andmaterial, expi- • Orderyourcontactsfromasupplieryou • Ifyou do not get the exact lenses you
ration date (ifmandatedby your state), arefamiliarwithandknowisreliable. ordered, you should report the problem
and lens measurements, including • You won'tbreak any laws ifyou buy directly to the company that supplied
power, diameterand base curve. lenses on the Internet, by phone, or them.
• Make certain yourcontact lens pre- through the mail without aprescription,
scription is current when ordering. The but you should know that the company —C.L.
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