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Thread: Has sight testing been harmful to optometrists in BC?

  1. #76
    Master OptiBoarder mike.elmes's Avatar
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    The eyelogic system prompts you with the questions to ask during the refraction.... if you want them, I don't need them, you can turn that stuff off.. The system provides very consistent and reliable refractive results. We offer this service to adults who have Healthy eyes, as determined by a doctor within the last 3-4 years at the longest. The consumer has this choice available to them and they are made aware of the risks. We guaranty the satisfaction of clear comfortable vision no matter who's RX is used. So many people don't even get an eye exam...they spend years in Costco readers. Those are the people who are in the gravest danger. We refer all of them.

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    I am very much enjoying this thread. There has been some pretty logical and irrational points made. As an optician in a typical office setting, it is very encouraging to wear different hats in the optical field.

    From the auto refractor to the retinal camera, the OCT, NCT and topography, surfacing, dispensing, finishing..... the list goes on. But it is important to remember that everyone's demographic is different, laws are regional specific, and private offices vs. retail franchises can matter too. I guess depending on all these factors, then and only then, you can make the argument that a particular scenario works best for you.

    I don't refract, its not my job. I know plenty of refracting opticians/ophthalmic techs, but they do not work for OD's. They work for MD's, or they work for these small Warby Parker wannabe's (i.e. JINS) who have opticians/techs who refract in a small space within the brick n mortar and then video in an OD on stand by to verify the final RX. This works for them I guess, but it works for them because of all the scenarios I listed above, plus they found some kind of loophole that I am sure will be regulated eventually.

    I believe in a full comprehensive exam, and ultimately as opticians/health care professionals, our most important job is to educate our patients regarding the best way to take care of their health/eyes. What they choose to do after that to obtain an RX or buy glasses or whatever, is truly up to them and whatever we think the process should be is a matter of opinion that sometimes can be also kind of bias.
    Last edited by King of the Lab; 02-20-2018 at 08:02 PM. Reason: errors
    Erik Zuniga, ABOC.

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    Quote Originally Posted by King of the Lab View Post
    I am very much enjoying this thread. There has been some pretty logical and irrational points made. As an optician in typical office setting, it is very encouraging to wear different hats in the optical field.

    From the auto refractor to the retinal camera, the OCT, NCT and topography, surfacing, dispensing, finishing..... the list goes on. But it is important to remember that everyone's demographic is different, laws are regional specific, and private offices vs. retail franchises can matter too. I guess depending on all these factors, then and only then, you can make the argument that a particular scenario works best for you.

    I don't refract, its not my job. I know plenty of refracting opticians/ophthalmic techs, but they do not work for OD's. They work for MD's, or they work for these small Warby Parker wannabe's (i.e. JINS) who have opticians/techs who refract in a small space within the brick n mortar and then video in an OD on stand by to verify the final RX. This works for them I guess, but it works for them because of all the scenarios I listed above, plus they found some kind of loophole that I am sure will be regulated eventually.

    I believe in a full comprehensive exam, and ultimately as opticians/health care professionals, our most important job is to educate our patients regarding the best way to take care of their health/eyes. What they choose to do after that to obtain an RX or buy glasses or whatever, is truly up to them and whatever we think the process should be is a matter of opinion that sometimes be also kind of bias.
    I am enjoying this thread also. I love how the OD's wind up so easy and get so defensive over nothing.

  4. #79
    Master OptiBoarder mike.elmes's Avatar
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    My store, with a finish lab and site test office, is in a retail mall with Optometrists at the other end of the mall. When I first started do Eyelogic testing the Dr. at the other end of the mall was concerned and came for a visit. He is now totally fine with it.
    I refer hundreds of people to his practice every year. We can co-exist with Optometry. There is nothing to be threatened by. In a good month, I might use my setup a dozen times. It's not like I have a neon sign flashing free eye testing.
    I wouldn't do that to the Dr. at the other end of the mall.

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    You think it's nothing because you don't know what you don't know.

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    Quote Originally Posted by mike.elmes View Post
    My store, with a finish lab and site test office, is in a retail mall with Optometrists at the other end of the mall. When I first started do Eyelogic testing the Dr. at the other end of the mall was concerned and came for a visit. He is now totally fine with it.
    I refer hundreds of people to his practice every year. We can co-exist with Optometry. There is nothing to be threatened by. In a good month, I might use my setup a dozen times. It's not like I have a neon sign flashing free eye testing.
    I wouldn't do that to the Dr. at the other end of the mall.
    Your concern is misplaced. Screw the OD at the other end of the mall.

    It's the people to whom you are giving bad/fake eye care that you should be concerned about.

    But again, ignorance is bliss.

  7. #82
    Master OptiBoarder mike.elmes's Avatar
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    Quote Originally Posted by drk View Post
    You think it's nothing because you don't know what you don't know.
    Do you have a dispensary at your shop?
    Do you employ an Optician? Many of the best Optometric practices do. Many don't. Many have their receptionist, optometric assistants filling that roll. If your biggest worry is glaucoma, maybe I should buy a non contact tonometer. Shucks those were the days when I worked for an optometrist....The clients we test have been cleared by the local doctors for medical problems with their eyes. Why would I have to. They just want to see clearly. I provide that.

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    If you get an NCT, then you'd be closer to doing a good job for those people. But still far away.

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    Quote Originally Posted by drk View Post
    You think it's nothing because you don't know what you don't know.
    Ahh, poor little Bugsy is offended. Do you really have any patients or friends for that matter?

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    ohhhh, too many slippery slopes here....
    The OP wanted to know if sight testing is harmful to optometrists in BC. While he/she has every right to ask a question, it is the wrong question. It is the patients we all should be worried about. Dr. K. expresses that, but perhaps not in the most eloquent of terms.

    Some of the sight testers, somewhat eloquently, express why they are doing what they do, and justify it with the "approval" of the medical community...but, it is not within their bailywick to delegate someone elses profession. Only laws and regulations can allow this. Lack of such is just a convenient excuse.

    Everybody's mad...OMDs hate that ODs are taking medical care. Opticians hate that the internet is stealing business. ODs feel squished from both ends......

    There are many biases in this world but one of them is the fact that OMDs don't even want to give our profession (ODs) the satisfaction of saying, "yeah, they do know how to refract". They would rather see us fade away....replaced by a machine, or whatever. Anyway they can move this along is a good thing in their minds. BTW, this old line thinking is not shared so much by the newer OMDs who see ODs as a partner in medical eyecare.

    The emphasis should not be on what is good for our chosen professions, but what is best for the patient. Sorry to say, but this discussion is going to go nowhere because everyone thinks what they are doing is best. Laws are written, and laws will be skirted. We all just have to deal with it.

    There is really more I would like to say....but none of it really matters. I wish everyone well in what they choose to do, but please do it ethically.

  11. #86
    Master OptiBoarder optical24/7's Avatar
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    Some perspective to add to this conversation;

    Should a person not be allowed to buy aspirin without an Rx because his head hurts? Should he be forced to see a neurologists 1st to get tested for possible tumors?

    How are simple refractions and purchase of eye wear different?

    Also, Wasn't it Charles Prentice that successfully argued and lobbied the legislators in NY many years ago that refraction was not practicing medicine, but the bending of light?

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    optical 24/7 I love your response! I made a similar analogy somewhere else on optiboard, if a guy doesn't go in for his full physical regularly he shouldn't be restricted from buying tylenol for his headache. Someone who (unwisely) doesn't bother with a full comprehensive eye exam similarly shouldn't be precluded from buying glasses to improve his vision. We can't make these people take care of their health, but we can sell them glasses. Getting a pair of specs with a bad rx doesn't do any damage as far as I know, it just costs the optical to do a redo - so who's being harmed? What's needed to get people in for an exam is a healthcare system that covers it - I live in Canada and our healthcare system is alright, but in the States... most people don't want to pay $100 for an exam that may find nothing and produce the exact same prescription as last time. I think they'd be better off getting the exam but I don't know their budget, they do.

    EDIT: also - drk needs to relax, on this thread and all others I've seen them post on. Maybe a glaucoma specialist could prescribe you something that would help...

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    Quote Originally Posted by fjpod View Post
    While he/she has every right to ask a question, it is the wrong question.
    No. It isn't the wrong question if the purpose of me asking it, is because I'm considering a move there. As an OD, I want to know if I can make a living there under the local regs. Re-read the OP. It wasn't about patient care. And yes, in my situation, it is the right question to be asking.

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    Quote Originally Posted by optio View Post
    No. It isn't the wrong question if the purpose of me asking it, is because I'm considering a move there. As an OD, I want to know if I can make a living there under the local regs. Re-read the OP. It wasn't about patient care. And yes, in my situation, it is the right question to be asking.
    Ok

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    Quote Originally Posted by Lab Insight View Post
    Ahh, poor little Bugsy is offended. Do you really have any patients or friends for that matter?
    Not anymore. They have all moved north for the 99% accurate refractions.
    Last edited by drk; 02-21-2018 at 10:10 PM.

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    Quote Originally Posted by optical24/7 View Post
    Some perspective to add to this conversation;

    Should a person not be allowed to buy aspirin without an Rx because his head hurts? Should he be forced to see a neurologists 1st to get tested for possible tumors?

    How are simple refractions and purchase of eye wear different?

    Also, Wasn't it Charles Prentice that successfully argued and lobbied the legislators in NY many years ago that refraction was not practicing medicine, but the bending of light?
    Issue 1: OTC medication. Your logic: since OTC medications exist, then glasses should be OTC.
    The rebuttal: Since you have to have a Rx for antihypertensives, then glasses should be Rx only.
    The conclusion: That reasoning doesn't really work. Are glasses aspirin or lisinopril?

    Issue 2: Charles Prentice. Your logic: since Charles Prentice said something, we have to be held to what he said.
    The rebuttal: He also said you're fat.
    The conclusion: You're fat, or who the heck cares what Charles Prentice said.

  17. #92
    What's up? drk's Avatar
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    I never "relax", darkly.

    I'm like Batman, the Caped Crusader.

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    Master OptiBoarder optical24/7's Avatar
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    Quote Originally Posted by drk View Post
    Issue 1: OTC medication. Your logic: since OTC medications exist, then glasses should be OTC.
    The rebuttal: Since you have to have a Rx for antihypertensives, then glasses should be Rx only.
    The conclusion: That reasoning doesn't really work. Are glasses aspirin or lisinopril?

    That’s not where I was going. Aspirin: Class one medication, little chance of harm, BUT, you can od on them, get ulcers, etc. Glasses: Class one medical device, least chance of harm, can’t od on them, can’t cause permanent damage (unless really jacked to the point of being un-wearable).


    Issue 2: Charles Prentice. Your logic: since Charles Prentice said something, we have to be held to what he said.
    The rebuttal: He also said you're fat.
    The conclusion: You're fat, or who the heck cares what Charles Prentice said.
    Where I was going is that over-testing is part of the reason for the astronomical cost of health care. How come can’t a person opt for a refraction only? They are required to get extra testing they either don’t want, need, or can afford. Why does a healthy 30 year old have only a one year window to obtain eye wear until their Rx “expires”?

    Why are tens of thousands of lay people allowed to self refract and “prescribe” daily for readers? Heck, we’ve all seen hyperopes wear readers for years for Drx glasses! Why is lens duplication legal in almost all states? Why?... Because of a lack of evidence of harm...

    So, once again, why can the public self prescribe a drug (aspirin), which can cause permanent harm, but they can’t obtain a simple refraction for a product with literally no harm?

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    Quote Originally Posted by drk View Post
    I never "relax", darkly.

    I'm like Batman, the Caped Crusader.
    You're actually more like Robin.

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    That one hurt.

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    Quote Originally Posted by optical24/7 View Post
    Where I was going is that over-testing is part of the reason for the astronomical cost of health care. How come can’t a person opt for a refraction only? They are required to get extra testing they either don’t want, need, or can afford. Why does a healthy 30 year old have only a one year window to obtain eye wear until their Rx “expires”?
    1. The way it should be with expiration dates: If the patient is progressive in their refractive error, there should be an appropriate expiration date, and it should be followed. If it's stable refractive error, there should be a longer expiration date. Expiration dates are for the benefit of the patient. Who's expiring a stable 30 yo's expiration date in one year? There should be a reason if so.

    2. If a patient wants a "refraction", I ask, "why"? If their vision's changed, they need to know why. That's what a doctor's for. A loss of vision shouldn't be ignored.
    Why are tens of thousands of lay people allowed to self refract and “prescribe” daily for readers? Heck, we’ve all seen hyperopes wear readers for years for Drx glasses
    1. People don't "self refract". They try on readers. No refracting involved. No prescribing involved.

    2. Nobody presumably gets amblyopia or crashes a motor vehicle when sitting down with a book and their OTC readers.

    3.There should be a law against wearing OTC readers for drivers licenses. But they don't know how to do it. There used to be minus readers available but they took them off the market.

    4. I think OTC readers are grandfathered in. I don't love them, to be honest, but it is what it is.

    Why is lens duplication legal in almost all states? Why?... Because of a lack of evidence of harm...
    I think that's bad policy. Good opticians don't like to duplicate. I don't duplicate. You know it's just working around the better method of calling the practitioner for the prescription.

    For that matter, online contacts are a public health hazard, as well, but we see that a lot of money goes a long way in Washington. So "legal" is not evidence of "good".

    So, once again, why can the public self prescribe a drug (aspirin), which can cause permanent harm, but they can’t obtain a simple refraction for a product with literally no harm?
    1. You can't get a "simple refraction". There are no "simple refractions". Do I have to do a bunch of scenarios?

    2. A refraction is not a prescription. There has to be a practitioner making a treatment plan for a vision problem.

    3. You can only imagine the number of people with loss of vision that think "magic glasses" will solve their problem.

    4. Even so, in America you have a right to be stupid and self-treat. If one want's to grind one's own lenses, somehow, more power to them. But in presumably an advanced society, there are protections against OTHER PEOPLE hanging out a shingle and taking money for providing cures that they don't know anything about. It's called "quackery".

    If someone comes to my office with reduced vision, and I diagnose macular degeneration, and I put them on a high-carb diet and recommend yoga, I'm a quack. My license to practice optometry on people will be yanked.

    If someone comes to your office with reduced vision, and you "diagnose" refractive error, and you put them in glasses but they really have a branch retinal vein occlusion, you're a quack. You need a license to be yanked. If you don't have a license, then the person doesn't have protection other than "buyer beware", like they have to do with a flea market.

    I suppose somewhere along the line society decided that on matters of health care, "buyer beware" isn't good enough. Check out the credentialing that ODs have to go through to be providers for VCPs and health insurances and to maintain licenses and board certifications and maintenance of said certifications (C.E.).

    It's not my problem if you undervalue your role in health care and see yourself as a glasses peddler.
    Last edited by drk; 02-22-2018 at 09:13 AM.

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    Quote Originally Posted by drk View Post
    That one hurt.
    Forgive me, I've now had my early morning java.

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    Redhot Jumper Glasses are something that is needed by everybody ..........................

    Quote Originally Posted by fjpod View Post



    Everybody's mad...OMDs hate that ODs are taking medical care. Opticians hate that the internet is stealing business. ODs feel squished from both ends......


    There is really more I would like to say....but none of it really matters. I wish everyone well in what they choose to do, but please do it ethically.




    Good point..............................

    In a few weeks from now the big merger ESSI - LUX will be approved or rejected by the European authorities which will be a historic date in our professions of working in eyesight correction.

    You all fight for a space in the whole business of eyesight correction in the USA and Canada while the whole world outside is working in different setups.

    For example in India which has a population of 1.324 billion (2016) and the USA 323.1 million (2016), Essilor has and is training 3,000 young people to refract, and they are then set up in their own small stores in poorer areas, selling and delivering eyeglasses.

    Essilor and Lux will own by far the biggest block of online opticals world wide after the merger.

    Glasses are something that is needed by everybody sometimes during their lifetime, so it is a very safe profession for anybody to be in it, but the big question is in what position will you end up.

    The service garage around the corner with a couple of gas pumps is gone, and has been replaced by a Fuel Corporation run gas station and store on this Continent.

    It could very well be that the optical retail business is on a similar path.

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    Quote Originally Posted by drk View Post
    1. The way it should be with expiration dates: If the patient is progressive in their refractive error, there should be an appropriate expiration date, and it should be followed. If it's stable refractive error, there should be a longer expiration date. Expiration dates are for the benefit of the patient. Who's expiring a stable 30 yo's expiration date in one year? There should be a reason if so.

    ​Though I mainly work with OMD's, 1/4th of our volume comes from walk-ins with OD Rx's. Not one of the 20+ OD's in my area vary expiration's. Every single one has a 1 year expiry, no matter what. One wouldn't perform a new exam on a pregnant patient of his OR release the latest Rx, even after being told she had busted her only pair. ( I duplicated her busted ones... Call me Gypsy Glasses Peddler..)

    2. If a patient wants a "refraction", I ask, "why"? If their vision's changed, they need to know why. That's what a doctor's for. A loss of vision shouldn't be ignored.

    Why do they need to know why? If you get a headache, do you need to know why? Should everyone with headaches go see a neurosurgeon? ( I could say yes to that question, I've know 3 people in my life with brain tumors. One, a 34 yr old OD I worked for that died in the early 80's.) The point is, there are no laws mandating doctoral care. Folks can go buy meds that have the potential to kill them, yet, they can't buy a device, with absolutely no history of nor likelihood of causing harm.

    1. People don't "self refract". They try on readers. No refracting involved. No prescribing involved.

    Call it what you want, prescribing? No. Determining which refractive error lenses seem to work best for them, yes. (which is better, pair one or two?)

    2. Nobody presumably gets amblyopia or crashes a motor vehicle when sitting down with a book and their OTC readers.

    3.There should be a law against wearing OTC readers for drivers licenses. But they don't know how to do it. There used to be minus readers available but they took them off the market.

    4. I think OTC readers are grandfathered in. I don't love them, to be honest, but it is what it is.

    OTC readers haven't been outlawed because there is no proof of harm.


    I think that's bad policy. Good opticians don't like to duplicate. I don't duplicate. You know it's just working around the better method of calling the practitioner for the prescription.

    ​I agree! IF the previous practitioner will release it! ( see my note on that subject above).

    For that matter, online contacts are a public health hazard, as well, but we see that a lot of money goes a long way in Washington. So "legal" is not evidence of "good".

    ​I wholeheartedly agree! CL's are a medical device that certainly can cause permanent harm. Glasses can't, that's the subject I think we're talking about here.



    1. You can't get a "simple refraction". There are no "simple refractions". Do I have to do a bunch of scenarios?

    ​Give me a plausible, common scenario on why a healthy 30 year old that's had a complete medical exam of his eyes within the last couple of years couldn't get a simple refraction to replace/purchase new eye wear.

    2. A refraction is not a prescription. There has to be a practitioner making a treatment plan for a vision problem.

    Again, wholeheartedly agree! A skilled practitioner should be involved in a medical treatment plan. Yes, refraction is not a prescription, it's also not a medical procedure, ( So says Mr Prentice! ) it's the bending of light that is practiced daily by non-certified personnel in OMD offices.

    3. You can only imagine the number of people with loss of vision that think "magic glasses" will solve their problem.

    Deal with it daily...AMD, cataracts, diplopia's, retina issues, ect. Those folks need a skilled practitioner! But once again, does every single person need a complete eye workup every year? How many of the folks in the age bracket they allow in Canada to get simple refractions will fall through the cracks? Yep, there will be some. But even here in the US we use risk assessments to determine level of care and what we allow the public to buy to "self medicate" ( People die taking Tylenol, yet it doesn't require an Rx because of the low risk assessment for the vast majority of the public.)

    4. Even so, in America you have a right to be stupid and self-treat. If one want's to grind one's own lenses, somehow, more power to them. But in presumably an advanced society, there are protections against OTHER PEOPLE hanging out a shingle and taking money for providing cures that they don't know anything about. It's called "quackery".

    ​See, I agree a lot with you! Training, credentialing, certifications and C.E's should definitely be required for anyone to recommend a treatment. My understanding of Canada is that they do require training a certification to perform refractions.

    If someone comes to my office with reduced vision, and I diagnose macular degeneration, and I put them on a high-carb diet and recommend yoga, I'm a quack. My license to practice optometry on people will be yanked.

    If someone comes to your office with reduced vision, and you "diagnose" refractive error, and you put them in glasses but they really have a branch retinal vein occlusion, you're a quack. You need a license to be yanked. If you don't have a license, then the person doesn't have protection other than "buyer beware", like they have to do with a flea market.

    ​Once again, risk assessment. Branch retinal vein occlusions, along with quite a few other ailments are not common.

    I suppose somewhere along the line society decided that on matters of health care, "buyer beware" isn't good enough. Check out the credentialing that ODs have to go through to be providers for VCPs and health insurances and to maintain licenses and board certifications and maintenance of said certifications (C.E.).

    It's not my problem if you undervalue your role in health care and see yourself as a glasses peddler.
    Doc, I have the highest respect for you, and your profession. My Mom was an instructor at UHCO. I know a ton of OD's and would love to see your profession advance more into the medical side with surgical privileges. You go though a ton of training, like Dentists. They can perform oral surgery, you should be able too on eye problems ( with training of course..)

    I'm merely playing devil's advocate here. I also think Opticianry should be allowed to advance too. ( With high quaility, extensive training and certification...)
    Last edited by optical24/7; 02-22-2018 at 01:16 PM.

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    Quote Originally Posted by drk View Post
    1. People don't "self refract". They try on readers. No refracting involved. No prescribing involved.
    Doesn't a phoropter just "try on" different lenses? Doesn't an OD's refraction rely on patient feedback? Seems fairly similar to someone trying on readers until they find a pair that works. Nobody's diagnosing or practicing medicine, it's just trying on different lenses until you find a pair that works. Not saying OD's can't do a better job of refracting or that there aren't other benefits to having a proper doctor such as yourself take a look at your eyes, just noting the broad similarities. A person isn't going to try (or at least wouldn't be successful at) suing the company that made the readers when they find out that they have glaucoma or something. Why is it so different for glasses that aren't off the shelf ready readers? Again, people should get proper eye exams from proper medical professionals. But if they don't want to do that, why shouldn't they be able to buy a pair of glasses? It isn't providing substandard medical care to duplicate an old pair of glasses - it isn't providing medical care of any kind.

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