Yoga Inversions and Retinal Tears

by Deirdra on January 11, 2012

 

With the recent storm in the media about the various “dangers” of yoga to the body, one thing caught my eye more than anything else, retinal tears were mentioned.

This is not the first time I have heard of retinal tears or detached retinas linked to yoga inversions.  As I have a personal occurrence of this (twice) I thought my experience would be valuable to teachers and students alike.

What is it?

First a very amateurish explanation of a retinal tear – I am not after all an eye surgeon but having discussed this with three top ones I think I can explain it in laymans terms.

In it’s simplest form the eye is a round ball with jelly (called the vitreous) inside.  The retina is a light-sensitive tissue lining the inner surface of the eye.  The optics of the eye create an image of the visual world on the retina, which serves much the same function as the film in a camera.

In your sight everything is upside down so the TOP part of the back of eye represents your LOWER field of vision and vice versa. (this is important to understand)

People who are myopic (short sighted) with a HIGH NEGATIVE (-) numbered eyesight prescription have an increasing egg shaped eyeball which is less stable. The jelly can pull away from the sides of the wall (through head traumas, age, or other things) of the inner eyeball and sometimes tear pieces of the retina with it.

Signs of retinal detachment can vary from flashing lights, flickering or a distinctive “shadow” in the eye.  It can tear slowly but requires quick action to save loss of vision. With today’s technology it can be fixed (several options depending on severity etc) If it is not rectified loss of sight will occur.

What Happened

My original retinal detachment in my belief was acerbated by a headstand workshop.  In any teacher training prolonged inversions are a precaution or even a prohibition for people who have had this condition Having not had a detachment before and not knowing all the above stuff I didn’t think about my risks.

I will point out CLEARLY that I have a HUGE predisposition to this happening, here is why:

  • My nearsightedness was over -13 in one eye (VERY shortsighted) giving me an egg shaped eyeball, less stable with loads of room for stuff to bump about in
  • I had lens replacement surgery for vision as my eyes eventually rejected contact lenses which I had worn since I was 8 years old. This gives a higher risk for retinal detachment as its invasive.
  • I’d had vitreal detachment that didn’t tear the retina years before (where jelly pulls away from the inner eye)
  • I also did huge amounts of “headbanging” (eg to rock music) in my 20s and 30s eg shaking the jelly around as well as my booty!

So why do I think the headstand workshop acerbated this if there were so many other factors?

The symptoms were starting on the way home…slowly. It took me a week to see that it was happening and only then because I am very aware.  They fixed it with a scleral “buckle” (external band aid if you will).

The tear was against gravity, the shadow in my eye was in the top of the field of vision, meaning the bottom part of my retina had been torn. So the jelly had pulled upwards (when I was upside down) This is my theory.

I have asked 3 top surgeons and they disagree but I just have a strong feeling about it.  My strong feeling got me to the hospital quickly before the symptoms were really noticeable.

I had another tear next to the same site recently which required invasive surgery.  The explanation was that the original buckle failed or became weak.  Since the original tear I do not do prolonged inversions.

So what do I think now?

It would be very short sighted of me to blame headstands or indeed dismiss a possible link altogether. But I have no firm conclusion, just an experience to share.

Who knows, I’m not the only one to link this to prolonged yoga inversions. All I like to do is share the information and I DO think that teachers should be aware that people with very high myopia should be very careful with prolonged inversions.

 

{ 28 comments… read them below or add one }

Su Menon January 11, 2012 at 11:07 pm

Excellent article-you write extremely well”

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Teagan March 1, 2012 at 11:26 pm

Thanks for your sharing your personal experience. I’m 29 but had a retinal tear in my right eye when I was about 13 years-old. I have 20/20 vision but see an eye doctor once a year since the tear was found. At last month’s visit, my doctor thought he saw a hole in my left eye (not the one with the tear) and sent me to a retinal specialist. Both doctors said my eyes were fine (it was just a pigment variation) but if I saw an increase in floaters or any flashes to call right away. I had been seeing tiny flashes for about a week (I didn’t follow directions completely) and decided last week to call my regular doctor. I went in and again, everything looked ok but he instructed that I call the specialist again just to see if he too wanted to see me. Today, I went in to see the specialist and he said I was fine but asked if I had been doing any increased activity. I’m a fairly active person but twice a week Vinyasa classes (90 mins each) is new for me. He thinks the inverted poses could be causing the “jelly” to pull on my retina. He instructed me to not even do down dog! Now I’m not even to shoulder standing yet but regardless, removing down dog from my practice seems a bit of a drastic measure. Then again, these are my eyes! My grandfather, a self-taught artist (among many things) had macular degeneration (he couldn’t see the center of his vision) so I don’t want to take this lightly. Do you still do down dog? What modifications have you made to your practice?

Thanks!

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Deirdra March 2, 2012 at 12:07 am

Gosh a tear at 13 with no predisposition? Seems strange. I have just returned to practise after last detachment where I had the gas bubble put in the eye to push and seal the retina back, successfully. The jelly is gone from that eye now but of course I always have the other which could pull. ALWAYS go if you see a shadow or flashing or more floaters, I went quickly this is why I have only a tiny blur in my peripheral vision now. You must trust your instinct, the specialist was surprised I even spotted mine but I stay very aware.
I am not able to advise medically but I do not do headstand ever now but I do forward folds which are inversions! I never stay in down dog for more than five breaths at a time. I have relaxed my Ashtanga practise so not as many dogs as less Vinyasas. It is very interesting this specialist is saying this as I do think there is something in it. You could do modified dog by keeping the head more up (looking at ground instead of back towards feet) but watch you don’t strain neck or scrunch your shoulders. Draw the shoulder blades down the back. When I was recuperating after 6 weeks off I did extended Childs pose to get the shoulder stretch. I know it’s incredibly worrying but there are lots of lovely postures that don’t invert fully.
All the very best of luck x

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Myron Joshua December 19, 2012 at 12:34 pm

I saw your comment at Jennifer Repo’s blog at Huffington…and now this… Many thanks As more and more “elders” (60+) are taking interest in Yoga it is critical that teacher learn about the “hidden” dangers of people with myopia. (Holding breath, downward facing dog and other inversions, swinging the head in Cat/Cow, etc)
Doctors who are also encouraging us to “be active”, excercise, etc should also be more forthcoming with advice and percautions.

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Deirdra December 19, 2012 at 2:35 pm

Thanks Myron, only too pleased to share my experience if it helps anyone at all, I was at a conference recently and none of the yoga teachers had heard of this at all but one had had a detached retina herself! Aside from the normal post-op advice she wasn’t given anything further. I’d love to research it further and properly rather than ad hoc anecdotal evidence but currently I do not have the time :(
I have had quite a lot of anatomy and physiology training aside from just yoga teacher training and my emphasis is always on safety. Having said that I had a wonderful experience recently with helping a young student who was completely ready and prepared to achieve her headstand :) I have no postures that I rule out – everyone is an individual, what is important assessing them as such.

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Meena Modi August 10, 2012 at 4:31 pm

I recommend that you read my recent blog post cited below. One study gives pictures of a woman’s eye before she began “postural yoga”, after it, and then a year after she had stopped it. It is quite telling. More will be posted on the effects of several positions.

Having just had a retinal tear myself, making people more aware of the dangers of inversions is quite important. I have very high myopia and am therefore in a higher risk group for tears and detachments and have known this for a long time. But anyone can have these issues according to the ophthalmologists and retinologists (some are family and friends) that I have spoken to and consulted with. I have seen my children’s friends in their 20s suddenly, for no apparent reason, have a retinal detachment.

Inversions of any kind, and there are many in yoga, do pose a special elevated risk. I was fortunately never taught headstand, handstand, and other challenging asanas in India–they were not taught to anyone in a general raja yoga class and especially not to beginners. High impact yoga is relatively new and poses threats to joints and eyes as well. Now they are routine in classes across the US. We were aware of the limitations and contraindications of these positions. So I have never done them or taught them in 30 years of teaching yoga, meditation, and yoga therapy. Now I am not even allowed sun salutations for a couple of months, no bending forward from the waist, no squats, no asanas and no breath retentions. Downward dogs can pose an issue and certainly they cannot be held for more than 10 seconds. Doctors in the family are very knowledgeable about these issues. Consulting a knowledgeable doctor is important as every situation is different.

On my blog, http://www.yogamedblog.wordpress.com, I have just posted “Headstand Inversions And Glaucoma” which cites and links to clinical studies that clearly indicate the potential danger to the eye with sirsasana. I will be posting more on the eye, retinal tears and detachments. Our local yoga centers pay no attention to these issues, do not teach this important information in teacher training programs, and this is a serious issue. Teachers and yoga practitioners in my experience have repeatedly pooh-poohed, ignored, been a little disdainful about the cautions/contraindications of a whole range of asanas and pranayamas when they are clearly pointed out–but people do so at their own peril. Retinologists routinely ask their patients if they have been practicing yoga and inversions because of the number of problems they see resulting from them. Ditto for physical therapists who routinely see patients due to yoga injuries to the back, shoulders, neck, and hip.

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Deirdra September 14, 2012 at 11:19 pm

Thank you for this information and I am glad to see serious study on the issue. Three top eye surgeons disputed it could have anything to do with my two tears but I still maintain my position about the risks. Thank you again for the information.

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spiros chryssanthakopoulos September 14, 2012 at 10:53 pm

Hi, my name is spiros and I am 51 years old. I am myopic since a very young age.
I am also very fit. I was doing handstands for 15 min and when I finished I saw a on the top of my left eye. I immediatelly realised that I had damaged my retina and I self admitted myself to the EYE & EAR HOSPITAL IN MELBOURNE.
I had an operationon 7 September 2012 and now I am fine. I completely agree with you that prolonged inversions might cause these type of problems

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Deirdra September 14, 2012 at 11:17 pm

Thank you very much Spiros for your information, despite surgeons disputing this when I bring it up I still believe it to be true and just want to warn practitioners and teachers of the risks especially if they are myopic, I do not believe there has been formal study on the linkage. Thanks again and I hope you are to resume and enjoy your practise with adaptations. I am still very careful after a second tear in one eye which required the insert of the gas bubble to rectify (10 days of lying in the same position is not fun but to save your sight it was a miracle), I do know I am very predisposed.

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spiros chryssanthakopoulos September 15, 2012 at 9:30 am

I would like to thank you as well for developing such a site where we can all share our knowledge/experience. Thank you also for your wishes for a quick recovery. In actual fact, I have already recovered mainly because I did not use the 3 different described medical eye drops which are full of serious side effects and they can even cause blidness. You can confirm this by googling side effects of the name of the eye drops.Naturally, I had to prepare my own drops. Your predisposition can be also reversed by some lifestyle changes. If you want to learn more, please feel free to conact me on 0408 532 914, for free. I am a lifestyle coach and I teach people how to live a balanced life free of drugs and other addictions. Take care, Spiros

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gold account September 27, 2012 at 9:42 am

Note that nearsightedness (myopia) are at a higher risk of retinal tears and detachments due to the possible thinning of the retina.

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Val April 11, 2013 at 8:13 pm

I am so very pleased to have found this site. I am 49 year young beginner to yoga. I had been going every day for about a month to “hot yoga”, as well as strength training with a personal trainer at the gym. Two weeks ago I had a detached retina. I asked EVERYONE I could if my inversions (downward dog, forward fold, rag doll, etc) had anything to do with my detachment. They all said NO. I have the gas bubble in my eye and is almost gone (now the size of a regular contact, if I look down). I would be SO very disappointed if yoga was the cause of my detachment. I actually thought blowing up many balloons might have been the cause. (I work with kids and use them to entertain them). That might have been a factor. I am so in love with my yoga practice, and love the hot yoga classes. I look forward to everyone’s thoughts regarding this.
Namaste, :-)

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Deirdra April 11, 2013 at 9:31 pm

Hi Val I am really very sorry to hear this, I know how stressful it can be and the bubble surgery requires longer healing. I cannot categorically say if yoga was the cause – but as I mentioned I quizzed some serious eye surgeons and doctors – they all passed it off – but I have had it twice and one after a headstand workshop – I encountered this more often from talking to people and recently met yet another yogi who got one after an intensive. However Just as I will not say this caused it, I think it is irresponsible for anyone to say it doesn’t.

It’s your sight after all, and we are really lucky these days there are options to save it.

I have gone back to downward dog without holding my head up (I faced the floor so head was level for a while which strained my neck!), I don’t hold forward folds too long nor anything inverted too long – you can still practise – I do every day.

Think about your prior risk factors (if any)

Good Luck

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brigitte May 28, 2013 at 2:31 pm

Hi everybody,
THANKS FOR SUCH A LOT OF USEFUL INFORMATIION ! I had a serios ret. detachment requiring 2 op`s last winter, now it seems to be ok but my sight is worse, of course, and I am really scared it will happen again.
When I went back to my yoga class last week I was asked by my teacher to consult my eye doctor if it was ok for me to practice yoga .-As my dr. is surely no expert in these matters, just a good eye dr., I consulted a yoga teacher plus healing specialist (natural medicine etc, very experienced but no medical dr) and she said: no inversions below hip level, that should be the rule for those with eye problems as high pressure (as I still have it, taking drops), glaucoma etc.
What do you think ?
Best wishes from Berlin, Germany
Brigitte

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Deirdra May 28, 2013 at 3:42 pm

Hi Brigitte

Sorry to hear about this – its not a nice operation and it looks like your sight was affected, that is very distressing of course.

I’m not a medical practitioner, that I want to make clear :)

But true, on my teacher trainings we were taught inversions were a contraindication for glaucoma. This is the case for Dr/GP Exercise Referral which I am qualified in as well. The hip level was a guide.

I think you need to play it safe really and follow this advice. The main thing as well is that you are fully aware of any symptoms and get to the hospital right away if you notice any, the technology is so advanced now if you catch it in time they can usually prevent any more damage to your sight.

You can still do yoga, I know it is frustrating but its all part of the journey. I have found injury and limitations to truly be when I found most pleasure in my practise as I had to explore it in more depth to find what worked for me…Adapt…Be flexible!!

Blessings

Deirdra

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Robyn June 17, 2013 at 12:04 am

Thank you for starting this discussion. I’ve been to 50+ optomologist web sites to try and find information on inversions and retinal detachments. Very few even address the subject. My doctor says their’s no connection.

I have been doing vinyasa yoga for 10 years. Arm balances and inversions are a big part of my practice. I also have been using a back swing (inversion table) daily. I gradually built up to being able to hang upside down for 10 minutes. I believe this may have played a role despite my surgeon’s opinion.

I had a retinal detachment repair two weeks ago. I’m only mildly near-sighted and have no other risk factors except my age…I’m 59.

Yoga is a huge part of my life and I’m so afraid I might never be able to to practice without being fearful of this happening again.

Thanks for listening.

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Deirdra June 17, 2013 at 1:23 am

Hi Robyn

I’m really sorry to hear of your experience, I know myself it’s very frIghtening and when yoga is a big part of your life, I’m a teacher as well, it’s a distressing thing.

Look I’ve consulted with three of the best retinal specialists in the UK and they kind of pooh poohed the idea there was a link but I still maintain some certainty there is.

Your sight is such a precious thing, I want to see my children’s faces smile clearly, I have adapted, I think I still take minor risks, it’s about balance…yoga is so much more than our physical practice…I’d bought an inversion trapeze before the last time, I just won’t use it even though I know it would do wonders for other bits of my body.

My daughter was showing me her hanging upside down on the monkey bars today, I wanted to do it and look at each other upside down, I just won’t do a full upside down blood the head inversion anymore for more than a few seconds.

All I can say is find the bits that don’t create fear, your practice should be free from anxiety otherwise it’s no good to anyone.

Namaste Robyn

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Robyn June 19, 2013 at 6:49 pm

Your reply brought tear to my eyes Deirdra. Your right, nothing is worth risking your sight.

I had my husband get rid of my inversion table, I just couldn’t look at it anymore. No great loss. It’s yoga that I’m worried about. Their’s so much conflicting information on the internet regarding recovery time.

My surgeon isn’t much help. He says I can get back to everything except jogging (which I don’t do anyway) but just “take it easy”. I did a few weights yesterday, but as you know the fear was so over whelming I really didn’t feel very good about it.

It’s so nice to talk to someone who has gone through this.
Thanks again for your insight and encouragement.

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Deirdra June 20, 2013 at 8:47 am

Robyn

I have been in touch with our cities Eye Research team – it is really annoying me now that there is so little formal evidence or advice out there and my own surgeons (three high profile ones) kind of dismissed this issue. I’ll see what they say and share it here if I come up with anything. In almost every teacher training or workshop I have been on not only were there incidences of detachment or tears BUT none of the teachers seem to be clued into the risks. There are basic guidelines on glaucoma contraindications but that is it.

Any I’ll see what they come back with.

Deirdra

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Robyn July 3, 2013 at 1:19 am

Deirdra,

I’m now one month out from retinal detachment surgery. I’ve been back to yoga, but I’m very careful not to hold any of the inversions for long. I’m also taking your advise about holding my head up in downward dog…at least for now.

Saw my surgeon today. I asked him if their had been any studies re: retinal tears/detachments related to prolonged inversions. His answer was “Their’s just not enough interest.” I want to believe their’s no connection, but like you, I’m just not sure and I’m not willing to take that chance.

Take Care,

Robyn

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Deirdra July 3, 2013 at 8:04 am

Hi Robyn

Glad to hear you are managing your situation well. One month is not a long time though so take it easy. And watch your neck! I got a sore neck with that adaptation in DD but better than worrying about the eyes :)

I found this study http://yogamedblog.wordpress.com/2012/08/13/inversions-glaucoma-suspects-retinal-tears-detachments/#comment-634
which is a clear indication there is some connection, well for glaucoma and increased pressure anyway….I approached the University with a view of collaborating but not interested, there is a level of arrogance or lack of interest which I’m surprised about – yoga is a multi billion dollar industry and so many people practise it that simple medical research and guidance would be valuable – after all I was told “no limitations whatsoever” by 3 surgeons…and this is not limited to yoga, people go “upside down” in other area of their life (life I will not go on those G-force roller coasters either now, not that I miss them!) I think you just have to listen to your body and trust your instinct.

Best regards
Deirdra

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Jenny Stedman July 14, 2013 at 5:56 pm

I was diagnosed with a detached retina 3 weeks ago.
5 consultants at the University of Wales had not seen a similar detachment.
The retina had detached from the bottom up and I had to return a week later.
The 6th consultant decided to operate but after a week I had no sight in the eye and the registrar I saw last week said the retina had lifted again.
I am going back tomorrow but fear that my macular is damaged.
I have been doing both Yoga and pilates 3 times weekly with a lot of inversions.

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Deirdra July 14, 2013 at 6:11 pm

Jenni

I am so sad very sad to hear this – did they not operate quickly? It is imperative to catch away!

Please feel free to ring again – Tuesday night is best probably

Kind regards and best wishes

Deirdra

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Jenny Stedman August 8, 2013 at 3:21 pm

I found a book of mine from 1990 ” Yoga for Common Ailments” by Dr R Nagarathna Dr HR Nagendra and Dr Robin Munro based on the system developed by Vivekananda Kendra Yoga Research Foundation Bangalore.The chapter on eye problems states AVOID INVERTED ASANAS if you have a tendency to DETACHED RETINA.It also states that the over contraction of the eye muscles distorts the shape of the eyeball and gives advice on reducing strain and building up the stamina of the eye muscles.

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Jenny August 8, 2013 at 3:31 pm

I have just been reading” Yoga For Common Ailments” DR R Nagarathna , Dr H R Nagendra ,Dr Robin Monro.Gaia Books 1990 which states AVOID INVERTED ASANAS IF YOU HAVE A TENDENCY TO DETACHED RETINA .

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Deirdra August 8, 2013 at 11:05 pm

Thank you Jenny, shame its not commonly communicated, I had a small procedure and the consultant said anecdotally he believes complete inversions are a huge risk factor for high myopic patients, this guy sees 8-10 people a day so I think he knows what he is talking about and experiencing with people but still the person treating me said “no dos or don’ts fallowing this”! Astounding…

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Beverly August 13, 2013 at 10:42 pm

Hello,

I recently had my annual eye check-up. I was told I do have a think retina and if I ever see floaters or flashes of light to see my eye dr. immediately. I didn’t notice anything of the sort. I noticed random stuff in my vision but didn’t think anything of it. Until yesterday during my check-up my eye dr. noticed a small hole and some fluid in my eye. They sent me to a Retinal Specialist to check me right away. The Retinal Specialist said that we caught it early where the treatment I had to undergo was Laser photocoagulation. It was a very uncomfortable procedure. I am near-sighted and I have a very thin retina. My dr. asked me if I did any activities that would cause lots of pressure in my head/eyes. I have started doing different heated/hot yoga classes for the past 4 months. Have recently been doing inversions more frequently as I get stronger. He says that the pressure could have caused the hole in my retina. He said there has been studies linking retinal damage from yoga. I want to believe that it is not true as I have grown to love yoga. He said that all I can do is walk, stationary bike or swimming for excercise. I am 35 y/o and I am very active and before yoga I have done other strenuous workouts like bootcamp, martial arts and circuit training. Now, I am told that I cannot do anything where I exert pressure to my eyes or bearing down. I am very disappointed and trying to do my own research. I haven’t found any factual studies. I am glad I am not alone in looking for answers. I just wanted to share my experience. Please continue to share and as I find any info I will too.

Namaste-
Beverly

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Deirdra August 14, 2013 at 1:13 pm

Hi Beverly

Sorry to hear this but heartened in a way that your eye doctor realised there may be a connection. I think there must be – look at all the people commenting here, I get phone calls about it too (I’m not an eye doctor!) and it is very distressing. I have posted a link above on a study done a while back. My MAIN reason for believing the connection is that I had a nontypical non gravity tear in the retina, e.g. it was against gravity, the hole/tear was at the bottom of my eye (causing a top down shadow) and therefore I think acerbated by inversions.

You can do a beautiful yoga practise without full inversions, I am not sure of your particular situation and it looks like there may be some pressure issues as well – glaucoma is a clear contraindication for inversions – but you will be able to do things!! Just don’t go crazy, respect your body and be so very thankful your sight was saved. Sounds like you caught it early and had an excellent treatment. You like myself have a LONG way to go with those eyes. Yoga is about adapting and being flexible. :)

All the best

Deirdra

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