astigmatism and myopia together

The alignment of the A-scan probe with the pupillary axis was assisted by a micro-manipulator while the animal was anesthetized (isoflurane 1.01.5% in oxygen) and eyelids held apart using a speculum. Pearsons correlation analyses were performed between refractive parameters, axial parameters, and MOFO responses. In addition, myopia and astigmatism frequently co-exist in humans and animal models with abnormal refractive development5, suggesting a potential interaction of these two refractive errors in modulating early eye growth. These lenses can be in the form of contact lenses or glasses. Ophthalmol. Comparisons of (a) refractive (spherical equivalent and refractive astigmatism) and (b) axial (vitreous chamber depth and axial length) parameters across four groups of birds were performed using one-way ANOVA with Bonferronis pairwise post-hoc tests. The refractive status of chicken eyes was measured using a modified Hartinger coincidence refractometer as described previously54. The stimulus pattern consisted of 61 unscaled hexagons with light and dark luminance of about 220cd/m2 and 3cd/m2 (extracted from the worksheet), respectively, covering approximately 34 horizontal and 30 vertical visual field. Cite this article. We use cutting-edge, specialized treatments and procedures to ensure the best care for your child. The refractive error of the eye is corrected by adjusting the intermediate image [I] using the focusing knob of the imaging system. 60, M31M88. & C.S.K. Optom. Astigmatism vs Myopia: What's the difference? - Essilor UK Myopia is when distant objects are seen out of focus. 51, 367375. Vision Res. Medically reviewed by Wut Win, Dispensing Optician at Feel Good Contacts on 31/03/2023. 114, 8995. By submitting a comment you agree to abide by our Terms and Community Guidelines. Recently, a modified multifocal electroretinogram (mfERG) paradigm11,12 (Global-Flash Multifocal Electroretinogram; MOFO mfERG) has been employed to examine both the outer and inner retinal responses simultaneously in myopic eyes13. 61, 7297 (2017). It should be noted that in addition to an elongated eyeball in our sphero-cylindrical lens treated chicks, they also developed a significantly higher magnitude of astigmatism compared to -10D lens (in particular the WTR treated group, Table 1), in agreement with the refractive and axial changes using sphero-cylindrical lenses with different magnitudes and axes in a separate study17. Eye Res. 87, 437445 (1966). Although they did not compare the retinal function of LIM chicks to control birds, the data presented in their study (see Table 1 in Fujikado et al.15) revealed a tendency of reduced amplitude of oscillatory potentials in the LIM chicks (op1: 0.750.15 and op2: 0.810.13) when compared to the control chicks (op1: 0.820.15 and op2: 0.840.18). With over 800 pediatric clinicians on staff, were dedicated to helping you connect with the right specialist for your needs. Unless otherwise stated, data are expressed as meanstandard error (SE). Invest. https://doi.org/10.1136/bjo.2004.045328 (2005). Your eye doctor may use various instruments, aim bright lights directly at your eyes and ask you to look through several lenses. Astigmatism is diagnosed easily by an Optometrist during an eye examination. Marmor, M. F. et al. https://doi.org/10.1016/j.exer.2013.04.020 (2013). Kang, B. S. et al. In all tests, the significance level was set to 95% level of confidence. 3). & Y.D. Opt. Mixed. Be sure to consult a doctor! Saudi J. Ophthalmol. 19, 607646 (2000). Astigmatism is a condition that occurs when an imperfection in the cornea or lens of your eyes causes light entering the eye to be scattered which causes cloudy vision. 1), the area centralis, supero-nasal to the pectin oculi, was identified39 and confirmed through the OCT line-scan function (green line in Fig. With the correct (regular) form of the disease, an angle of 90 is formed between the leading meridians. Pascolini, D. & Mariotti, S. P. Global estimates of visual impairment: 2010. Chea-su Kee. The complex form of the disease prevails over the simple one. Ophthalmol. In rare cases, it is caused by lid swellings such as chalazia, and corneal scars, or by keratoconus (a rare condition in which the cornea becomes misshapen and pointed rather than smooth and rounded). Experimentally induced myopia and myopic astigmatism alter - Nature Guidelines for basic multifocal electroretinography (mfERG). Schedule an Appointment with a CEENTA eye doctor. Zhou, X., Pardue, M. T., Iuvone, P. M. & Qu, J. Dopamine signaling and myopia development: What are the key challenges. Astigmatism usually occurs along with myopia or hyperopia. Invest. The regional responses obtained using multifocal stimulation was grouped into two regions: Central (green) and peripheral (red) regions for data analysis. The responses were band-pass filtered from 10 to 300Hz and were amplified 100,000 times. Mixed model ANOVAs (between groups: across 4 groups; within groups: central vs peripheral) showed that lens treatment had a significant effect on both direct component (DC) and induced component (IC) implicit times (p<0.05), whilst the retinal region had a significant effect on DC implicit times (p<0.05) and IC amplitude (p<0.001). https://doi.org/10.1002/cne.902100210 (1982). What are the symptoms of astigmatism? 210, 198203. Berkley, M. A., Kitterle, F. & Watkins, D. W. Grating visibility as a function of orientation and retinal eccentricity. Ho, W.-C., Kee, C.-S. & Chan, H.H.-L. Myopic children have central reduction in high contrast multifocal ERG response, while adults have paracentral reduction in low contrast response. Vis. https://doi.org/10.1038/s41598-022-25075-8, DOI: https://doi.org/10.1038/s41598-022-25075-8. Among these parameters, refractive astigmatism was the only one that was associated with MOFO central IC for all three lens treatment groups. Google Scholar. Retin Eye Res. Astigmatism, Hyperopia and Myopia are the most common refractive errors, all of which affect vision and may require corrective lenses. We have expertise in treating children and educating families on hundreds of different conditions. Bull. Taken together, all these results support the hypothesis that myopia alters inner retinal function. However, it is important to consider the anatomical difference in retinal organization between humans and chicks. Ophthalmol. Eye Res. Astigmatism: Astigmatism FAQs - All About Vision Wait a moment and try again. Thus, both human and animal studies have shown altered inner retinal functions in myopic eyes, but whether and how these functions are also affected by myopic-astigmatic development have not been investigated. CAREERS. Both can affect anyone and at any age. Support for this interpretation comes from pharmacological dissection studies, which reported the cellular origin of MOFO responses in pigs21 and chicks23: The DC response is primarily attributable to the photoreceptors and bipolar cells, whereas the IC originates from cells in the inner retinal layer. Second, in contrast to previous studies, which used a standard mfERG protocol, a variant of the mfERG (MOFO) paradigm13,14 was used to assess the outer and inner retinal responses11,21. These changes are usually caused by astigmatism, myopia, and presbyopia. Astigmatism among myopics and its changes from childhood to adult age Continue with Recommended Cookies. Although astigmatism has been linked to visual functions such as contrast sensitivity41 and resolution acuity42, studies investigating the electrophysiological responses have usually only included subjects with a low degree of astigmatism13,14. Google Scholar. Thibos, L. N., Wheeler, W. & Horner, D. Power vectors: An application of Fourier analysis to the description and statistical analysis of refractive error. 2, 706712 (1999). The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Some people may also notice that . Astigmatism and myopia are common eye conditions that can result in blurry vision. A novel finding from the current study is the relationship between the magnitudes of refractive astigmatism and central IC (Fig. However, in case of intolerance, the cylindrical component is increased in stages, taking into account the adaptation of the patient. Considering the potential effects of isoflurane anesthesia on the eye movement and retinal functions18, chicks were anaesthetized using a mixture of ketamine and xylazine for the mfERG recording. In case of significant change in retinal location due to eye movement, the recording was paused automatically by the in-built eye tracking system and resumed only after regaining the original location of the pecten by adjusting the cSLO device. Exp. First, decreased retinal dopamine levels were reported in chicken developing form deprivation myopia26. But they're 2 different eye conditions. CAS Myopia typically develops in childhood and continues to progress into adulthood. Ophthalmol. The term "refractive errors" refers to four conditions: Astigmatism. The main diagnostic methods include visometry, computer autorefractometry, biomicroscopy, keratotopography, retinoscopy, ophthalmoscopy. In this instance, the lens has variations that cause images to reach the back of the eye, or retina, in a distorted way. A full range of comprehensive services all under one roof. Hyperopia is when objects up close are seen out of focus. 33, 257266 (2013). However, those procedures are not effective solutions for patients with higher ranges of myopia and astigmatism. All Rights Reserved. CAS Perception 2, 304304 (2011). If the treatment lens was found dislocated or detached during the treatment period, the bird was excluded from further analysis. Astigmatism: Causes, Symptoms, and Treatment | Patient Through a routine eye exam, the eye doctors at CEENTA can determine how your vision has changed and give you a prescription for glasses or contact lenses. 106, 105 (2003). & Chan, H. H. The cellular origins of chick global flash multifocal electroretinogram. An impedance of less than 5K was maintained during the recording. It is important to follow the recommendations on visual hygiene, which include visual gymnastics, daily walks in the fresh air, working near with sufficient lighting. HOMEWHY CHOOSE CEENTA?PROVIDERSLOCATIONSSERVICES & CONDITIONS 26, 9199 (2012). This typically takes place around age forty. https://doi.org/10.1097/00006324-199706000-00019 (1997). Hood, D. C. et al. Similar disorders are noted in violation of the transparency of the lens or lenticonus. Clinical manifestations: decreased vision, distortion and blurring of the image in front of the eyes, squinting of the eyes. 243, 739756 (1974). The contrast was set at 99%. Vision correction using an excimer laser (LASIK, laser keratomylosis) makes it possible to eliminate the need for glasses and soft contact lenses or reduce their strength. In summary, both myopic and myopic-astigmatic eye growth altered retinal responses in the central region. 1 and Table 1). Vis. Vision Correction Solution for High Levels of Myopia & Astigmatism Correlations between refractive astigmatism with amplitude (Left) and implicit time (Right) of the central induced component (IC). Toric contact lenses allow you to achieve better visual acuity and eliminate aberrations. When an individual has both myopia and astigmatism, the prescription is more complicated. An aged-matched control group without any lens treatment provided normal data (n=12). The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. PLoS ONE 13, e0207189 (2018). The myopic chicks induced by 10D lens-wear in this study showed a reduction of inner retinal responses (IC) in the central region. 3 and Table 3). With concomitant myopia of a high degree, patients are at risk of the formation of a choroidal neovascular membrane, myopic macular retinoschisis, peripheral posterior vitreous detachment. Cumulative evidence from human and animal studies have demonstrated that postnatal refractive development is regulated by visual signals6, but whether and how the presence of myopia and myopic-astigmatism influence the retinal signaling pathway remains largely unknown. At the same time, surgical correction of vision is contraindicated in case of sharp thinning of the cornea (according to the results of pachymetry), progression of the disease or a high degree of concomitant myopia. There are some common symptoms of astigmatism: 78, 266 (1972). How can I tell if my child has vision problems? 74, 367375. Symptoms of Myopic Astigmatism. Acta Ophthalmol. 85, 414419 (2001). Rosli, S. A., Chen, A.-H., Alwi, N.-F.C. 2a (top, red box), both H-WTR (blue) and H-ATR (red) had increased latency of approximately 7.8% when compared to the normal (grey) and 10D (black) groups. Sudden pain in or around the eyes. Opt. You can also get it after an eye injury, an eye disease, or surgery. The combination of mfERG and cSLO paradigm allowed assessment of retinal functions at different regions (central vs. periphery) and layers (outer vs. inner). These results await a systematic follow-up using pharmacological dissection to study the neuronal origins of MOFO responses. 2). Headaches Trouble seeing at night Astigmatism Causes Most people are born with it, but experts don't know why. Myopic astigmatism is accompanied by headache, increased fatigue with prolonged visual load. Graefes Arch. The level of significance is indicated as follows: *p<0.05, comparisons between groups (normal vs three treatment groups); p<0.05, comparisons between 10D and two sphero-cylindrical lenses treated groups; p<0.05, comparisons between two sphero-cylindrical lenses treated groups (H-WTR and H-ATR); and p<0.05, comparisons within groups (central vs peripheral) between regions. Myopia normally starts to appear between the ages of eight and twelve years old, and almost always before the age of twenty. Other refractive errors. 2c), this regional difference in IC amplitude was lost in the 10D group: the central IC amplitude of these myopic birds was only as high as the peripheral IC amplitude of normal birds (Fig. Thus, the first three rings of the 61 unscaled hexagons were grouped to extract the central (Fig. In addition, a higher refractive astigmatism in H-WTR was associated with a shorter central IC implicit time (Fig. Surgical treatment involves performing laser keratomylosis (LASIK). 49, 858867. Both normal and H-ATR groups had significantly higher IC amplitude in the central than peripheral. Sci. Comparison of the two sphero-cylindrical lens-wear groups showed that the H-WTR group developed less myopia, higher refractive astigmatism, significantly different J0 and J45 astigmatic components, a shallower anterior chamber, and thinner scleral thickness than the H-ATR group (One-way ANOVA with Bonferronis post hoc tests, all p<0.01). Doc. Optom. Causes of Myopia Symptoms of Myopia Treatment Options for Myopia What is Astigmatism? Briefly, under isoflurane anesthesia (1.01.5% in oxygen), the animal was held gently using a beak holder in an upright position on a platform. Just as different people have different shaped feet or hands, people also have different shaped corneas. My credo in life is "If you want to do something well, do it yourself.". Bradley, A., Thomas, T., Kalaher, M. & Hoerres, M. Effects of spherical and astigmatic defocus on acuity and contrast sensitivity: A comparison of three clinical charts. Objects up close and at a distance appear blurry. As illustrated in the MOFO IC waveforms of the central region in Fig. In the general structure of astigmatism, the share of myopic species accounts for about 54%. Get the most important science stories of the day, free in your inbox. Eye exercises and diet are the keys to this type of therapy. You are using a browser version with limited support for CSS. 38, 10971103 (1998). Graefes Arch. Compared to normal and -10D group, both sphero-cylindrical lens-wear groups (H-WTR and H-ATR) had delayed induced component (longer IC implicit time) in the central region. You do not need to make an appointment for this service, Congenital Heart Surgery Real Time Outcomes , Neuromuscular & Movement Disorders Program, Nicklaus Children's Pediatric Specialists, Nicklaus Children's Pediatric Virtual Care, Orthopedics, Sports Medicine & Spinal Surgery Institute, Orthopedics, Sports Medicine & Spine Institute. Both occur due to the eye having an irregular shape, which affects how light focuses in the eye. First, the influence of the astigmatism was assessed only after 7days of treatment. Retin Eye Res. Opt. Stone, R. A., Lin, T., Laties, A. M. & Iuvone, P. M. Retinal dopamine and form-deprivation myopia. Exp. What is Myopia, Hyperopia, and Astigmatism? For data analysis, refractive errors were converted into spherical-equivalent (SE), J0, and J45 astigmatic components56. Only Pearsons r with statistical significance is shown. & Schmid, K. L. Delayed mfERG responses in myopia. Kee, C. S. & Deng, L. Astigmatism associated with experimentally induced myopia or hyperopia in chickens. Multifocal contact lenses are made specifically for people who have presbyopia. Google Scholar. 126, 199210 (2013). In chicken, the area centralis is a rod-free circular region of approximately 3 mm35 in diameter, corresponding to approximately 23. To the best of our knowledge, only one study reported a significant association between high astigmatism (>1.5D) and ERG abnormalities in human ametropes (high myopia to high hyperopia)43. In clinical ophthalmology , the disease is classified into the following types: This disease is characterized by a decrease in vision, which is most noticeable when looking into the distance (inability to see the number of public transport, street names, the inscription on the blackboard at school, etc.). Astigmatism occurs when the cornea is curved more in one direction than another. Visual influences on diurnal rhythms in ocular length and choroidal thickness in chick eyes. The H-WTR group also developed less myopia compared to 10D (p<0.001) and H-ATR (p<0.001) groups. The chick eye in vision research: an excellent model for the study of ocular disease. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Save my name, email, and website in this browser for the next time I comment. Data was analyzed by SPSS statistical software (IBM Inc, version 23.0.0, Illinois, USA). Early astigmatism can alter myopia development in chickens. & C.S.K. Many times, myopia is diagnosed during school screenings. Fischer, A. J., McGuire, J. J., Schaeffel, F. & Stell, W. K. Light-and focus-dependent expression of the transcription factor ZENK in the chick retina. Laser ablation improves visual functions at dusk, which is important for drivers. Here the image that is far away is focused in front of the retina making distant objects appear out of focus. 55, 35013501 (2014). The amount of power that is needed in glasses to correct for presbyopia is dependent on the strength of the glasses needed for distance vision. May 16, 2023 Myopia and astigmatism are two of the most common vision problems that affect people of all ages. Home Myopia Myopia VS Astigmatism: Know the Difference April 28, 2022 Eye Health Healthy living Myopia Myopia (commonly known as short-sightedness) and astigmatism are examples of refractive error that cause blurry vision and, albeit the similarity, they are two different conditions. Experimentally induced myopia and myopic astigmatism alter retinal electrophysiology in chickens, $${J}_{0}=-\frac{C}{2}\times \mathrm{cos}2\alpha$$, $${J}_{45}=-\frac{C}{2}\times \mathrm{sin}2\alpha$$, https://doi.org/10.1038/s41598-022-25075-8. Mitchell, D. E. & Wilkinson, F. The effect of early astigmatism on the visual resolution of gratings. Vis. We've sent you an email to reset your password. It protects these structures and helps to transmit light through the eye. Using sphero-cylindrical lenses to impose hyperopic astigmatism, which is commonly found in the clinic, we recently reported the differential effects of astigmatic subtypes on myopia progression17. Yes, you can be short-sighted and astigmatic. Scientific Reports Doc. Because our recent study found a small, but significant interocular effects in the fellow untreated eyes of the sphero-cylindrical lenses treated groups17, we only collected and compared data in the treated/right eyes of treatment and normal groups. They can also be corrected by glasses. Br. Natl. The main reasons for the acquired form: More often, myopic astigmatism is a genetically determined pathology inherited by an autosomal dominant type. The retinal electrophysiological changes reported in the current study may only represent the consequence of abnormal refractive development. Neil 586 subscribers Subscribe 243K views 11 years ago Ocuport video explaining refractive error (myopia, hyperopia, astigmatism).. They contain multiple zones of vision correction instead of just one, which allows both your eyes to work together so you can see things both up-close and at a distance with just one lens. Myopic astigmatism is a pathology of refraction in which parallel rays of light do not gather into a single focal line on the inner shell of the eye. 23, 133140. Can you be short-sighted and have astigmatism at the same time? Flitcroft, D. I., Adams, G. G., Robson, A. G. & Holder, G. E. Retinal dysfunction and refractive errors: An electrophysiological study of children. Lastly, the IC implicit time at the central region was significantly delayed (longer) in the two sphero-cylindrical lens-wear groups compared to the normal (both p<0.01) and 10D (both p<0.01) groups. Join our newsletter Why Us The more pronounced the cylindrical index, the higher the probability of repeated intervention. Experimental Setup, fundus image acquisition and MOFO stimulation. Graefes Arch. https://doi.org/10.1136/bjophthalmol-2011-300539 (2012). Vis. Astigmatism, hyperopia and myopia are all improved or corrected with eyeglasses, contact lenses or laser corrective surgery. Astigmatism - Diagnosis and treatment - Mayo Clinic Second, the MOFO mfERG responses were recorded using the 61-hexagon stimuli, covering approximately 34 horizontal and 30 vertical visual fields. The cause of refractive errors tends to be multifactorial with genetic (inherited from parents in a variety of ways with some linked to other genetic disorders), and environmental factors playing a role. All Rights Reserved. rule astigmatism,' both will be on the same page. Opt. The authors declare no competing interests. IMI: Report on experimental models of emmetropization and myopia. Myopia and Astigmatism: Understanding the Differences and - TXOME This condition is called nearsightedness or myopia. Sci. With eyelids held open using a lid retractor, three measurements of the two principle meridians were obtained and averaged using power vector analysis56. 96, 614618. Eye Res. In our study, all the MOFO responses that showed significant correlations with astigmatic components were found in the central region (see Table 3, RA, J0 & J45). Astigmatism, Hyperopia, and Myopia - Boston Children's Hospital The key findings in this study were: (1) normal and H-ATR groups showed a higher inner retinal response (IC) in the central than the peripheral region, but this regional variation was not observed in either the 10D or H-WTR groups; (2) compared to the normal and 10D groups, the sphero-cylindrical lens-wear groups showed delayed inner retinal responses in the central region; and (3) in all lens-treatment groups, refractive astigmatism was significantly associated with the amplitude of inner retinal responses in the central region. Ophthalmol. Most astigmatism is regular astigmatism; however irregular astigmatism can also be experienced. General Practitioner. Most astigmatism is regular astigmatism; however irregular astigmatism can also be experienced. How can I tell if my contact lens is inside out? However, the occurrence of the disease in persons with an unencumbered family history is not excluded. The irregular variant is characterized by a change in the refractive power mainly in one direction. Aust. Vision Res. Vis. Prior to recording, chicks were anesthetized with an intramuscular injection of ketamine (60mg/kg) and xylazine (4mg/kg) mixture and placed on a platform connected to a warm water bath to maintain the body temperature at 37C. Mitchell, D. E., Freeman, R. D., Millodot, M. & Haegerstrom, G. Meridional amblyopia: Evidence for modification of the human visual system by early visual experience. In humans, the amplitude of MOFO responses in six peripheral retina areas (15 eccentricity, 60 apart radially) was positively correlated with local hyperopic errors, but the MOFO responses were neither correlated with the local astigmatic component nor with the optically imposed astigmatism52. 38, 28442851 (1997). The authors thank the University Research Facility for Behavioral and Systems Neuroscience (UBSN) for technical and facility support. Myopic astigmatism is often accompanied by a violation of the position of the eyes and accommodation disorders, so it is important to assess accommodation reserves and make a test with overlap (cover-uncover test). In the current study, the sphero-cylindrical lens imposed the same magnitude of spherical-equivalent refractive defocus (10D) as the negative spherical lens (10.00DS). astigmatism, myopia and nystagmus - Eye Care - MedHelp In terms of retinal electrophysiological responses, Ostrin et al. Br. Table 4 summarizes the monocular treatments received by four groups of chicks starting from P5: (A) aged-matched normal birds without any treatment (normal group; n=12); (B) negative spherical lens-wear (10.00DS; n=12); (C) sphero-cylindrical lens-wear, axis oriented vertically; with-the-rule (H-WTR: 6.00DS/8.00DC90; n=15); (D) sphero-cylindrical lens-wear, axis oriented horizontally; against-the-rule (H-ATR: 6.00DS/8.00DC180; n=11). I would like to receive friendly reminders when its time to re-order. J. Ophthalmol. Retin Eye Res. For DC, the amplitude was not significantly different between any of the groups (all p>0.05), but the implicit time in the H-ATR group was significantly longer than that of the H-WTR group (p<0.05). Astigmatism and short-sightedness can be corrected with toric contact lenses or glasses, which also cater for those with long-sightedness. Compared to the normal and -10D groups, both sphero-cylindrical lenses groups showed delayed IC responses in the central region (Fig. 3). 15 (2013) with the current study. When the eye is too big or the cornea is too steep, visual images are focused in front of the retina. 3, both 10D and H-WTR groups displayed positive correlations of refractive astigmatism with central IC; in contrast, the H-ATR group showed a negative correlation between these two parameters. Men get sick more often than women. The two astigmatic components, J0 and J45, represented astigmatism using power vectors56, allowing the incorporation of the magnitude and axis of all forms of astigmatism for statistical analysis. Neurol. As shown in Fig. Prog. Astigmatism: Symptoms, causes, diagnosis, and treatment 86, 704706 (1989). Myopia vs. Astigmatism: What's the Difference? - Vivid Eye Care Further studies are needed to investigate the retinal neuronal pathways and cell types involved in this process. The results showed that myopic-astigmatic eyes had altered inner retina responses in the central region. Astigmatism vs Myopia: What Are the Differences - Koalaeye.com Myopia and astigmatism are among the most common causes of vision impairment, particularly in children aged 5 to 15 years1. Mon - Fri: 8:00am - 9:00pm Sat - Sun: 9:00am - 5:30pm Bank Holidays: 9:00am - 5:30pm. ; Analyzed the data: S.A.V., Y.D., H.H.L.C., T.L. The level of significance is indicated as follows: *p<0.05, comparisons between normal and treated groups (10D, H-WTR and H-ATR); p<0.05, comparisons between 10D and the two sphero-cylindrical lenses treated groups (H-WTR and H-ATR); p<0.05, comparisons between two sphero-cylindrical lenses treated groups (H-WTR and H-ATR).
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