Optometry and Vision Science最新文献

{"title":"Does the palpebral morphology influence the tear meniscus height between Caucasian and Asian eyes?","authors":"Maëlys Guinel, Etty Bitton","doi":"10.1097/OPX.0000000000002180","DOIUrl":"https://doi.org/10.1097/OPX.0000000000002180","url":null,"abstract":"<p><strong>Purpose: </strong>The central lower TMH is used as a clinical measure of tear volume in the assessment of contact lens candidates and patients with dry eyes. Ethnic differences in eyelid morphology may influence the measurement of the TMH. Furthermore, with the advent of larger contact lenses, such as scleral lenses, it would be of clinical value to assess the TMH centrally and peripherally. The purpose of this study was to evaluate and compare the TMH at different positions along the palpebral margin between Caucasian and Asian eyes.</p><p><strong>Methods: </strong>This prospective study evaluated the lower TMH in five positions (central, temporal and nasal limbus and temporal and nasal periphery) of the right eye using the Keratograph 5M (Oculus) instrument in Caucasian and Asian participants between 10 am and 12 pm . The TMH at each position was taken three times and averaged and analyzed using a 5 × 2 repeated-measures analysis of variance.</p><p><strong>Results: </strong>Central TMH did not differ significantly ( F = 0.02, p=0.88) in Caucasians (n = 20, aged 24.45 [2.30] years, TMH 0.320 [0.052] mm) and Asians (n = 20, aged 22.25 [3.43] years, TMH 0.325 [0.048] mm). A difference was noted with respect to TMH positions along the lid margin ( F = 64.17, p<0.001), independent of ethnicity ( F = 2.15, p=0.15). A post hoc analysis revealed a significantly higher TMH temporally when compared with centrally or nasally (p<0.001).</p><p><strong>Conclusions: </strong>This study demonstrated the similarity of the central TMH and the differences in the peripheral TMH within Caucasian and Asian eyes. This may be clinically relevant when using the Tear Film & Ocular Surface Society Dry Eye Workshop II diagnostic algorithm for dry eyes and when fitting scleral contact lenses. Future studies need to consider that ethnic differences may exist for certain tests in order to personalize the care and management of each patient.</p>","PeriodicalId":19649,"journal":{"name":"Optometry and Vision Science","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feature Issue: Advances in Refractive Error Research.","authors":"","doi":"10.1097/OPX.0000000000002191","DOIUrl":"https://doi.org/10.1097/OPX.0000000000002191","url":null,"abstract":"","PeriodicalId":19649,"journal":{"name":"Optometry and Vision Science","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moderate-severe peripheral neuropathy in diabetes associated with an increased risk of dry eye disease.","authors":"Shyam Sunder Tummanapalli,Leiao Leon Wang,Roshan Dhanapalaratnam,Ann Poynten,Eric B Papas,Arun Vishwanathan Krishnan,Maria Markoulli","doi":"10.1097/opx.0000000000002178","DOIUrl":"https://doi.org/10.1097/opx.0000000000002178","url":null,"abstract":"SIGNIFICANCEThis study establishes an increased risk of developing dry eye disease (DED) in patients with diabetic peripheral neuropathy using validated diagnostic criteria for both conditions.PURPOSEThe disruption of ocular surface homeostasis has been associated with diabetes. However, it remains unclear if this association is independently influenced by peripheral neuropathy secondary to diabetes. This study aimed to investigate the clinical signs and symptoms of DED and their association with the severity of peripheral neuropathy in participants with type 2 diabetes.METHODSThis prospective cross-sectional study recruited 63 participants with type 2 diabetes. All participants underwent a detailed assessment of DED using dry eye questionnaires (Ocular Surface Disease Index, Dry Eye Questionnaire-5), tear osmolarity, lipid layer thickness, noninvasive keratographic tear breakup time, phenol red thread test (PRT), and ocular surface staining. Corneal nerve morphology was imaged using corneal confocal microscopy. Based on the Total Neuropathy Scale, participants were stratified into no/mild (n = 48) and moderate/severe (n = 15) neuropathy groups.RESULTSDry eye disease was diagnosed in 31 participants (50%) of the total cohort, and the odds of developing DED in the moderate/severe neuropathy group were four times (95% confidence interval, 1.10 to 13.80; p=0.030) higher compared with the no/mild neuropathy group. The Dry Eye Questionnaire-5 scores were significantly higher (p=0.020), and PRT values (p=0.048) and corneal nerve fiber length (p<0.001) were significantly reduced in the moderate/severe neuropathy group compared with the no/mild neuropathy group. In regression analysis, neuropathy scores were independently associated with PRT measurements (β = -0.333, p=0.023) and nerve fiber length (β = -0.219, p=0.012) while adjusting for age, gender, hemoglobin A1c, and duration of diabetes.CONCLUSIONSType 2 diabetic patients with peripheral neuropathy have a risk of developing DED, which increases with the severity of neuropathy. The observation that worsening peripheral neuropathy is associated with reduced tear secretion suggests that it may contribute to aqueous insufficiency.","PeriodicalId":19649,"journal":{"name":"Optometry and Vision Science","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142257107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal refractive errors over 36 months in Hispanic and Black children.","authors":"Yi Pang,Qiong Li,Sandra S Block,Jingyun Wang","doi":"10.1097/opx.0000000000002182","DOIUrl":"https://doi.org/10.1097/opx.0000000000002182","url":null,"abstract":"SIGNIFICANCEThis study brings awareness of racial/ethnic difference of refractive error characteristics in clinics.PURPOSEThis study aimed to assess longitudinal change in refractive errors over a 36-month period in Hispanic and Black children.METHODSChildren (2.4 to 15 years old) were studied. Cycloplegic refraction was measured annually. Spherical equivalent was calculated. Astigmatism was evaluated by magnitude of cylinder and power vector (J0 and J45). Absolute value of interocular spherical equivalent difference was used to calculate anisometropia. Mixed-linear model was used to analyze longitudinal annual change in spherical equivalent, cylinder, J0, and J45 over 36 months.RESULTSA total of 485 participants (310 Black, 175 Hispanic) met the criteria. At the baseline examination, prevalence of myopia, emmetropia, and hyperopia was 39% (n = 187), 31% (n = 150), and 30% (n = 148), respectively. Spherical equivalent of Black children was not significantly different from that in Hispanic children (0.10 ± 2.92 vs. -0.37 ± 2.05 D, p=0.06); however, the Hispanic children had a significantly higher cylinder compared with Black children (Hispanic: 1.46 ± 1.57 D vs. Black: 0.92 ± 1.07 D; p<0.001). Both J0 (p<0.001) and J45 (p=0.01) were significantly different between two groups; the Hispanic children had more with-the-rule astigmatism and oblique astigmatism than the Black children. Prevalence of anisometropia (≥1 D) was higher in Black children (14%) compared with Hispanic children (5%, p=0.006). Over 36 months, spherical equivalent significantly decreased an average of 0.69 D (0.23 D/y, p<0.001) for both groups; neither astigmatism nor anisometropia changed significantly (p>0.05).CONCLUSIONSAstigmatism in the Hispanic children was significantly higher than in Black children. However, the Black children had a higher prevalence and degree of anisometropia than the Hispanic children.","PeriodicalId":19649,"journal":{"name":"Optometry and Vision Science","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ocular thermography and clinical measurements in symptomatic and asymptomatic soft contact lens wearers.","authors":"Maryam Moghadas,Daniela S Nosch,Emanuele Käser,Jennifer Klostermeier,Verena Santer,Paul Demian,Giovanni Bertolini,Mouad Lamrani","doi":"10.1097/opx.0000000000002177","DOIUrl":"https://doi.org/10.1097/opx.0000000000002177","url":null,"abstract":"SIGNIFICANCESymptoms of dryness and discomfort are the main reasons for contact lens dropout. Clinical tests for this purpose are invasive or subjective. Ocular thermography may help to assess the ocular discomfort and dryness in noninvasive and objective manner.PURPOSEThis study aimed to investigate the relationship of ocular thermography with clinical measurements in habitual symptomatic and asymptomatic soft contact lens wearers.METHODSForty habitual contact lens wearers were evaluated in two age- and gender-matched asymptomatic and symptomatic groups (Contact Lens Discomfort Questionnaire scores ≤8 and ≥14, respectively). Clinical measurements took place during visit 1 (with contact lens in situ and after contact lens removal) and at baseline after a 2-week washout period (visit 2). The Ocular Surface Disease Index (OSDI) questionnaire, noninvasive tear breakup time, bulbar conjunctival hyperemia, and corneal staining were assessed. Thermal cooling rate was computed in the central and lower cornea during natural blinking (30 s) and sustained eye opening (10 s).RESULTSDry eye symptoms (OSDI score) were significantly higher in the symptomatic group during contact lens wear (p<0.001) and at baseline (p = 0.001). Thermal cooling rate was significantly higher in the symptomatic group in the lower cornea (10 s, p=0.013) with the contact lens in situ and in the central cornea (30 s, p=0.045) after contact lens removal. At baseline, dry eye symptoms (OSDI score) significantly correlated with cooling rate in the central cornea region for the symptomatic group (30 s: r = -0.5, p=0.03; 10 s: r = -0.63, p=0.005). Noninvasive tear breakup time correlated with cooling rate in the central cornea region at baseline in the symptomatic group (30 s, r = 0.6, p=0.005; 10 s, r = 0.55, p=0.018). Cooling rate in the central cornea region (10-s duration, p<0.0001) and noninvasive tear breakup time (p<0.0001) were identified as significant predictor variables for dry eye symptoms at baseline.CONCLUSIONSNoninvasive tear breakup time and thermal cooling rate were identified as significant predictor variables for contact lens-induced dry eye. These findings may suggest the potential for the additional application of ocular thermography in the evaluation of contact lens discomfort.","PeriodicalId":19649,"journal":{"name":"Optometry and Vision Science","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spectral transmission of commercially available high-energy visible light-filtering spectacle lenses.","authors":"Nishanee Rampersad,Anthony Carlson","doi":"10.1097/opx.0000000000002171","DOIUrl":"https://doi.org/10.1097/opx.0000000000002171","url":null,"abstract":"SIGNIFICANCEHigh-energy visible (HEV) light-filtering spectacle lenses are being widely promoted despite limited evidence to support their use. The spectral transmission properties of commercially available lenses varied, particularly in the HEV light region, and they do not perform in the same way for transmission of ultraviolet (UV)-A and HEV light.PURPOSEAlthough HEV light is important for several visual and nonvisual functions, there are concerns over the potential adverse effects of increased HEV light exposure. High-energy visible light-filtering spectacle lenses are being widely marketed to promote ocular health and improve sleep by reducing exposure to HEV light. This study reports on the spectral transmission characteristics of commercially available HEV light-filtering spectacle lenses based on the recommendations of the Spectral Bands Task Force technical report.METHODSThe spectral transmission of light through nine afocal plastic lenses, including eight commercially available HEV light-filtering lenses and one clear uncoated control lens, was evaluated using a Cary 5000 UV-Vis-NIR spectrophotometer (Agilent Technologies, Johannesburg, South Africa) for wavelengths 250 to 780 nm. The percentage transmission values are reported for UV radiation and visible light, with emphasis for HEV light (380 to 500 nm) and the three subbands therein.RESULTSAll lenses blocked UV-C and UV-B radiation (250 to 315 nm). For UV-A radiation (315 to 380 nm), six lenses showed optimal 100% absorption, whereas three lenses allowed ≤12%. The transmission values for the HEV light-filtering lenses ranged from 55 to 90% and 75 to 95% for HEV light of wavelengths 400 to 455 nm and 455 to 500 nm, respectively. In contrast, the control lens showed 92 (400 to 455 nm) and 93% (455 to 500 nm) transmission.CONCLUSIONSThe HEV light-filtering spectacle lenses varied in their transmission properties and do not necessarily perform in the same way for transmission of UV-A and HEV light. Optometric personnel should consider these transmission properties, particularly for HEV light, when making recommendations to patients about HEV light-filtering spectacle lenses.","PeriodicalId":19649,"journal":{"name":"Optometry and Vision Science","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Running the enrollment numbers on ophthalmic clinical trials in the United States.","authors":"Andrew D Pucker,Nicole Derthick,Lanita Scott","doi":"10.1097/opx.0000000000002174","DOIUrl":"https://doi.org/10.1097/opx.0000000000002174","url":null,"abstract":"SIGNIFICANCEThis is one of the first reports to summarize the enrollment metrics for ophthalmology trials completed in the United States (US).PURPOSEThis study aimed to describe US ophthalmology clinical trial enrollment metrics to facilitate planning and budgeting of US Food and Drug Administration-regulated ophthalmological drugs trials.METHODSA GlobalData PLC search was conducted on or before February 27, 2024, to evaluate the clinical trial landscape for completed ophthalmology clinical trials conducted in the US. The primary search contained only the term \"ophthalmology,\" which was restricted to trials that were completed and were conducted within the US. Trials were classified as multicenter when trials included three sites or more, and when the enrollment search resulted in ≥30 multicenter trials for an individual indication, enrollment data were further broken down by Food and Drug Administration trial phase.RESULTThe search yielded 2229 trials, which analyzed 980 different drugs produced by 854 different sponsors. The most common indications evaluated in US trials were macular degeneration, glaucoma, macular edema, allergies, and keratoconjunctivitis. Multicenter trials by indication had an overall median enrollment period range of 4.8 to 35.1 months; number of subjects enrollment, range of 36 to 518 subjects; number of sites utilized, range of 4 to 74 sites; and enrollment rate, range of 0.11 to 4.04 subjects/sites per month. There were 17 indications with ≥30 multicenter trials, which allowed for enrollment metric calculation by trial phase.CONCLUSIONSThis study provides sponsors with an understanding of the number of subjects and sites needed to complete a trial while also setting realistic enrollment timelines. Although this work represents the US market, more work is needed to better understand other countries given that country-specific guidelines and subject beliefs may impact enrollment metrics.","PeriodicalId":19649,"journal":{"name":"Optometry and Vision Science","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of age and race on axial elongation in myopic children: A systematic review and meta-regression.","authors":"Noel A Brennan,Wright Shamp,Elizabeth Maynes,Xu Cheng,Mark A Bullimore","doi":"10.1097/opx.0000000000002176","DOIUrl":"https://doi.org/10.1097/opx.0000000000002176","url":null,"abstract":"PURPOSEAxial elongation is the basis of progression in primary myopia and the preferred metric to monitor its evolution. We conducted a meta-regression to model axial elongation and its associated factors in children with low to moderate myopia.METHODSA comprehensive electronic systematic search was performed using Ovid Medline, EMBASE, and Cochrane Central Register of Controlled Trials of studies conducted up until October 2021. The mean rate of axial elongation was analyzed using a multivariate linear mixed-effects meta-regression model, with backward stepwise elimination of nonsignificant covariates. The model included three levels of random effects, allowing both prediction and confidence intervals to be estimated.RESULTSA total of 64 studies with 83 subpopulations and 142 evaluations of mean axial change from baseline met our inclusion criteria and had no missing significant covariates in the final model. A separate analysis including all populations with axial length data (202 evaluations) but missing variance or covariate data produced a similar model to that for the analysis with complete data. The mean axial elongation is 38% greater in Asian children (95% confidence interval, 19 to 61%; p<0.01) compared with non-Asians, but both groups show a 15% decline per year as age increases (95% confidence interval, 12 to 17% p<0.0001). Prediction intervals indicate substantial variability around the axial elongation estimates.CONCLUSIONSThis analysis provides mean values of axial elongation for evaluation of efficacy of myopia control. The broad prediction intervals emphasize the large range of individual axial elongation rates in the population, illustrating the challenge in managing individual children. Interpretation of the analysis is limited by the use of aggregated data rather than individual subject data.","PeriodicalId":19649,"journal":{"name":"Optometry and Vision Science","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142226068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of eye drop retention time using fluorophotometry in three commercially available lubricant eye drops.","authors":"Tianni Jia, Fiona Stapleton, Fatima Iqbal, Jared Showyin, Dibyendu Roy, Maitreyee Roy, Jacqueline Tan","doi":"10.1097/OPX.0000000000002172","DOIUrl":"https://doi.org/10.1097/OPX.0000000000002172","url":null,"abstract":"<p><strong>Significance: </strong>This is the first study to evaluate the retention time of lubricating eye drops containing various concentrations of sodium hyaluronate using fluorophotometry in a symptomatic dry eye population. Information regarding eye drop retention may be useful for eye care practitioners to assist in the selection of more effective treatments for managing dry eye.</p><p><strong>Purpose: </strong>This study aimed to use fluorophotometry to compare retention time on the ocular surface of three commercially available lubricating eye drops, each containing varying concentrations of sodium hyaluronic acid (HA), and their effects on tear film stability post-instillation in a population with symptoms of dry eye.</p><p><strong>Methods: </strong>Adults with symptoms of dry eye (Ocular Surface Disease Index score, >12) were enrolled in this prospective, double-masked comparison of eye drops containing 0.15% HA-hydroxypropyl guar (HPGuar), 0.2% HA, and 0.1% HA. Participants were randomized to the eye drop order and the study eye under evaluation. Each eye drop was admixed with a fluorescent tracer (70-kDa fluorescein isothiocyanate-dextran) at 10% wt/vol, and 10 μL volume was instilled for each evaluation. A fluorophotometer was used to measure the time for the tracer signal to return to baseline. Fluorescein tear breakup time was measured following fluorophotometry assessment.</p><p><strong>Results: </strong>Retention time for 0.15% HA-HPGuar and 0.2% HA was significantly longer compared with 0.1% HA (p=0.02 and p=0.03). Fluorescein tear breakup time was significantly longer for the 0.15% HA-HPGuar eye drop compared with both the 0.1% HA eye drop (p=0.01) and 0.2% HA eye drop (p=0.003).</p><p><strong>Conclusions: </strong>Retention time on the ocular surface of the two eye drops containing higher concentrations of HA was longer than the eye drop with the lowest concentration of HA. The tear film was also more stable with the 0.15% HA-HPGuar eye drop compared with the eye drops containing HA alone, which may be attributable to the other components in the 0.15% HA-HPGuar eye drop.</p>","PeriodicalId":19649,"journal":{"name":"Optometry and Vision Science","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mentoring to build future editorial talent.","authors":"Michael Twa","doi":"10.1097/opx.0000000000002181","DOIUrl":"https://doi.org/10.1097/opx.0000000000002181","url":null,"abstract":"","PeriodicalId":19649,"journal":{"name":"Optometry and Vision Science","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142203348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}