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Catch up on the top stories in optometry during the week of March 3-March 7.

Takeaways from this week in optometry: March 3 - March 7

Articles

Within the optical industry, eyeglass cases of Chinese, Mexican, and Canadian origin are projected to be of one of the products most affected by both future and current tariffs implemented.

The Vision Council webinar discusses significant tariff implications on optical industry

Videos

The California Optometric Association and the Los Angeles County Optometric Society have compiled resources for optometrists to get involved in continuing relief efforts.

How ODs are helping with Los Angeles wildfire cleanup

Discover a unique blend of cutting-edge eye care education and world-class wine tasting at the CRU Eye Symposium in Napa Valley, where learning meets luxury in an intimate setting.

CRU 2025: Sipping fine wine and sharpening minds

The leading source of breaking news, news analysis, and emerging research reports in optometry, Optometry Times® disseminates practical content by optometrists for optometrists that can be immediately applied to improve the clinical experience.

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Neda Gioia, OD, CNS, FOWNS, details the positive feedback gained so far from other optometrists that have been recommending the NutriTears supplement to their dry eye patients.

AAOpt 2024: What optometrists think of the NutriTears supplement so far

Neda Gioia, OD, CNS, FOWNS, outlines the poster entitled, "Clinical Evaluation of a Multi-Ingredient Oral Supplement on Dry Eye Symptoms and Tear Volume," in an interview with Optometry Times.

AOA 2024: AOA names poster on Blink NutriTears one of top 5 presented in 2024

Dr. Nate Lighthizer shares key takeaways from the SECO Showcase on anterior segment technology and full laser certification course offered at SECO.

SECO 2025: Exploring the latest in anterior segment technology and laser treatments

SECO continues to be a leader in optometric education, providing practitioners with hands-on exposure to the latest advancements in anterior segment technology. This year’s SECO Anterior Segment Showcase, led by Nate Lighthizer, OD, FAAO, and Chris Wroten, OD, offered an engaging and interactive experience for attendees.

The session focused on cutting-edge technology that enhances anterior segment diagnosis and treatment. Companies like Nidek showcased their latest advancements in anterior segment lasers, including selective laser trabeculoplasty (SLT). Additionally, participants explored anterior segment imaging through optical coherence tomography (OCT) and innovative radio frequency devices designed for cosmetic and therapeutic applications.

One particularly exciting highlight of the event was the incorporation of wearable technology designed to enhance auditory assistance, demonstrating how optometrists can integrate multidisciplinary solutions into their practices. The discussion also covered the expanding role of intense pulsed light (IPL) therapy in managing ocular surface diseases and dry eye conditions.

After an initial introduction to the latest technological advancements, Lighthizer and Wroten facilitated a unique hands-on workshop. Attendees were divided into small groups and rotated through multiple stations, each offering a 10-minute interactive session with different devices. This format allowed practitioners to gain practical experience with new tools, including lasers, imaging systems, and radio frequency treatments, providing valuable insights on how these innovations could be implemented in clinical settings.

Workshops like the SECO Anterior Segment Showcase are crucial for keeping optometrists at the forefront of technological advancements. By offering real-world exposure to emerging devices and treatment modalities, SECO helps bridge the gap between theory and clinical application, ensuring that optometrists can deliver the highest level of patient care.

As technology continues to evolve, events like these reinforce the importance of continuous education and hands-on training. Optometrists who stay informed about the latest developments in anterior segment technology will be better positioned to provide advanced, patient-centered care in their practices.

Conference

-correcting IOLs has been evolving rapidly. Several new IOLs have entered the market in the past few years, and more are expected to become available in the future. Helping our patients navigate the decisions regarding these lenses often improves their satisfaction after 

. Patients look to us for advice on whether to consider a presbyopia-correcting IOL, what attributes to prioritize in their choice of lens, and whether their postoperative visual experiences are typical. Despite immense amounts of online information, this information is often hard to discover, obscured by marketing, and difficult to verify.

Our surgery center has kept up with the current explosion in multifocal IOLs, and we have learned many lessons by observation and by the assistance of patients who kindly share their experiences with us. This article will explain the advantages and disadvantages of the best of the current presbyopia-correcting IOLs, how the changing technology affects appropriate patient selection and counselling, and what to expect if your patient receives these lenses.

The laws of physics prohibit the creation of an ideal multifocal IOL; it is impossible to create a lens that can provide a perfect image at varying distances, with no aberrations and no loss of light. Therefore, the key to successful multifocal IOL selection is an intimate knowledge of the compromises inherent in each option. In addition, the more your patient can clearly state which strengths are the most desirable to them personally and which compromises are acceptable, the better their satisfaction will be with the final decision.

 Some of the more common strengths of the current multifocal IOLs are shown in 

, where prioritizing 1 wing of the triad will generally result in a compromise in the other 2 wings.

Multifocal IOLs are not a good option for everyone, whether due to patient temperament, the additional cost, the vagaries of neuroadaptation, the effect on daytime and nighttime vision, or simply an affection for glasses. Certain patients will never be pleased with multifocal IOLs and should not be pressured.

However, improved optical properties in newer multifocal IOLs mean that more and more patients can be considered for these lenses. Long regarded with suspicion due to significant optical aberrations, the newest crop of multifocal IOLs have finally achieved a remarkable level of performance and are a good choice for many patients.

There have also been recent advancements in monofocal IOL technology, with several next-generation monofocal IOLs entering the market, including the Tecnis Eyhance (Johnson & Johnson Vision) and the RayOne EMV (Rayner). Although one of the noticeable improvements over conventional monofocal IOLs has been a small increase in the depth of focus, those IOLs are still not powerful enough to be considered extended-depth-of-focus (EDOF) IOLs and thus are not reviewed in this article.

The PanOptix IOL (Alcon) is still the only trifocal IOL available in the United States, and many surgeons have adopted it enthusiastically as an improvement over older bifocal IOLs. One of this IOL’s most attractive features is the usefulness of its 3 focal points—emmetropia, 24 in (+1.67 D), and 16 in (+2.50 D)—corresponding comfortably to many common activities. The PanOptix IOL is available in spherical powers and with toric correction of between approximately 1.00 and 2.60 D. It achieves its effect with a sophisticated series of diffractive steps molded onto its anterior surface.

Diffractive optics reduce contrast sensitivity, the ability to discern objects with similar color and brightness, especially in low lighting. Because corneal or macular disease will also reduce contrast sensitivity, all diffractive IOLs are contraindicated in eyes with these diseases to avoid any additive effect.

 Even with its superior chromatic aberration control, the PanOptix IOL is still contraindicated in eyes with significant ocular surface disease, basement membrane dystrophy, epiretinal membranes, and diabetic retinopathy. 

Like all diffractive lenses, the PanOptix IOL produces glare, haloes, and starbursts, collectively known as dysphotopsias. The PanOptix technically has 4 focal points, 2 of which overlap to strengthen distance acuity. This strategy also works to reduce dysphotopsias to some extent.

The PanOptix IOL tends to provide good distance, intermediate, and near vision, with nighttime aberrations that are acceptable to most patients. For a patient who desires good vision across a wide range of distances, the PanOptix IOL is a great choice.

Like the PanOptix, the Tecnis Synergy IOL (Johnson & Johnson Vision) is a diffractive multifocal, though with a slightly different mechanism. The Synergy IOL has 1 focal point at plano and a broad range of near vision, from approximately 26 in (1.50 D) to 13 in (3.00 D). The Synergy IOL is available in spherical powers and as a toric version with astigmatism correction from 1.00 to 2.60 D.

 The design of the Synergy IOL borrows several successful elements from the TECNIS Symfony IOL, including an EDOF design (here used to cover the near range), minimization of chromatic aberration, and reduction of spherical aberration. The Synergy IOL has a syncopated concentric sawtooth pattern lathed onto its posterior surface, as well as a frosted edge to reduce dysphotopsias.

 Patients often notice slightly better very near vision with the Synergy IOL compared with the PanOptix IOL.

The more aggressive range should produce greater glare and haloes, but the Synergy uses a violet light filter on the posterior surface that blocks wavelengths from 360 to 460 nm, reducing these aberrations. On average, patients rate the glare and haloes as similar to those of the PanOptix IOL. The Synergy IOL is contraindicated for any case of corneal or macular disease due to the compounding effect of contrast sensitivity degradation.

The Synergy IOL is a great choice for patients who want good distance, intermediate, and near vision, and particularly those who have enjoyed and want to preserve very near vision and who do not mind some nighttime aberrations.

EDOF IOLs trade less satisfying near visual acuity in exchange for crisper distance vision and fewer aberrations. They tend to be a good choice for patients who are concerned about the risk of nighttime glare and haloes, those who are prevented from getting a diffractive multifocal IOL because of mild corneal or macular disease, and those who do not prioritize very near vision.

EDOF IOLs are defined by the FDA as lenses that provide Snellen visual acuity to within 1 letter of that provided by a monofocal IOL, and a depth of field that is at least 0.50 D greater than a monofocal.

 Depending on pupil size, most monofocals already provide 0.75 D to 1.00 D of depth of field, so an additional 0.50 D of depth of field increases that from 1.25 D to 1.50 D. This brings objects that are only 24 to 30 in away into focus, encompassing vehicle dashboards, computer monitors, and tablets.

EDOFs are well suited for patients who want some depth of field to increase their glasses independence but do not mind resorting to reading glasses for close work or work in dim light. They tend to perform very well for active individuals who spend a lot of time outdoors and want some near function but will not tolerate compromises to their distance vision.

Although Bausch + Lomb’s Crystalens (2003) and Johnson & Johnson’s Tecnis +2.75 (2015) both arguably fit into the EDOF category, neither is used much anymore; the pseudo-accommodative movement of the Crystalens rarely worked as hoped, and the older optics of the Tecnis have fallen out of favor.

 Therefore, we will primarily cover 2 newer EDOF IOLS: the Vivity and the Symfony.

In contrast to the diffractive multifocal IOLs, the Vivity IOL (Alcon) is a nondiffractive (or refractive) lens, using sophisticated optical elements on its anterior and posterior surfaces to elongate the range of focus significantly. The Vivity functions as an EDOF IOL, with continuous vision from infinity to approximately 26 in (+1.50 D).

 The Vivity is available as a spherical and a toric version, with toric powers compensating for 1.00 to 2.45 D of corneal cylinder.

Despite its weaker performance at near when compared with other MFIOLs, patients have been enthusiastic about the Vivity; one big reason for this is the near absence of glare and haloes. A great benefit of its nondiffractive design is having similar nighttime aberrations to those of a monofocal IOL. Patients commonly describe their vision through this lens as “natural.”

Because of the minimal aberrations, the Vivity IOL can sometimes be implanted in patients with mild corneal or macular disease, as long as they receive appropriate counselling. Thus, the Vivity has expanded our pool of potential candidates for presbyopia-correcting IOLs. According to one study, although the Vivity IOL can be implanted in eyes with mild epiretinal membranes, the macular pathology may negate much of the EDOF effect, effectively leaving the patient with an expensive monofocal.

The Vivity provides good distance and intermediate vision, but like other EDOFs, it does not typically allow for good uncorrected near vision. If acceptable to the patient, a minimonovision strategy can bolster near vision considerably. The Vivity IOL is a great lens for patients who want good distance and intermediate vision, do not mind wearing reading glasses for some near tasks, and would dislike any glare or haloes.

The TECNIS Symfony EDOF IOL (Johnson & Johnson) uses diffraction to split light between 2 close foci, resulting in a bifocal IOL with focal peaks at plano and at +1.75 D (22 in). These peaks merge such that in most lighting conditions, patients experience a continuous range of good vision all the way from infinity to intermediate distance. In dim lighting, a perceptive patient may notice 2 separate peaks.

 The Symfony IOL comes in a spherical and a toric version; the toric model can correct for corneal astigmatism of between 1.0 to 2.6 D.

The Symfony is a diffractive lens with a concentric sawtooth surface pattern on the anterior surface.

 This IOL may produce glare, haloes, and starbursts similar to those of the Synergy.

One of the more ingenious strategies employed by the Symfony is a reduction in chromatic aberration that is achieved by manipulation of the diffractive design. This results in superior contrast sensitivity compared with most other presbyopia-correcting IOLs.

 This same design strategy has been employed in the Synergy IOL. Even with its superior chromatic aberration control, the Symfony is still contraindicated in the presence of any corneal or macular disease.

The Symfony tends to provide good distance and intermediate vision but does not perform well at near vision. Some patients are amenable to a strategy of minimonovision, whereby the nondominant eye is targeted at –0.50 D; this slight adjustment can give more functional uncorrected near vision.

 With the success of the Synergy, which employs similar optics but achieves a more powerful range, many surgical centers have seen the use of the Symfony IOL decrease. In general, the Symfony is a good IOL for patients who desire good distance and intermediate vision and do not mind some compromise to their near vision and some nighttime aberrations.

A new type of EDOF IOL has been recently FDA approved in the United States—the IC 8 small-aperture IOL (AcuFocus, Inc)—although it is yet to be released for widespread use. The design involves creating a pinhole effect with a 3.23-mm central black circular mask with a 1.36-mm central aperture. 

The mask has more than 3200 microperforations to limit any negative effect on patient’s field of vision. The pinhole effect provided by this IOL may allow for good distance, intermediate vision, and potentially functional near vision. We have yet to try this IOL in practice.

Many companies are looking far past the current options of diffractive or refractive multifocal IOLs, toward what is often referred to as the “Holy Grail” of IOLs: a truly accommodating IOL. Such an IOL could change its refractive power, driven by contraction of the ciliary body—just as in a prepresbyopic human eye. Presently, the leaders are the FluidVision (Alcon), the modular Juvene (LensGen, Inc), and the JelliSee (JelliSee Ophthalmics, Inc); the first 2 of these are already undergoing human trials.

 The JelliSee claims to deliver an astonishing 6 D of true accommodation.

In addition to the careful consideration of your patient’s priorities and of the characteristics of each IOL, priority should be given to the preferences of your cataract surgeon. Many surgeons find that some multifocal IOLs work well in their hands, whereas others do not—this should be respected.

The field of presbyopia correction already includes many excellent IOLs that can offer a significant range of spectacle-free vision for a motivated patient, yet the field continues to evolve rapidly in search of lenses that offer better accommodation with less adverse effects. For a truly successful outcome, your patient must clearly understand their priorities, and you and your surgery center must understand the options.

Multifocal Intraocular Lenses: The Art and the Practice

Braga-Mele R, Chang D, Dewey S, et al. Multifocal intraocular lenses: relative indications and contraindications for implantation. 

. 2014;40(2):313-322. doi:10.1016/j.jcrs.2013.12.011

Kohnen T, Marchini G, Alfonso JF, et al. Innovative trifocal (quadrifocal) presbyopia-correcting IOLs: 1-year outcomes from an international multicenter study. 

. 2020;46(8):1142-1148. doi:10.1097/j.jcrs.0000000000000232

Alió JL, Pikkel J. Multifocal intraocular lenses: preoperative considerations. In: Alió JL, Pikkel J, eds. 

Kohnen T, Herzog M, Hemkeppler E, et al. Visual performance of a quadrifocal (trifocal) intraocular lens following removal of the crystalline lens. 

. 2017;184:52-62. doi:10.1016/j.ajo.2017.09.016

Ribeiro F,J Ferreira TB, Silva D, Matos AC, Gaspar S. Visual outcomes and patient satisfaction after implantation of a presbyopia-correcting intraocular lens that combines extended depth-of-focus and multifocal profiles. 

. 2021;47(11):1448-1453. doi:10.1097/j.jcrs.0000000000000659

Gabrić N, Gabrić I, Gabrić K, Biščević A, Piñero DP, Bohač M. Clinical outcomes with a new continuous range of vision presbyopia-correcting intraocular lens. 

. 2021;37(4):256-262. doi:10.3928/1081597X-20210209-01

Ferreira TB, Ribiero FJ, Silva D, Matos AC, Gaspar S, Almeida S. Comparison of refractive and visual outcomes of 3 presbyopia-correcting intraocular lenses. 

. 2022;48(3):280-287. doi:10.1097/j.jcrs.0000000000000743

Kohnen T, Suryakumar R. Extended depth-of-focus technology in intraocular lenses. 

. 2020;46(2):298-304. doi:10.1097/j.jcrs.0000000000000109

de Vries NE, Webers CA, Touwslager WR, et al. Dissatisfaction after implantation of multifocal intraocular lenses. 

. 2011;37(5):859-865. doi:10.1016/j.jcrs.2010.11.032

Kohnen T. Nondiffractive wavefront-shaping extended range-of-vision intraocular lens. 

. 2020;46(9):1312-1313. doi:10.1097/j.jcrs.0000000000000247

Arrigo A, Gambaro G, Fasce F, Aragona E, Figini I, Bandello F. Extended depth-of-focus (EDOF) AcrySof IQ Vivity intraocular lens implant: a real-life experience. 

. 2021;259(9):2717-2722. doi:10.1007/s00417-021-05245-6

Jeon S, Choi A, Kwon H. Clinical outcomes after implantation of extended depth-of-focus AcrySof Vivity intraocular lens in eyes with low-grade epiretinal membrane. 

. 2022;260(12):3883-3888. doi:10.1007/s00417-022-05751-1

Loicq J, Willet N, Gatinel D. Topography and longitudinal chromatic aberration characterizations of refractive-diffractive multifocal intraocular lenses. 

. 2019;45(11):1650-1659. doi:10.1016/j.jcrs.2019.06.002

Carones F. Residual astigmatism threshold and patient satisfaction with bifocal, trifocal and extended range of vision intraocular lenses (IOLs). 

. 2017;7(1):1-7. doi:10.4236/ojoph.2017.71001

Davison JA, Simpson MJ. How does the ReSTOR lens work? 

Sandoval HP, Lane S, Slade S, Potvin R, Donnenfeld ED, Solomon KD. Extended depth-of-focus toric intraocular lens targeted for binocular emmetropia or slight myopia in the nondominant eye: visual and refractive clinical outcomes. 

. 2019;45(10):1398-1403. doi:10.1016/j.jcrs.2019.05.019

Sánchez-González JM, Sánchez-González MC, De-Hita-Cantalejo C, Ballesteros-Sánchez A. Small aperture IC-8 extended-depth-of-focus intraocular lens in cataract surgery: a systematic review. 

. 2022;11(16):4654. doi:10.3390/jcm1164654

Garg S, De Jesus MT, Fletcher LM, Chayet A, Barragán E, Casey P. Twelve-month clinical outcomes after implantation of a new, modular, anterior shape-changing fluid optic intraocular lens. 

. 2022;48(10):1134-1140. doi:10.1097/j.jcrs.0000000000000935

Technology. JelliSee Ophthalmics, Inc. Accessed January 25, 2023. http://www.jellisee.com/technology.html

Managing patient expectations is key to selecting the best lens

A practical guide to the best of the current multifocal IOLs

Steven T. Reed, OD, American Optometric Association's president, overviews the 2024 highlights and how the organization plans to extend success into 2025.

Legislative, vision plan headway cited as AOA's 2024 highlights

Steven T. Reed, OD, provides the American Optometric Association's (AOA) most memorable wins of 2024, including reimbursement and fairness coverage regarding vision plans and scope expansion legislation.

This transcript has been lightly edited for clarity.

I would say that one of the first things is we continue to battle, as well as make progress, on the reimbursement and fairness coverage as it regards to vision plans. We've had an issue for quite a while with vision plans. I know in my own practice, I've been practicing for 30 years, and I don't even remember the last time that I received a pay increase. And so here we are; the average optometrist is working to pay their staff, pay their bills, and yet we're not getting any reimbursement to even cover the cost of living. So we're working to right the wrong in that area. We've had lots of discussions. We had 2 town halls last year to inform members about what was going on. We continue to work on both a federal level – the AOA, of course, works on a federal level with our DOC Access bill to avert some of the issues with vision plans there and then, of course, we assist states and continue to work with them in passing their state laws as their regards to their particular issues in state. So anyway, we were proud of our progress there. We continue to work on that, although we know we have quite a piece to go in that sense.

Other areas: we are very proud of the 12 states we have now that have laser privileges. Our Future Practice Initiative program is 1 that you may have heard of. It was started years ago with the intent of assisting states that wanted to go for meaningful scope expansion. Of course, all scope expansion is meaningful, but we wanted to make sure that we cross that laser line, because that really gets us closer to where we're actually trained within our optometry schools. And it's important to be able to practice at the level we're trained to benefit the patients that we serve. And so anyway, the FPI program not only assists them in giving a blueprint about successful actions, but at the very end, if a state has really worked hard, we're willing to come in and provide some extra funds to get them across the finish line, so to speak. Right now we have, I think it's 14 to 16 states that are going for scope expansion this year. And I can't give any names, but I will say there are a few that I'm expecting any day now that's going to happen. And that's not only a win in optometry, but that's a win with our patient care, because it really benefits them, especially in the rural communities. So I say vision plan issues and the scope expansion are two of the big areas that we have found success in and will continue to work on.

We're always adjusting the framework, because we learn more each battle that we have. We know exactly what the opposition is going to say, and we know, you know, who they're going to bring in next. And so every time we go through a battle, we say, "Alright, let's pull it back in, let's look at it," and we tighten it down. And it has really become a well-oiled machine over time.

Scope expansion, vision plan headway cited as AOA's 2024 highlights

In 2023, we made the decision to do better for our patients who have diabetes by integrating electroretinography (ERG) in our 5 clinics. We viewed the investment as a necessary step in elevating the level of care we provide. Before adding ERG, our functional assessments were subjective and relied on patient performance and feedback, leaving room for error and poor or unreliable data. We were drawn to a handheld device because it is practical and provides objective, actionable information. After performing 1,500 tests, we discovered that it is useful across multiple pathologies, including optic neuritis.

Our ERG protocol has evolved. We began by making the decision to obtain a diabetic retinopathy (DR) score on every patient who has diabetes. The goal was to test these patients annually or more often depending upon the level of severity or presence of retinopathy.This protocol applies whether the patient has diabetic retinopathy or is newly diagnosed with diabetes. The goal for us is to obtain a baseline exam.We make it standard of care in our practice because we believe it is in the best interest of our patients.

In addition to utilizing the DR score, we routinely use the RET

 device’s photopic negative response (PhNR) protocol to measure ganglion function and aid and support diagnosis, management, and treatment of optic nerve neuropathies, including glaucoma. Finally, we now also perform the Flicker 16 protocol on all macular pathologies, including drusen.

 device is the portability. In our clinics, we see a relatively high volume of patients, which means we don’t have the luxury of slowing down. Space is also a concern. Many of our instruments take up a full workup testing room. For example, our other subjective test—the visual field—needs to be carefully orchestrated because we can accommodate only 1 patient in the room at a time. This portable electroretinography (ERG) device can be used in the exam room after the workup, which works seamlessly with our general flow.

Optic neuritis case report: Patient history

An established patient presented for a comprehensive exam in 2023. This 70-year-old white female had a family history of diabetes, hypertension, and cancer. She was also positive for multiple sclerosis, thyroid dysfunction, and high cholesterol. More than 10 years ago, she had an episode of optic neuritis in her left eye. Interestingly, relative to her multiple sclerosis, she says she was told that she no longer needed treatment, nor did she need to be seen by neurology. This concerned us given what the Optic Neuritis Treatment Trial tells us about the high likelihood of recurrence in optic neuritis in patients with a history of diagnosis of multiple sclerosis.

The patient’s best corrected vision in the left eye was hand motion. Her vision in the right eye was 20/20. She had mentioned previously that she had a family history of legal blindness, which was somewhat poorly defined; she mentioned glaucoma, cataracts, and degenerative disorders of the macula.

The fundus exam showed asymmetry of the optic nerves in terms of pallor (OS>OD) as well as mild cupping and drusen in both eyes (

). We performed visual field testing, but the patient routinely failed the visual field testing based on high fixation losses, which greatly underscores the value of an objective functional test.The best visual field index we had seen was 21%.
Optical coherence tomography (OCT) showed mild drusen and macular thickening OD and poor fixation and a significant epiretinal membrane OS (

). Given the patient’s inability to focus on a target straight ahead due to poor vision, even our OCT findings were limited. Fortunately, at this more recent visit, we were able to perform a baseline ERG. We thought this would be helpful for a couple of different reasons. First, due to the history of optic neuritis, we wanted to be able to have a functional assessment of the retina comparing the right eye to the left eye. Also, because the patient has a macular pathology (drusen), we want to be ultra protective of the vision in the right eye. We had recently instituted a drusen protocol that prompted the technician to proceed with a Flicker 16 test. Although this was not the most useful protocol (PhNR is preferred in this case), it helped provide clarification given the difficulty we were having capturing actionable detail using other tests.

Neda Gioia, OD, CNS, FOWNS

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