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Stoor K, Karvonen E, Leiviskä I, Liinamaa J, Saarela V. Comparison of imaging parameters between OCT, GDx and HRT in the Northern Finland birth cohort eye study. Acta Ophthalmol 2021; 100:e1103-e1111. [PMID: 34668318 DOI: 10.1111/aos.15046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/25/2021] [Accepted: 10/06/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of the study was to assess and compare the optic nerve head (ONH) and retinal nerve fibre layer (RNFL) parameters and image quality parameters obtained by Cirrus HD-OCT, GDxECC and HRT3 in a population-based screening study. METHODS This analysis examined 2566 subjects taking part in the Northern Finland Birth Cohort Eye study. Images with spectral domain OCT (Cirrus HD-OCT 4000), scanning laser ophthalmoscopy (HRT3) and scanning laser polarimetry (GDxECC) were obtained from each subject. The correlation of average and regional parameters of RNFL and ONH between devices was evaluated. RESULTS The RNFL thickness was 90.9 µm when measured with OCT, 24.6 µm with HRT and 48.1 µm with GDx. There was a high correlation between the disc and cup measurements with the HRT and OCT and the RNFL thickness of the OCT and GDx (r > 0.5). A statistically significant correlation was found between RNFL measurements of the HRT and OCT in the superior, temporal and inferior quadrants. Optical coherence tomography (OCT) signal strength correlated with the image quality parameters of the HRT and GDx. The percentage of good quality images was the lowest with the GDx. CONCLUSION The RNFL thickness in Northern Finland birth cohort was at a lower level compared to other studies. The study confirms the difference in measuring ONH parameters between the imaging devices. However, significant correlations between devices were found in the cup volume and cup disc area ratio parameters of the OCT and HRT. The correlations between image quality parameters and glaucoma detection parameters were relatively low.
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Affiliation(s)
- Katri Stoor
- Department of Ophthalmology PEDEGO Research Unit and Medical Research Center University of Oulu and Oulu University Hospital Oulu Finland
| | - Elina Karvonen
- Department of Ophthalmology PEDEGO Research Unit and Medical Research Center University of Oulu and Oulu University Hospital Oulu Finland
| | - Ilmari Leiviskä
- Department of Ophthalmology PEDEGO Research Unit and Medical Research Center University of Oulu and Oulu University Hospital Oulu Finland
| | - Johanna Liinamaa
- Department of Ophthalmology PEDEGO Research Unit and Medical Research Center University of Oulu and Oulu University Hospital Oulu Finland
| | - Ville Saarela
- Department of Ophthalmology PEDEGO Research Unit and Medical Research Center University of Oulu and Oulu University Hospital Oulu Finland
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Karvonen E, Stoor K, Luodonpää M, Hägg P, Leiviskä I, Liinamaa J, Tuulonen A, Saarela V. Combined structure-function analysis in glaucoma screening. Br J Ophthalmol 2021; 106:1689-1695. [PMID: 34230023 DOI: 10.1136/bjophthalmol-2021-319178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/11/2021] [Indexed: 11/03/2022]
Abstract
AIM To assess the applicability of a structure-function (S-F) analysis combining spectral-domain optical coherence tomography (SD-OCT) and standard automated perimetry (SAP) in glaucoma screening in a middle-aged population. METHODS A randomised sample of 3001 Caucasian participants aged 45-49 years of the Northern Finland Birth Cohort Eye Study was examined. We performed an eye examination, including 24-2 SAP, optic nerve head (ONH) and retinal nerve fibre layer (RNFL) photography and SD-OCT of the peripapillary RNFL. The S-F report was generated by Forum Glaucoma Workplace software. OCT, SAP and the S-F analysis were evaluated against clinical glaucoma diagnosis, that is, the positive '2 out of 3' rule based on the clinician's evaluation of ONH and RNFL photographs and visual fields (VFs). RESULTS At a specificity of 97.5%, the sensitivity for glaucomatous damage was 26% for abnormal OCT, 35% for SAP and 44% for S-F analysis. Estimated areas under the curve were 0.74, 0.85 and 0.76, and the corresponding positive predictive values were 8 %, 10% and 12%, respectively. By applying a classification tree approach combining OCT, SAP and defect localisation data, a sensitivity of 77% was achieved at 90% specificity. In a localisation analysis of glaucomatous structural and functional defects, the correlation with glaucoma increased significantly if the abnormal VF test points were located on borderline or abnormal OCT zones. CONCLUSION SAP performs slightly better than OCT in glaucoma screening of middle-aged population. However, the diagnostic capability can be improved by S-F analysis.
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Affiliation(s)
- Elina Karvonen
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland .,PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu University, Oulu, Finland.,Department of Ophthalmology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Katri Stoor
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu University, Oulu, Finland
| | - Marja Luodonpää
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu University, Oulu, Finland
| | - Pasi Hägg
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu University, Oulu, Finland
| | - Ilmari Leiviskä
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu University, Oulu, Finland
| | - Johanna Liinamaa
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu University, Oulu, Finland
| | - Anja Tuulonen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Ville Saarela
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Faculty of Medicine, Oulu University, Oulu, Finland
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Liinamaa MJ, Stoor K, Leiviskä I, Saarela V. Correlation of iCare ic100 tonometry with iCare TA01i in screening of unselected population in Northern Finland Birth Cohort Eye study. Eur J Ophthalmol 2021; 32:11206721211014387. [PMID: 33951959 DOI: 10.1177/11206721211014387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE iCare tonometers are easy-to-use and portable devices for measuring the intraocular pressure (IOP). Purpose was to evaluate the IOP values measured by both novel iCare ic100 and conventional model TA01i devices in unselected population. METHODS IOP was measured with iCare ic100 and TA01i tonometers in 149 participants aged 32-33 years (born in 1985 or 1986) of the Northern Finland Birth Cohort Eye 2 study. The right eye of each participant was selected for analysis. We also collected data on axial length, corneal curvature and central corneal thickness (CCT). Bland-Altman plot was used for comparing the values obtained by these devices. RESULTS Mean IOP measured with the ic100 device was 13.8 (3.4) mmHg, with TA01i it was 12.5 (3.0) mmHg. The mean difference between these devices was 1.30 mmHg (p < 0.001) and R2 was 0.694. In Bland-Altman analysis, the agreement between the two tonometers ic100 and TA01i was constantly good (mean difference -1.30, ic100 device showing higher measures). There was a correlation between IOP and CCT (r = 0.269, p < 0.001 for ic100 and r = 0.255, p = 0.002 for TA01i), but not with IOP and corneal curvature or IOP and axial length. CONCLUSION In summary, we found ic100 rebound tonometry to be both reliable and effective, although CCT may influence IOP measurements with ic100 and TA01i. Therefore, iCare ic100 is suitable for IOP measurement in large cohort studies.
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Affiliation(s)
- M Johanna Liinamaa
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland
- MRC Oulu, University of Oulu, Oulu, Finland
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Katri Stoor
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland
- MRC Oulu, University of Oulu, Oulu, Finland
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Ilmari Leiviskä
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland
- MRC Oulu, University of Oulu, Oulu, Finland
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Ville Saarela
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland
- MRC Oulu, University of Oulu, Oulu, Finland
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
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Stoor K, Karvonen E, Ohtonen P, Liinamaa MJ, Saarela V. Icare versus Goldmann in a randomised middle-aged population : The influence of central corneal thickness and refractive errors. Eur J Ophthalmol 2020; 31:1231-1239. [PMID: 32517497 DOI: 10.1177/1120672120921380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE The aim of this study was to compare the measurements of intraocular pressure by two tonometers, the Icare rebound tonometer and the Goldmann applanation tonometer, in a randomised screening study. The influence of refraction and central corneal thickness on the measurements was also evaluated. METHODS Intraocular pressure was measured with rebound tonometer and Goldmann applanation tonometer in 1266 participants; refraction and central corneal thickness were also determined. One randomised eye of each participant was selected for this report's analysis. A Bland-Altman plot was used to compare the values obtained with the two devices. RESULTS The correlation between rebound tonometer and Goldmann applanation tonometer was good: the intraclass correlation coefficient (r) between the two methods was 0.735 (p < 0.001). The mean difference (rebound tonometer-Goldmann applanation tonometer) was 0.11 ± 2.3 mmHg. The difference was not statistically significant (95% confidence interval: 0.11 to 0.13, p = 0.09). With increasing central corneal thickness, not only did intraocular pressure values with both devices increase, but the difference between them also increased. Refraction (spherical equivalent) did not influence intraocular pressure or the rebound tonometer-Goldmann applanation tonometer difference. However, high astigmatism (≥2D) exerted an influence on intraocular pressure values taken with Goldmann applanation tonometer. CONCLUSION Measurements with rebound tonometer and Goldmann applanation tonometer are relatively uniform although rebound tonometer slightly overestimated intraocular pressure. Both rebound tonometer and Goldmann applanation tonometer and the difference between these devices were affected by central corneal thickness but not by refraction. Higher astigmatism affected Goldmann applanation tonometer more than rebound tonometer. It is concluded that rebound tonometer is a reliable method for measuring intraocular pressure in a population-based screening study.
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Affiliation(s)
- Katri Stoor
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Elina Karvonen
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Pasi Ohtonen
- Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Division of Operative Care, Oulu University Hospital, Oulu, Finland
| | - M Johanna Liinamaa
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Ville Saarela
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, University of Oulu, Oulu, Finland
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Karvonen E, Stoor K, Luodonpää M, Hägg P, Lintonen T, Liinamaa J, Tuulonen A, Saarela V. Diagnostic performance of modern imaging instruments in glaucoma screening. Br J Ophthalmol 2020; 104:1399-1405. [PMID: 31949097 DOI: 10.1136/bjophthalmol-2019-314795] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/12/2019] [Accepted: 12/10/2019] [Indexed: 11/04/2022]
Abstract
AIM To evaluate the applicability of imaging devices (spectral-domain optical coherence tomography (Cirrus SD-OCT), scanning laser polarimetry (GDx) and scanning laser ophthalmoscopy (Heidelberg Retinal Tomograph, HRT3)) for glaucoma screening in a middle-aged unselected population. METHODS Participants of the population-based Northern Finland Birth Cohort Eye Study, aged 45 to 49 years, underwent a comprehensive eye examination including modern imaging with five methods (retinal nerve fibre layer (RNFL) and macular ganglion cell layer +inner plexiform layer (GCIPL) analysis and their combination with SD-OCT, GDx and HRT). The performance of the automated classification of the imaging devices was assessed using a clinical glaucoma diagnosis as reference, that is, the '2 out of 3' rule based on the evaluation of optic nerve head and RNFL photographs and visual fields. RESULTS We examined 6060 eyes of 3039 subjects; in the clinical evaluation, glaucomatous damage was found in 33 subjects (1.1%) in 43 eyes. The following sensitivities were obtained; RNFL analysis (53%), GCIPL analysis (50%), OCT combination analysis (61%), GDx (56%) and HRT (31%) with corresponding specificities of 95%, 92%, 90%, 88% and 96%. The area under the curve values were 0.76, 0.73, 0.75, 0.75 and 0.73, respectively. Post-test probabilities of glaucoma after positive imaging finding with each of these methods in this unselected population were 11%, 7%, 6%, 5% and 7%, respectively. CONCLUSION Screening capabilities of the OCT, GDx and HRT were rather similar. The accuracy of all evaluated parameters was only moderate and thus screening with these parameters alone is not reliable.
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Affiliation(s)
- Elina Karvonen
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland .,PEDEGO Research Unit and Medical Reserch Center, Oulu University Faculty of Medicine, Oulu, Finland
| | - Katri Stoor
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Oulu University Faculty of Medicine, Oulu, Finland
| | - Marja Luodonpää
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Oulu University Faculty of Medicine, Oulu, Finland
| | - Pasi Hägg
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Oulu University Faculty of Medicine, Oulu, Finland
| | - Timo Lintonen
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Oulu University Faculty of Medicine, Oulu, Finland
| | - Johanna Liinamaa
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Oulu University Faculty of Medicine, Oulu, Finland
| | - Anja Tuulonen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Ville Saarela
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit and Medical Reserch Center, Oulu University Faculty of Medicine, Oulu, Finland
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Karvonen E, Stoor K, Luodonpää M, Hägg P, Kuoppala J, Lintonen T, Ohtonen P, Tuulonen A, Saarela V. Prevalence of glaucoma in the Northern Finland Birth Cohort Eye Study. Acta Ophthalmol 2019; 97:200-207. [PMID: 30198084 DOI: 10.1111/aos.13912] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 08/09/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To report the prevalence of glaucoma in the Northern Finland Birth Cohort (NFBC) Eye Study. METHODS Subjects of the population-based Northern Finland 1966 Birth Cohort (NFBC), aged 45-49 years at the time of the field examination, were randomized to eye screening (50%) and control (50%) groups. The eye examination protocol included best corrected visual acuity (BCVA), measurements of intraocular pressure and central corneal thickness, Humphrey 24-2 perimetry, stereoscopic optic nerve head (ONH) and retinal nerve fibre layer (RNFL) photography and imaging with optical coherence tomography (OCT), scanning laser polarimetry (GDx) and scanning laser ophthalmoscopy (HRT). The diagnosis of glaucoma was made by two independent general ophthalmologists and three independent glaucoma experts based on the evaluation of the ONH and RNFL photographs and the visual fields. RESULTS Totally, 10 321 subjects of the NFBC main study were alive in Finland in 2011, and they were randomized to the NFBC Eye Study group (n = 5155) and the control group (n = 5166). Of the randomized subjects, 3039 of 5155 (59%) responded and had sufficient data for the study. Glaucoma was suspected in 172 subjects (5.7%) at the first phase of the evaluation protocol. The interobserver agreement between two screening ophthalmologists was moderately good (kappa value 0.54 [95% confidence intervals (CI) 0.46-0.61]). Finally, definite glaucoma was found in 33 subjects (1.1% [95% CI 0.8-1.5]). CONCLUSION The study provides up-to-date information on the prevalence of glaucoma in a middle-aged Caucasian population in Finland. The baseline data reported here allows the evaluation of the cost-effectiveness of screening later on.
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Affiliation(s)
- Elina Karvonen
- Department of Ophthalmology PEDEGO Research Unit and Medical Research Center University of Oulu and Oulu University Hospital Oulu Finland
| | - Katri Stoor
- Department of Ophthalmology PEDEGO Research Unit and Medical Research Center University of Oulu and Oulu University Hospital Oulu Finland
| | - Marja Luodonpää
- Department of Ophthalmology PEDEGO Research Unit and Medical Research Center University of Oulu and Oulu University Hospital Oulu Finland
| | - Pasi Hägg
- Department of Ophthalmology PEDEGO Research Unit and Medical Research Center University of Oulu and Oulu University Hospital Oulu Finland
| | | | - Timo Lintonen
- Department of Ophthalmology PEDEGO Research Unit and Medical Research Center University of Oulu and Oulu University Hospital Oulu Finland
| | - Pasi Ohtonen
- Division of Operative Care Medical Research Center University of Oulu and Oulu University Hospital Oulu Finland
| | - Anja Tuulonen
- Tays Eye Centre Tampere University Hospital Tampere Finland
| | - Ville Saarela
- Department of Ophthalmology PEDEGO Research Unit and Medical Research Center University of Oulu and Oulu University Hospital Oulu Finland
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Stoor K, Karvonen E, Liinamaa J, Saarela V. Evaluating refraction and visual acuity with the Nidek autorefractometer AR-360A in a randomized population-based screening study. Acta Ophthalmol 2018; 96:384-389. [PMID: 29193822 DOI: 10.1111/aos.13636] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/01/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The evaluation of visual acuity (VA) and refraction in the Northern Finland Birth Cohort Eye study was performed using the Nidek AR-360A autorefractometer. The accuracy of the method for this population-based screening study was assessed. METHODS Measurements of the refractive error were obtained from the right eyes of 1238 subjects (mean age 47), first objectively with the AR-360A and then subjectively by an optometrist. Agreement with the subjective refraction was calculated for sphere, cylinder, mean spherical equivalent (MSE), cylindrical vectors J45 and J0 and presbyopic correction (add). Visual acuity (VA) was measured using an ETDRS chart and the autorefractometer. RESULTS The refractive error measured with the AR-360A was higher than the subjective refraction performed by the optometrist for sphere (0.007 D ± 0.24 D p = 0.30) and also for cylinder (-0.16 D ± 0.20 D p < 0.0005). The bias between the measurements of MSE, J45 and J0 was low: -0.07 D ± 0.22 D (p = 0.002), 0.01 D ± 0.43 D (p = 0.25) and -0.01 D ± 0.42 D (p = 0.43), respectively. The amount of add measured by the autorefractometer was higher than the subjective 0.35 D ± 0.29 D (p < 0.0005). There was a statistically significant correlation between VA (p < 0.0005) and the difference between the subjective and objective refraction. In 99.2% of the measurements, visual values were within one decimal line of each other. CONCLUSION The Nidek AR-360A autorefractometer is an accurate tool for determining the refraction and VA in a clinical screening trial.
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Affiliation(s)
- Katri Stoor
- Department of Ophthalmology; Oulu University Hospital; Oulu Finland
| | - Elina Karvonen
- Department of Ophthalmology; Oulu University Hospital; Oulu Finland
| | - Johanna Liinamaa
- Department of Ophthalmology; Oulu University Hospital; Oulu Finland
| | - Ville Saarela
- Department of Ophthalmology; Oulu University Hospital; Oulu Finland
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Affiliation(s)
- K. Stoor
- Ophthalmology; Oulu University Hospital; Oulu Finland
| | - E. Karvonen
- Ophthalmology; Oulu University Hospital; Oulu Finland
| | - J. Liinamaa
- Ophthalmology; Oulu University Hospital; Oulu Finland
| | - V. Saarela
- Ophthalmology; Oulu University Hospital; Oulu Finland
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