Review Category : Dr. Mark Siegel, MD FAAO

Vitamins reduce risk of age-related macular degeneration

By Mark S. Siegel, MD, FAAO

More than a decade after the first age-related eye disease study (AREDS) showed that taking daily high doses of vitamins C and E, beta-carotene, zinc and copper can slow down the progress of age-related macular degeneration (AMD) a second study (AREDS 2) has revealed that adding certain antioxidants to the original formula does not provide any extra benefit to patients.

Advanced AMD can lead to significant vision loss, and in the United States it is the leading cause of blindness. About 2 million Americans have advanced AMD; another 8 million are at risk.

The first AREDS study was conducted by the National Eye Institute and concluded in 2001. It showed that the original AREDS formula could reduce patients’ risk of the advanced form of AMD by about 25 percent. The formula helps protect people’s central vision, which is needed for reading, driving, recognizing faces and other daily activities.

AREDS2, which concluded in 2011, tested several antioxidant nutrients that earlier research had suggested might protect the eyes: lutein, zeaxanthin, and omega-3 fatty acids. Omega-3 fatty acids are produced by plants and are present in oily fish such as salmon. Lutein and zeaxanthin are carotenoids, a class of plant-derived vitamins that also includes beta-carotene, and are present in leafy green vegetables. The body uses these nutrients to maintain the health of the retina, the part of the eye that can be damaged by AMD. Participants in AREDS2 were assigned to take one of four different AREDS formulas daily for five years.

The AREDS2 research team did find that two patient subgroups benefited from taking variants of the original AREDS formula. The risk of developing advanced AMD was reduced by about 18 percent in study participants who took the variant that included lutein and zeaxanthin but no beta-carotene, compared with participants who took the variant that had beta-carotene but no lutein or zeaxanthin. And those participants whose diets were low in lutein and zeaxanthin at the start of the study, but who took a variant with lutein and zeaxanthin during the study, were about 25 percent less likely to develop advanced AMD, compared with similar participants who did not take lutein and zeaxanthin.

The researchers say that removing beta-carotene from the AREDS formula and adding lutein and zeaxanthin will result in a single formula that is safe and effective for all AMD patients. Until now, people who were current or former smokers could only use a formula that excluded beta-carotene, because it had been linked to risk of lung cancer for these patients. About half of AREDS2 participants were former smokers.

Another recent AREDS report showed that the benefits of taking the AREDS formula appear to be long-lasting. Participants in the first AREDS study who took the original formula daily for five years continue to enjoy a 25 percent lower risk of developing advanced AMD. Most report that they are still taking the supplement.

It is recommended that you discuss these research results with your ophthalmologist and primary care physician before changing or adding a supplement to your regimen.

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Study finds tablets help people with low vision

By Mark Siegel, MD

When gift shopping this year, you have the opportunity to give back a priceless gift to a loved one with low vision: the joy of reading.

People who have eye diseases that damage their central vision can again read quickly and comfortably by using digital tablets, a study shows. On average, patients with moderate vision loss significantly increased their reading speed and comfort using an iPad digital tablet. The researchers think that other tablets that feature back-lit screens and font-enlargement capabilities would offer similar benefits.

Millions of people who have eye diseases such as macular degeneration or diabetic retinopathy struggle with the loss of their central vision. These diseases damage the light-sensitive cells of the eye’s retina, which relays images to the optic nerve for transmission to the brain. When treatments like eyeglasses, medications, or surgery are no longer effective, ophthalmologists and eye care professionals help patients make the most of their remaining sight by using low vision aids. Before digital tablets came along, reading aids were limited to lighted magnifiers, which are cumbersome and inconvenient by comparison.

Reading is a simple pleasure that we often take for granted until vision loss makes it difficult. The findings show that at a relatively low cost, digital tablets can improve the lives of people with vision loss and help them reconnect with the larger world.

All of the 100 participants in the study, conducted at Robert Wood Johnson School of Medicine, gained at least 42 words-per-minute when using the iPad2 set to 18-point font, compared with reading a print book or newspaper. People with the poorest vision showed the most improvement in speed when using an iPad or Kindle™, compared with print. The Kindle model used in the study did not have a backlit screen, although a newer model, the Kindle Fire, does.

Today’s high-tech gadgets have features that make living with low vision a bit easier. And if you or a loved one is using such devices for their built-in magnification and backlighting, consider adding apps to track eye health as well. You have more tools at your disposal than ever before to take control of your eye health.

Some features of these devices and their apps can include:

Enlargement. Smartphones, tablets and e-readers all have enlargement capabilities, though they will not enlarge text as much as a dedicated CCTV magnifier will. Not all e-readers can increase contrast, which can be a big help for people with low vision. Shop around to see if a particular e-reader will meet your needs.

Lighting. Apps for many tablets and smartphones use your device’s camera and light source to illuminate text or other things you need to see more clearly.

Voice interface. Many smartphones have some level of voice-recognition, which may help to send texts and emails among other things. Smartphone mapping apps will give turn-by-turn voice commands to help drivers with low vision to find their way when they have trouble reading street signs.

If you or someone you know has low vision, consider some of these latest high tech gadgets. They can be a big help, and they are getting better every year.

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Must-do’s to preserve vision in diabetics

By Mark S. Siegel, MD, FAAO

If you have diabetes, you are at higher risk of developing certain eye diseases, including diabetic retinopathy, glaucoma and retinal detachment. The good news is that you can preserve your vision and reduce your chances of eye disease. Follow these steps now to make sure you preserve your vision in the years to come.

Get a comprehensive dilated eye examination from your ophthalmologist at least once a year.
In its early stages, diabetic eye disease often has no symptoms. A dilated eye exam allows your ophthalmologist to examine more thoroughly the retina and optic nerve for signs of damage before you notice any change to your vision. Regularly monitoring your eyes’ health allows your ophthalmologist to begin treatment as soon as possible if signs of disease do appear.

Control your blood sugar.
When your blood sugar is too high, it can affect the shape of your eye’s lens, causing blurry vision, which goes back to normal after your blood sugar stabilizes. High blood sugar can also damage the blood vessels in your eyes. Maintaining good control of your blood sugar helps prevent these problems. If you cannot control your blood sugars in conjunction with your primary care doctor, then consider an endocrinology consult. An endocrinologist is a specialist in diabetes and other hormonal diseases.

Maintain healthy blood pressure and cholesterol levels.
High blood pressure and high cholesterol can put you at greater risk for eye disease and vision loss. Keeping both under control will not only help your eyes but your overall health.

Quit smoking.
If you smoke, your risk for diabetic retinopathy and other diabetes-related eye diseases is higher. Giving up tobacco will help reduce that risk.

Exercise.
Exercise is good for your eyes. It’s also good for your diabetes. Regular exercise can help your eyes stay as healthy as possible while helping to control your diabetes.

If you have diabetes, you can preserve good vision. Make sure you actively manage your disease with your ophthalmologist so that you reduce your risk of eye disease.

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The facts about cataracts

By Mark S. Siegel, MD, FAAO

What is a cataract?
We are born with a crystalline lens inside the eye located behind the pupil that helps the eye focus light onto the back of the eye.  A cataract is the clouding of the natural lens in the eye. When the natural lens is clouded, this can lead to decreased vision.

What causes a cataract?
Most commonly, this clouding occurs due to the normal aging process, usually after the age of 60. Other causes of cataracts include ocular diseases, medical problems (such as Diabetes Mellitus), trauma to the eye, the use of certain medications such as steroids and excessive UV radiation exposure.

How do I know if I have a cataract?
People with cataracts usually complain of blurred vision and sometimes experience difficulty reading or driving. Sometimes it may seem that you are looking through a cloudy window. Another common symptom of cataracts is increased glare. People with cataracts may notice significant glare around lights or oncoming headlights when they are driving which can make it harder to drive at night. Some people also notice that colors do not appear as vibrant or bright as they used to. If you have any of the above risk factors and are experiencing difficulty with your vision, you may have a cataract. Your eye physician can diagnose cataracts by performing a complete eye exam. Light passes through the normal lens properly to a focused point on the back of the eye. However, in the cloudy lens affected by cataract, light is bent in all different ways and prevents the light from focusing on the back of the eye. This causes blurred vision.

How are cataracts treated?
There are no medications or drops that can help treat a cataract. Once cataracts affect your vision to the point where your activities of daily life are affected, they can be removed in order to improve vision. Many people believe that cataracts can be removed with laser surgery. This is not true, as they can only be removed by microscopic eye surgery in the operating room by your eye physician and surgeon. Lasers are beginning to be used to perform portions of cataract surgery such as the incisions to enter the eye, the opening of the lens (capsulotomy) and dividing the lens into fragments. The laser is not covered by any insurance and is still performed in an OR. However, a phacoemulsification (ultrasound) probe is still required to remove the cataract fragments, which is covered by insurance.

What can I do to prevent the formation of cataracts?
Cataracts occur due to the natural aging process, but there are some steps you can take that may be helpful in delaying a cataract. First, if you are a smoker, quitting smoking may help delay the progression of a cataract. Also, protecting yourself from excessive exposure to UV light, by wearing sunglasses and a hat, may also help delay cataracts.

How is cataract surgery performed?
If the cataract is found to be affecting your activities of daily living, the cataract can be removed by your eye physician and surgeon in the operating room. First, the eye that is undergoing surgery will be numbed, typically with topical anesthesia. You will usually be made to feel sleepy during the surgery, but will still be able to hear the surgeon and staff interacting with you. You will not need to worry about keeping your eye open during the procedure because the surgeon will do that for you. Then, a small incision is made into the front window of the eye (cornea) and the cloudy lens is removed through this incision using ultrasound power and suction. After the cloudy lens is removed, a clear acrylic or silicone lens is inserted in its place in order to properly focus light onto the back of the eye again. Cataract surgery is one of the most successful surgeries performed in the United States. It is uncomplicated and successful in 95% of patients who undergo the surgery.

Are there different types of lens implants?
Yes, there are many different types and powers of lens implants. Your eye physician will determine the proper lens power to be implanted by taking measurements in the office before surgery. The standard lens implants are typically “monofocal” lenses, or lenses that focus the vision to a certain distance. In order to have clear near vision, reading glasses are still needed. There are other types of lens implants, such as “multifocal” or “accommodative” lenses, or lenses with more than one focus point. These lenses allow you to focus both near and far. Ask your eye physician for more information about multifocal lens implants.

What happens after surgery?
Immediately after surgery you will typically be monitored for about 30 minutes to an hour. You should have someone with you to drive you home. It is best that you rest for the remainder of the day after surgery. Your eye surgeon will have more specific instructions of what you should do after surgery. For more information, consult with your eye surgeon.

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Protect your eyes this Fourth of July

By Mark Siegel, MD, FAAO

As the Fourth of July holiday approaches and Americans make plans to celebrate the stars and stripes with a little red glare from celebratory rockets, ranging from professional public fireworks displays to amateur impromptu backyard shows, I’m urging the public to take important steps to prevent fireworks-related eye injuries. Parents and other adults need to exercise caution when handling fireworks themselves and to be especially diligent in managing and monitoring their use by children.

Of the more than 9,000 fireworks injuries that occur in the United States each year, approximately 45 percent are sustained by children ages 15 and under. Eyes are among the most injured body parts, and 1 in 6 fireworks-related eye injuries results in permanent vision loss or blindness.

I recall a particularly horrific firework injury while I was still an ophthalmology resident. A 6-year-old boy found an M-80 firework in his home and lit it with a grill lighter. The explosion resulted in a traumatic injury that impacted the boy’s throat, face and eyes. His parents called 911 for help and his eye injuries required an immediate cornea transplant, intraocular lens replacement, and he has undergone several additional eye surgeries since then with permanently reduced vision.

All fireworks are dangerous if not properly handled; however, sparklers cause the most injury and are particularly dangerous since many children handle them on their own. Sparklers typically burn at 1,200 degrees Fahrenheit. That temperature is nearly 1,000 degrees hotter than the boiling point of water, double the heat required to burn wood, hot enough to melt glass and cause third-degree burns to the skin. Out-of-control bottle rockets also cause some of the most serious eye injuries, including corneal abrasions, traumatic cataract, retinal detachment, optic nerve damage and rupture of the eyeball — all of which can lead to potential blindness.

I feel that the best way to avoid potentially blinding injuries is to attend a professional public fireworks display instead of putting on a backyard fireworks show. For those who decide to purchase and use legal consumer fireworks, here are a few safety tips to prevent eye injuries:

• Never handle fireworks without protective eyewear and ensure that all bystanders are also wearing eye protection.

• Never let young children play with fireworks of any type. If older children are permitted to handle fireworks, ensure they are closely supervised by an adult and wear protective eyewear.

• Clear the area of flammable materials and view fireworks from at least 500 feet away.

Leave the lighting of professional-grade fireworks to trained pyrotechnicians. If you find unexploded fireworks, do not touch them. Immediately contact your local fire or police departments. If you do experience an eye injury during a fireworks accident, seek immediate medical help.

Always remember our eyes are very delicate, and you only get two of them.

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Protect your eyes from the summer sun

By Mark S. Siegel, MD, FAAO

June is UV Safety Awareness Month.  Dr. Siegel and the staff of Sea Island Ophthalmology takes this seriously, and wants to remind everyone of the importance of keeping their eyes protected from the sun, especially during the summer months when more time is spent outdoors.

UV radiation, whether from natural sunlight or indoor artificial rays, can damage the eye’s surface tissues as well as the cornea and lens.  Unfortunately, many people are unaware of the dangers UV light can pose. By wearing UV blocking sunglasses, you can enjoy the summer safely while lowering your risk for potentially blinding eye diseases and tumors.

In addition to wearing sunglasses while outdoors, below are a few more tips on how to protect your eyes from the sun’s damaging UV rays.

Don’t focus on color or darkness of sunglass lenses: Select sunglasses that block UV rays. Don’t be deceived by color or cost. The ability to block UV light is not dependent upon the price tag or how dark the sunglass lenses are.

Check for 100% UV protection: Make sure your sunglasses block 100 percent of UV-A and UV-B rays.

Choose wrap-around styles: Ideally, your sunglasses should wrap all the way around to your temples, so the sun’s rays can’t enter from the side.

Wear a hat: In addition to your sunglasses, wear a broad-brimmed hat to protect your eyes.

Don’t rely on contact lenses: Even if you wear contact lenses with UV protection, remember your sunglasses.

Don’t be fooled by clouds: The sun’s rays can pass through haze and thin clouds. Sun damage to eyes can occur anytime during the year, not just in the summertime.

Protect your eyes during peak sun times: Sunglasses should be worn whenever outside and it’s especially important to wear sunglasses in the early afternoon and at higher altitudes, where UV light is more intense.

Never look directly at the sun: Looking directly at the sun at any time, including during an eclipse, can lead to solar retinopathy, damage to the eye’s retina from solar radiation.

Don’t forget the kids: Everyone is at risk, including children. Protect their eyes with hats and sunglasses. In addition, try to keep children out of the sun between 10 a.m. and 2 p.m., when the sun’s UV rays are the strongest.

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May is Healthy Vision Month

By Mark Siegel, MD, FAAO

In honor of the American Academy of Ophthalmology’s May monthly observance, I’d like to remind everyone of the importance of taking care of your eyes.

Your eyes are an important part of your health. There are many things you can do to keep them healthy and make sure you are seeing your best.  Follow these six simple steps for maintaining healthy eyes well into your golden years.

Have a comprehensive dilated eye exam. You might think your vision is fine or that your eyes are healthy, but visiting your eye care professional for a comprehensive dilated eye exam is the only way to really be sure. When it comes to common vision problems, some people don’t realize they could see better with glasses or contact lenses. In addition, many common eye diseases such as glaucoma, diabetic eye disease, and age-related macular degeneration often have no warning signs. A dilated eye exam is the only way to detect these diseases in their early stages.

During a comprehensive dilated eye exam, your eye care professional places drops in your eyes to dilate, or open, the pupil to allow more light to enter the eye the same way an open door lets more light into a dark room. This dilation enables your eye care professional to get a good look at the back of the eyes and examine them for any signs of damage or disease. Your eye care professional is the only one who can determine if your eyes are healthy and if you are seeing your best.

Know your family’s eye health history. Talk to your family members about their eye health history. It’s important to know if anyone has been diagnosed with a disease or condition since many are hereditary. This information will help to determine if you are at higher risk for developing an eye disease or condition.

Eat right to protect your sight. You’ve heard carrots are good for your eyes. But eating a diet rich in fruits and vegetables, particularly dark leafy greens such as spinach, kale, and collard greens, is important for keeping your eyes healthy, too. Research has also shown there are ocular benefits from eating fish high in omega-3 fatty acids, such as salmon, tuna, and halibut.

Maintain a healthy weight. Being overweight or obese increases your risk of developing diabetes and other systemic conditions which can lead to vision loss from diabetic eye disease or glaucoma. If you are having trouble maintaining a healthy weight, talk to your doctor.

Don’t smoke. Smoking not only increases your risk of cancer and lung, cardiovascular and brain disease, but it also increases the risk of damage to your eyes. Smoking damages blood vessels that can reduce blood flow to your eyes resulting in “strokes” of the retina and optic nerve. It also increases one’s risk of developing age-related macular degeneration, progression of cataracts and possibly glaucoma.

Wear protective eyewear. Wear protective eyewear when playing sports or doing activities around the home. Protective eyewear includes safety glasses and goggles, safety shields, and eye guards specially designed to provide the correct protection for a certain activity. Most protective eyewear lenses are made of polycarbonate, which is 10 times stronger than other plastics. Many eye care providers sell protective eyewear, as do some sporting goods stores.

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Keep your peepers safe this spring

By Dr. Mark Siegel

You wouldn’t know it by our temperatures lately, but technically it is spring: typically warmer weather, longer days filled with outdoor sports and recreational activities like baseball, basketball, tennis, and fishing.

Unfortunately, spring ushers in tens of thousands of sports and recreation-related eye injuries each year. The good news is that 90 percent of serious eye injuries are preventable through use of appropriate protective eyewear.

The risk of eye injury can vary depending on the activity. Make sure the level of eye protection you or others in your family use is appropriate for the type of activity. Regular eyeglasses do not offer proper eye protection.

High-Risk Sports

For all age groups, sports-related eye injuries occur most frequently in baseball, basketball and racquet sports.

Boxing and full-contact martial arts pose an extremely high risk of serious and even blinding eye injuries. There is no satisfactory eye protection for boxing, although thumbless gloves may reduce the number of boxing eye injuries.

In baseball, ice hockey and men’s lacrosse, a helmet with a polycarbonate (an especially strong, shatterproof, lightweight plastic) face mask or wire shield should be worn at all times. Protective eyewear with polycarbonate lenses should be worn for sports such as basketball, racquet sports, soccer and field hockey. Choose eye protectors that have been tested to meet the American Society of Testing and Materials (ASTM) standards or that pass the CSA racquet sports standard.

If you already have reduced vision in one eye, consider the risks of injuring the stronger eye before participating in contact or racquet sports, which pose a higher risk of eye injury. Check with your ophthalmologist to see if appropriate eye protection is available and whether or not participating in contact or racquet sports is advised.

Other Risky Leisure Activities

While sports account for a particularly high number of eye injuries, they are by no means the only hobby that poses a risk to your sight. According to physicians surveyed for the 2008 Eye Injury Snapshot conducted by the American Academy of Ophthalmology and the American Society of Ocular Trauma, more than 40 percent of patients treated for eye injuries sustained at home were involved in home repairs, yard work, cleaning and cooking. Use common sense and err on the side of caution, whatever the activity.

• Consider the risk of flying debris or other objects during activities and wear appropriate eye protection.

• Remember that eyeglasses aren’t sufficient protection.

• Be careful during activities or games involving projectiles and other sharp objects that could create injury if in contact with the eye. For example, the U.S. Eye Injury Registry indicates that fishing is the number one cause of sports-related eye injuries.

• If you wear contacts or eyeglasses, pack a back-up form of vision correction during bike trips or other activities where you could lose or shatter a lens.

If an eye injury occurs, see an ophthalmologist or go to the emergency room immediately, even if the eye injury appears minor. Delaying medical attention can result in permanent vision loss or blindness.

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March is Age-related macular degeneration awareness month

By Dr. Mark Siegel, MD FAAO

 Age-related macular degeneration (AMD) is a leading cause of severe vision loss among Americans ages 65 and over. Knowing your risk factors, being aware of your family history, and keeping regular appointments with your eye doctor can help reduce your risks for vision loss from macular degeneration. In its most severe form, known as wet AMD, the disease can lead to permanent loss of central vision, which is essential for driving, reading and recognizing faces.

March is AMD Awareness Month, and Sea Island Ophthalmology encourages everyone to know their risks for AMD.

The past few years have been marked by significant improvement in understanding the causes and the treatment of AMD. New research and clinical advances are helping us to better treat both the “dry” and “wet” forms of AMD. One strong risk factor that people may not be aware of is family history. It’s important to find out whether your relatives have had AMD and to tell your eye doctor if you have a history of AMD in your family. Knowing your risks can save your sight.

Here are the top 5 risk factors for AMD:

• Being over the age of 60

• Having a family history of Age-related Macular Degeneration

• Cigarette smoking

• Obesity

• Hypertension

If you have any two of these risk factors, you should schedule an appointment with your eye doctor for a complete dilated eye examination. Your eye doctor may recommend certain preventive measures that can reduce your risk of vision loss from this disorder.

People who are at risk should know the symptoms of wet AMD, the form most likely to cause rapid and serious vision loss. These include sudden, noticeable loss or distortion of vision, such as seeing “wavy” lines. See an eye doctor right away if these symptoms occur. Current treatments for wet AMD provide an excellent chance of stopping vision loss and may actually restore some vision when macular degeneration develops. Earlier diagnosis of wet AMD gives a better chance of successful treatment.

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Aspirin and AMD: Separating correlation from causation

By Mark S. Siegel

A patient of mine recently asked me if he should stop his aspirin since he read an article about a study that showed that aspirin use may cause Age-related Macular Degeneration (AMD). (Never mind that this patient doesn’t have AMD, but does have a significant past medical history of coronary artery disease, hypertension and hyperlipidemia.) The media has picked up this story and there have been a number of misleading headlines about aspirin and AMD. Some have been quite alarmist. While a recent study did reveal an increased risk of late AMD in people who took aspirin regularly, there is a lot more to the story. And, as they say, the devil is in the details.

The article that was recently published only observed a large group of people who were already part of an ongoing demographic study. In this case, it was the population of Beaver Dam, Wisconsin, where the health of the residents has been monitored for decades.

A review of 5,000 people in that study showed that aspirin users had a 1.4 percent increased risk of getting wet AMD as opposed to a 0.6 percent risk for those who did not take aspirin regularly. Only 10% to 15% of people with AMD develop wet AMD. When the risk statistics are applied to the population as a whole, the actual risk is minimal. It’s actually a very small increased risk.

There has never been a randomized clinical trial on the use of aspirin among people with macular degeneration. That would involve taking two groups of people and giving aspirin to one group and not to the other and recording their eye health over a long period of time. Such a study would give us a lot more useful information than an observational study.

We can say that aspirin use is associated with an increased risk of AMD, because both are happening at the same time. But we cannot say that aspirin use is a cause of the increased risk, for a number of reasons. One is that only a controlled clinical trial might give enough data to make such a statement and we don’t have that data now. Also, the age at which people start taking daily aspirin for heart health is about when early signs of macular degeneration can be seen. Heart disease and poor circulation are known risk factors for AMD. So, is it the aspirin or the heart condition that contributed to the development of wet AMD?

Dr. Barbara Klein, from the University of Wisconsin, is the lead author in the study. She noted that it requires more study and that the link between aspirin and AMD risk is not clearly understood. In the meantime, “One should not alter aspirin use based on these findings. It’s better to have blurry vision but still be here to complain about it than to die of a heart attack.”

Make sure your internist and cardiologist know you have macular degeneration — and that your ophthalmologist knows you take aspirin for your heart. As with most things, the risk needs to be balanced against the benefits.

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