Blue Light: What is it and Why Should I be Concerned?

By Stephen Cohen, O.D. Optometrist, Scottsdale

We are fortunate that, in spite of the pandemic, we can work remotely, and our children can learn remotely. However, this benefit does not come without consequences. For one thing, we are not “designed” to spend extended periods of time engaged in near vision activities (like staring at a computer screen). On top of that, many of us and many of our children spend leisure time on a smart phone or tablet. Additionally, when we spend time in these activities, we don’t blink as much (often half as often as usual), and it is the blinking process that allows us to coat our eyes with new tears.

There is another issue with device use: Blue light. Blue light is the wavelength of light that is on one end of the rainbow, and it is right next to ultraviolet light (UV). We know that UV can be damaging to our skin and to our eyes, and now have learned that blue light can penetrate deeply into the eyes and cumulatively over time, can contribute to the development of macular degeneration. It can also cause eyestrain, headaches and, since it can deplete melatonin, can impact our sleep cycle. We are now exposed to higher levels of blue light indoors, due to some of the new overhead lighting as well as from tablets, phones and computer monitors.

With the amount of screen time skyrocketing, there are a number of steps we can take to combat these issues. For one thing, we can periodically use artificial tears during the day. We should also follow the mantra of “20-20-20,” where every 20 minutes on a device, we take a 20 second break and look at something 20 feet away. This is akin to taking breaks between sets of weightlifting, where we can get some “recovery” before proceeding further. We should also periodically do blink exercises where we squeeze our eyelids tightly shut four to five times in a row. This promotes clearing out of the glands in our lids that produce the part of our tears that prevents them from evaporating too quickly. Lastly, protection from prolonged blue light exposure can be very helpful, especially for children. There are blue light glasses that can be purchased on line, but you first need to find out how much blue light blockage they have, and, while using these glasses can be beneficial, also keep in mind that these often have lower quality lenses that can actually distort vision and create eyestrain. Optically ground computer glasses can have custom eyestrain reducing prescriptions, and coatings that will block glare, almost 100 percent of UV, and up to 90 percent of blue light.

While “Don’t it Make My Brown Eyes Blue?” is a classic song, we don’t want blue light and prolonged device use to make our precious vision and eye health to be compromised. Now…give me 20-20-20!


Dr. Stephen Cohen has been in private practice in Scottsdale since 1985. His office motto is, “Where modern technology meets old-fashioned care,” and he provides eye care from infants to seniors.  He can be reached at 480.513.3937 or by email at stephen.cohen@doctormyeyes.net.  His website is doctormyeyes.net.


 

Eye Care During These Surreal Times

By Stephen Cohen, O.D.

Many people have delayed getting their eyes examined during this time, whether it is due to avoiding going out, other priorities or work situations. Many eye doctors have closed their offices during this crisis. In some parts of the country (e.g., New Jersey), eye care practitioners are only permitted to see true eye emergency patients or face State Board disciplinary action. Fortunately, it is not that drastic here in Arizona and in many other places.

Here are a few facts and recommendations as we work through this crisis. I will base some of the information on how our office is working with our patients, and you can check with your regular eye doctor to see what their procedures are right now.

First, there is a form of conjunctivitis (inflammation of the white part of the eye) that has been associated with COVID-19. It is not among the most common signs of the disease, and there are many other causes of red eye besides this specific virus, so don’t panic if your eyes get red. When you call, your eye doctor’s office will likely ask if you have other symptoms (e.g., fever, cough, etc.) to see if it is OK for you to be seen in their office. If you do show other symptoms, or if you are just not comfortable going out, they, like us, might offer “virtual consultations” through telemedicine (text, photos, videos, FaceTime, Zoom), where a diagnosis could be determined and a treatment plan put in place without you having to leave your home. We have been encouraging all patients with eye emergencies to avoid emergency rooms and Urgent Care centers so that their resources can focus on people who might be sick from the virus and to help protect you from possible exposure to people who might be sick from the virus. Your eye doctor, like us, may also have an after-hours emergency system where they can be paged. Over the past month, I have met numerous patients at my office over the weekend with serious eye problems like sudden retinal detachments and strokes in the eye, issues that cannot wait until this crisis passes. If you have something sudden and dramatic, do not delay…call!

Your doctor might be willing to extend out expiration dates on ocular medications and contact lenses. We are refilling medication requests and are extending contact lens expiration dates as well as shipping a supply of contact lenses directly to patients, with no charge for shipping. As far as contact lenses are concerned, the CDC has determined that contact lens use during this crisis is still acceptable. Just make sure you wash your hands before and after insertion of contact lenses. While routine eye care can be delayed for now, we are “triaging” each patient who calls to determine when it would be best to schedule their appointment. Your eye doctor may be doing the same, so they may be available for more than just true emergencies.

All of our lives have been drastically impacted during this crisis. It is hard to fully grasp how different life is now than it was just two months ago. We all believe this will pass, and there will be changes in our day-to-day existence. Hopefully, many will be for the better. Stay safe!


Dr. Stephen Cohen has been in private practice in Scottsdale since 1985. His office motto is, “Where modern technology meets old-fashioned care,” and he provides eye care from infants to seniors.  He can be reached at 480.513.3937 or by email at stephen.cohen@doctormyeyes.net.  His website is www.doctormyeyes.net.


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Blue Light: The Visible Danger

By Stephen Cohen, O.D.

Over the past decade, our lives have been transformed due to smart phones, tablets and other handheld devices. These devices are backlit by LED light. Also, legislation has been implemented that require that incandescent light bulbs be replaced by more energy efficient LED bulbs. Unfortunately, this change in technology has come with a price tag: these devices emit high levels of “blue light.”

Think about the colors of the rainbow. On the spectrum, blue light is right next to ultraviolet radiation (UV). We know that UV (which we cannot see) can be damaging to our skin and to our eyes. Its neighbor, blue light, has been found to cause numerous problems in higher and extended doses.

Although the sun is the major source of all wavelengths of light, including blue light, we have experienced a tremendous increase in blue light exposure in other settings, such as in our office, on our laptop and even in our beds when we tend to use our smart phones and tablets before going to sleep.

Here are some of the challenges we now face. Blue light suppresses melatonin, which helps us fall asleep. Using a smart phone in bed for a short time in anticipation of sleep actually wakes us up. Apple, for example, has come up with an adjustment to turn down the blue light at night in an attempt to counteract this problem for its iPhone users. Blue light also causes significant eyestrain. This can affect visual comfort, moods and behavior, whether for adults in an office, or, more significantly, for children in a classroom.

Blue light (which has been found to penetrate deeper into our eyes) has been implicated as a contributing factor to developing Macular Degeneration later in life. Protecting your eyes now will not only help to improve your quality of life today, it can also help in the future. There are now coatings that can be applied to lens surfaces of eyeglasses that block UV, glare, and blue light. This can enhance clarity (since the “blue” end of the visible spectrum tends to be more distorting), reduce strain and protect your eyes. Special filters on computer/tablet screens can reduce blue light exposure. Using the adjustment settings on your smart phone can also reduce exposure to higher levels of blue light.

We are familiar with the term “unintended consequences,” where some advances in technology provides benefits but can also cause unanticipated challenges. Such is the case with lighting changes that were made for environmental benefits, as well as digital device technology. So, while we help to protect our environment, let’s protect our eye health and visual comfort as well.


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The Great American Epidemic

By Stephen Cohen, O.D. —

Although life expectancy is at an all-time high, the current diabetes epidemic is getting much worse, increasing by 27 percent in just the past 10 years. Seventeen million people are diabetic, and about one-third (almost six million) do not know it. Diabetics are at risk for heart disease, kidney disease, loss of a limb and blindness. November has been labeled “Diabetes Awareness Month.”

Every year, as many as 24,000 people go blind as a result of eye damage (diabetic retinopathy) brought on by diabetes. It is estimated that 95 percent of vision loss can be prevented through early detection and treatment. Diabetic retinopathy typically shows no early warning signs. Without timely treatment, there can be fluctuations of vision and changes in your eye prescription, as well as increased chances of developing glaucoma, macular degeneration, dry eyes and/or cataracts. Almost 30 percent of diabetics haven’t had an eye exam within the past year, but prevention starts with early detection through a comprehensive eye exam. New technology can potentially pick up changes five to 10 years sooner than they become obvious. Only your eye doctor can fully evaluate your eyes and detect the early signs of retinopathy, glaucoma and cataracts.

There are several things you can do to decrease the chance of developing diabetic eye disease. A stable A1C level and blood pressure control can reduce the damage to blood vessels in the eye, thereby reducing damage to sensitive ocular structures. As a matter of fact, a stable but mildly higher average A1C level is potentially less damaging that a lower average A1C that fluctuates significantly when it comes to damage to the eyes. Besides the fact that some of the most frightening aspects of diabetes is the potential loss of vision that can be associated, it is also through the eyes that diabetes can be monitored and sometimes identified to begin with. A healthy diet and exercise program are obvious, but underutilized defenses, such as an annual eye exam, needs to be near the top of the list. Remember that “an ounce of prevention is worth a pound of cure.” In this case, “an ounce of prevention is worth a lifetime of vision.”


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Reducing the Risk of Macular Degeneration

By Stephen Cohen, O.D. —

Age-related eye conditions will triple in the next 15 years. Macular degeneration alone will account for 50 percent of visual impairment and 20 percent of blindness. It is also estimated that 30 million people are developing cataracts, due to factors such as: increased life expectancy, poor nutrition, ultraviolet (UV) exposure, diabetes, smoking and certain medications. Recently, “blue light” (most commonly emitted by the sun along with all other wavelengths of light, but now found in higher levels indoors due to overhead lighting, computer screens, tables and smart phones) has been labeled as a future cause of macular degeneration.

However, it is now shown that taking specific supplements can reduce macular degeneration by almost 25 percent and cataracts by 15 percent. This could save our healthcare system almost $7.5 billion. Additionally, four separate clinical studies performed in four different countries around the world showed that dietary supplementation can provide better visual acuity after just one year!

The three main components of this supplement are retinal carotenoid” that help with the metabolism in the back of the eye. You may have seen commercials for vitamins that include “lutein for macular health.” Lutein is the main component, which, interestingly, is also found in our brain. As a matter of fact, there has been a relationship established between macular degeneration and cognitive loss, and a belief that a deficiency in lutein may contribute to both problems. Lutein is found in green, leafy vegetables. The second component is zeaxanthin, which is found in orange vegetables, like orange peppers. The third carotenoid, Meso-Zeaxanthin, has only been recently discovered, and in our body is only found in the macula of our eyes. Unfortunately, it is very hard to obtain meso-zeaxanthin in our diets. As a matter of fact, it has been calculated that you would need to eat 220 pounds of fish skin to receive two milligrams of meso-zeaxanthin! No thanks!

There are numerous supplements available that contain one or two of these components, and at least one product, called “MacuHealth” that contains all three. Studies show that products like these can protect the eyes from oxidative stress, which is what happens when things rust. As such, these products have been affectionately called “ocular rust preventers,” or “internal sunglasses.” Vision can be sharper, and it has been shown that people with driving challenges (night driving, glare, peripheral awareness [such as at intersections]) can see improve in as little as one year after beginning this regimen.


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The Myopia Epidemic

By Stephen Cohen, O.D. —

Nearsightedness (difficulty seeing things far away), aka myopia, is growing at an alarming pace and is estimated to impact one in two Americans by the middle of this century. In parts of Asia, it affects 80–90 percent. Although genetics plays a role (two nearsighted parents are more likely to have a nearsighted child), other factors are becoming more prevalent.

We have not gone through an evolutionary phase, but over the past few hundred years we have gone from hunters and farmers to industrialists, to now, “computerists.” More and more time is spent engaged in activities that are no more that 1–3 feet from our faces. We have two eyes to help us with depth perception (3-D vision) and with peripheral vision to be aware of things to our side. With the exception of driving and sports, we pay less and less attention to our peripheral vision.

The typical manner in which this has been addressed is for children to be fit with glasses. At their next annual exam, if their prescription increased, glasses were updated. Statistically, things start to level off at about age 17–18, but with the amount of time being spent on devices, we are seeing myopia progress even at later ages. Recent studies, however, have shown that this is not just a matter of how thick the glasses wind up, it can also be a predictor for more serious vision and eye health issues. It has been found that for people with stronger prescriptions, cataracts can develop earlier, and the risk of glaucoma and degeneration of the back of the eye increases substantially.

For parents (and interested others, such as grandparents, pediatricians, school nurses, teachers, etc.), there are things that can be done to prevent or slow down this progression. Two-and-a-half hours has been found to be a critical time period. For young children, the chances of becoming nearsighted can be decreased by having a child spent at least 2.5 hours per day outdoors. Additionally, it was found that for a child who spends 2.5 hours or more on a digital device, the degree of nearsightedness can increase dramatically. Having young children engage in outdoor activities will help to stop nearsightedness from developing and reducing the amount of time on digital devices can help to slow down or stop the progression of nearsightedness, where the prescription continues to increase over time.

Studies have also shown that there are other ways to slow down this progression. Bifocal glasses or contact lenses (even for children), certain types of contact lenses that reshape the eyes, as well as certain eye drops used at bedtime, can slow down the progression by 30–60 percent. The key here is that slowing down the progression means it is less likely for the child to reach that level of nearsightedness that increases the risk of cataracts, glaucoma and retinal changes.

For many years, eye care practitioners sought ways to slow down the insidious increase in nearsightedness. There are now techniques available to not only improve a child’s vision now, but to help protect his or her eyes for the future!


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It’s All Greek to Me

By Stephen Cohen, O.D. —

Myopia. Hyperopia. Astigmatism. Presbyopia. “I have no idea what you’re talking about-opia.” If you are like millions of other Americans, one of these terms describes you. Presbyopia alone affects over 100 million people, but don’t worry, it’s not contagious. These are the terms that describe how your eyes work, or, in some cases, do not work. They are terms that are often thrown around, but at the same time, are often not really understood.

The first two terms, myopia and hyperopia, are more commonly known as “nearsightedness” and “farsightedness,” respectively. However, even these more common terms are often misunderstood. When you are nearsighted, you are “sighted for near,” and may have difficulty seeing far away. When you are farsighted, you are “sighted for far.” In this case, you may have difficulty seeing things up close, or your eyes may have to work harder to see things up close. Nearsightedness and farsightedness involve the shape of the front of our eyes, and/or the length of our eyes from the front to the back. Up to the age of about five or six, farsightedness is not only fairly common, it is expected. Conversely, nearsightedness tends to develop during the school age, most commonly between about third grade through the late teens to early twenties.

Presbyopia, on the other hand, is the loss of our ability to focus on things up close. This is also known as the time when “our arms get too short,” and involves changes in the capability of the lens inside our eyes to change shape to be able to focus with reading. That is different than farsightedness. Presbyopia typically becomes noticeable at around 40 years of age. As a matter of fact, may people think it comes on very suddenly, as if someone came in during the night of their 40th birthday and “stole” their reading vision. In reality, these changes are very gradual, yet progressive, typically leveling off in our mid-50’s. When presbyopia affects us, we find that we have to hold things further away from our face to read. Small print will be difficult to see, and we need better lighting and contrast. Reading glasses or bifocals are the most common remedies, but there are also several contact lens options, including bifocal contacts.

Astigmatism, sometimes called “that ‘stiga’ thing,” also typically involves the shape of the front of our eyes. Unlike nearsightedness, most astigmatism develops at a very young age. With astigmatism, instead of our eyes being shaped round, like a baseball, they will be shaped more like a football, with one curve being different than another. Light will then focus on different places in the back of our eyes, causing blur. It would be like sitting in a movie theater and having the projector lens distorted a bit so that light focuses at several places, none of which are on the screen itself. Like presbyopia, glasses are the most common treatment, but, again, there are many contact lens options available to address astigmatism.

There are now also both surgical (e.g., LASIK) and non-surgical (e.g., Corneal Refractive Therapy, using contact lenses that reshape your eyes while you sleep) options available for many of these conditions.

However, you “look” at it, we have more options than ever to treat whatever “opia” ails you.


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‘Drying Out’ After the New Year

By Stephen Cohen, O.D. —

“Go on that diet.” “Exercise more.” “Spend more time with my family.” “Save more money.” The start of the New Year gives us a clean slate to work with. While you’re “editing” your 2019 list of resolutions, let me add a few small things you can do on a regular basis that will enhance your most precious sense, your vision, and provide you with better comfort as well.

Our eyes are coated by a very complex protective layer of tears. Each time we blink, we recoat our eyes with new tears that help to maintain the quality of our vision. When this layer of tears is disrupted, we can experience symptoms such as irritation, burning, stinging, heaviness, fatigue, scratchiness, blur, redness, itchiness and foreign body sensation. Because their association with dry eyes is often overlooked, fatigue (especially late in the day), and blur (particularly with complaints of fluctuation of vision) need to be emphasized.

Humidity on an airplane can be as low as four percent, which may not sound that extreme to us here in the desert. In addition to our dry environment, other factors can affect our tears and our eyes. Wind, air conditioning, central heating and fans will greatly increase evaporation of our tears. Working on a computer or reading will typically decrease the rate at which you blink, leading to dryness. Certain skin disorders and diseases will affect our tears, as will many medications (e.g., antihistamines, tranquilizers, diuretics). Smoke, dust and excessive eye makeup can also irritate our eyes.

With that background, here is a list of “dry eye resolutions”:

  • Don’t wait until your eyes hurt to use artificial tears. Keep your eyes lubricated throughout the day. It is akin to preventing a fire rather than trying to put one out.
  • Carry the right type of eye drop with you. Not all drops are the same, and some that claim to treat dryness (those with vasoconstrictors to “get the red out,” and others with certain preservatives) may actually increase dry eye symptoms.
  • DRINK WATER! Although carrying bottled water has become common, most of us do not consume enough of it. A new daily standard is to consume one ounce of water for every two pounds of body weight (e.g., a 150 lb. individual should consume 75 ounces of water daily).
  • If you wear contact lenses, make sure you are using the right contact lens solution, and not just “whatever is on sale.” Some newer solutions will actually help to keep your contacts hydrated during the day. There are also new contact lens materials that are designed to help people with dry eyes. Lastly, if you travel, consider wearing your glasses on the airplane.
  • A warm, moist compress can help, which can even be done in the shower. This will help to “melt” oils that can clog certain tear glands and will also help to stimulate tear production. Optimally, you need 8–10 minutes of moist heat (more effective than dry heat) to help with the flow of these oils, but even shorter periods of time can be helpful.
  • Increase consumption of Omega-3 fatty acids (cold water fish, certain salad dressings, and supplements such as flaxseed oil and fish oil). These fatty acids are not naturally produced by our bodies, and studies are showing that these might help to decrease dry eyes. Optimally, an Omega-3 in a triglyceride form (the way it is found in nature) of at least 2000mg per day will provide anti-inflammatory benefit. Also, don’t use a combination Omega-3 that also has Omega-6s. We ingest too high a level of Omega-6s in our diet, and it is trying to balance the Omega-3s that is critical.
  • GET YOUR EYES EXAMINED. If you experience even occasional symptoms associated with dry eyes, there are tests to determine the exact cause and specific treatments that can help. A thorough review of your current systemic meds can help to uncover problems, and there are also now prescription medications and other procedures to treat the causes of dry eyes.

These simple steps can help to make 2019 even brighter, clearer, and more comfortable than last year. Now give me 50 and then get back on that Peleton!


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An Antioxidant A Day…

– By Stephen Cohen, O.D.

So much research continues about the role that diet and supplements can play in our health. This has now become the focus of research regarding diet and glaucoma.

Glaucoma is a chronic and, if untreated, progressive disease where gradual damage can cause irreversible loss of vision. It is often called “the silent thief of sight,” because, like hypertension, there are typically no symptoms that you will feel while the disease is developing and progressing. Regular eye exams are the only assured way of catching the disease in the early stages to prevent vision loss.

The same oxidation process (free radicals) that rusts metal and damages cells in our body (like sun exposure can do to our skin), can also damage parts of our retina in the back of our eyes. Antioxidants help to stabilize these free radicals.

Science continues to look for foods and supplements that can help manage glaucoma in addition to any possible medical therapy. Higher intakes of fruits and vegetables (especially carrots and green, leafy vegetables) may be associated with decreased risk of glaucoma. Tea, coffee, nuts, and seeds also contain high amounts of antioxidants. It has also been found that limiting carbohydrates can reduce the production of these potentially damaging free radicals. Omega-3’s can also possibly reduce the pressure inside the eyes. Our diets tend to be too high in Omega-6’s, which can become pro-inflammatory, so we need to better balance these by taking Omega-3 supplements. The Mediterranean Diet, for one, has been shown to have many benefits, and protection against glaucoma could be one. Additionally, supplements and foods like bilberry, ginkgo biloba, black currants, CoQ10, magnesium and melatonin have all shown possible benefits.

Even our sleep position can have an impact on eye pressure. Sleeping in a supine position tends to raise pressure but sleeping with your head elevated by about 20–30 degrees can lessen the effect. A glaucoma study showed that for people with glaucoma who tend to sleep on one side, that side experiences greater loss of peripheral vision. Alcohol, in smaller amounts, can temporarily reduce eye pressure but high alcohol intake increases eye pressure. Similarly, moderately intense exercise tends to lower eye pressure for both people with glaucoma as well as people without glaucoma. However, weight lifting can cause a transient increase in eye pressure that dissipates quickly after completion, and yoga positions that involve a headstand or that place the eyes below the heart can almost double eye pressure, but this, too, will return to baseline within a few minutes.

While glaucoma can occur despite our best efforts (fairly strong genetic predisposition), there is much we can do to help reduce those risks and the progression of this vision-threatening disease. Most of these concepts are common sense, but now research is showing specific benefits for your eyes. When it comes to making lifestyle changes, just follow the old adage: Begin. The rest is easy.


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Macular Degeneration: A Major Health Problem In The United States

– By Stephen Cohen, O.D.

Most people have an awareness that glaucoma can lead to loss of vision, and that diabetes can damage the back of our eyes. However, there is a disease that is more prevalent than glaucoma and diabetic retinopathy combined. It is estimated that this disease will affect about 7 percent of the population above the age of 40, more than 10 percent aged 60 or more, and about one in three people aged 75 or older! This disease? Macular Degeneration (ARMD).

Deposits in the sensitive part of our retina responsible for our sharp, central vision, will gradually damage the macular area. This could lead to significant or total loss of our central vision, leaving the patient with only blurry peripheral vision to function. Tasks like reading, driving and watching TV can be severely impaired.

As is true with most progressive diseases, early diagnosis of ARMD is critical to help treat and prevent it from getting worse, which it will do if left untreated. However, this is not always easy in the early stages, in part, due to the fact that people often delay going to their eye doctors, and in part, because the early signs are not always easy to detect by your doctor. As a matter of fact, about 25 percent of “normal” senior patients have ARMD and don’t know it. People with fair skin and light eyes are considerably more susceptible to this disease, but there are also modifiable risk factors (e.g., long-term exposure to UV and “blue light,” smoking [a major risk factor], high fat diets).

There is new technology (AdaptDx) that can identify these subclinical processes three or more years before they will show up on other tests. Until very recently, it was only available in a laboratory setting. The testing, called “dark adaptation” (an example of how this affects us would be entering a dark movie theater and waiting until you can see enough to find your seat), is a painless and relatively fast test that can predict whether or not you have the early form of the disease, with an accuracy of more than 90 percent. Early diagnoses can provide an opportunity to make lifestyles changes (low-fat diet, green-leafy vegetables, cessation of smoking, vitamin supplements, protective eyewear), which can slow down or stop the progression of Macular Degeneration. The test is recommended to anyone over the age of 50 who is experiencing changes in their night vision.

Unfortunately, if left undiagnosed and untreated, this disease will progress and can lead to irreversible damage. To get a sense of how things might look to someone with Macular Degeneration, put a glob of Vaseline on the center of your glasses and try looking through it. Your peripheral vision will stay intact, but your central sharp vision will be diminished.

The adage that “an ounce of prevention is worth a pound of cure” could not be more applicable when it comes to this vision-threatening disease. Take the steps now to help ensure a lifetime of wonderful vision. Your eyes will thank you!


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