This document summarizes a clinical trial evaluating a presbyopia treatment using the VISX laser system. It provides details on:
1) The study centers and investigators involved in Canada and the US.
2) The VISX treatment design which uses a central zone for near vision surrounded by a peripheral zone to expand the depth of focus.
3) Early results showing significant improvements in uncorrected distance and near vision up to 12 months, with most eyes achieving 20/20 or J1 or better respectively.
Ioannis Pitas, Professor, Aristotle University of Thessaloniki, Department of Informatics (IEEE Fellow), Semantic 3DTV Content Analysis and Description
Nagamatsu Gaze Estimation Method Based On An Aspherical Model Of The Cornea S...Kalle
The document proposes a novel gaze estimation method based on an aspherical model of the cornea as a surface of revolution about the optical axis of the eye. This model improves upon previous spherical models which were found to be less accurate, especially around the boundary regions of the cornea. The method determines the optical axis using light reflections captured by two cameras and calculates user dependent parameters through calibration to estimate the visual axis and final point of gaze. An evaluation of the new method found it to have higher accuracy than one based on a spherical cornea model.
The document discusses online learning tools for asynchronous and synchronous learning. It describes asynchronous learning as student-centered and using tools like email, blogs, wikis and discussion boards. Asynchronous learning communities have 5 stages of development and require an active facilitator. Synchronous learning uses tools like chat, audio/video conferencing and web conferencing for real-time communication. Both methods have benefits like flexibility and interactivity, but also weaknesses around technology access and skills. The document provides guidance on designing final projects according to objectives for online discussions.
Learning What is truly important in Laser Vision Correction by Dr. Jeff MachatMachat LASIK
The document discusses laser vision correction and wavefront technologies. It notes that Dr. Jeffery Machat has performed nearly 50,000 laser procedures and used 17 different laser systems and wavefront technology for 6 years. It summarizes that the laser vision correction market is highly fragmented, with 63% of procedures performed by independent surgeons. It also discusses how fear is the primary factor preventing more people from getting laser vision correction. The document emphasizes that every aspect of the patient experience is important to reduce fear and discusses the benefits of wavefront-optimized and wavefront-guided laser technologies.
The document discusses technology's role in society through comparisons between Aldous Huxley's Brave New World and the real world. In Brave New World, technology is used to manipulate and control humans to maintain social stability, with embryos conditioned and people brainwashed. However, excessive technological development could destroy human dignity and individuality. While technology may build an ideal society in Brave New World, in reality it risks tragedy if it undermines human values and freedom.
Ioannis Pitas, Professor, Aristotle University of Thessaloniki, Department of Informatics (IEEE Fellow), Semantic 3DTV Content Analysis and Description
Nagamatsu Gaze Estimation Method Based On An Aspherical Model Of The Cornea S...Kalle
The document proposes a novel gaze estimation method based on an aspherical model of the cornea as a surface of revolution about the optical axis of the eye. This model improves upon previous spherical models which were found to be less accurate, especially around the boundary regions of the cornea. The method determines the optical axis using light reflections captured by two cameras and calculates user dependent parameters through calibration to estimate the visual axis and final point of gaze. An evaluation of the new method found it to have higher accuracy than one based on a spherical cornea model.
The document discusses online learning tools for asynchronous and synchronous learning. It describes asynchronous learning as student-centered and using tools like email, blogs, wikis and discussion boards. Asynchronous learning communities have 5 stages of development and require an active facilitator. Synchronous learning uses tools like chat, audio/video conferencing and web conferencing for real-time communication. Both methods have benefits like flexibility and interactivity, but also weaknesses around technology access and skills. The document provides guidance on designing final projects according to objectives for online discussions.
Learning What is truly important in Laser Vision Correction by Dr. Jeff MachatMachat LASIK
The document discusses laser vision correction and wavefront technologies. It notes that Dr. Jeffery Machat has performed nearly 50,000 laser procedures and used 17 different laser systems and wavefront technology for 6 years. It summarizes that the laser vision correction market is highly fragmented, with 63% of procedures performed by independent surgeons. It also discusses how fear is the primary factor preventing more people from getting laser vision correction. The document emphasizes that every aspect of the patient experience is important to reduce fear and discusses the benefits of wavefront-optimized and wavefront-guided laser technologies.
The document discusses technology's role in society through comparisons between Aldous Huxley's Brave New World and the real world. In Brave New World, technology is used to manipulate and control humans to maintain social stability, with embryos conditioned and people brainwashed. However, excessive technological development could destroy human dignity and individuality. While technology may build an ideal society in Brave New World, in reality it risks tragedy if it undermines human values and freedom.
Mississauga Lasik CE 2008 by Dr. Jeff MachatMachat LASIK
The document discusses laser refractive surgery. It notes that over 12 million North Americans have had laser vision correction in the past 20 years. It describes the two main procedures as PRK/LASEK where laser pulses are applied to the front of the eye, and LASIK where a corneal flap is created and laser pulses are applied underneath. It emphasizes that fear is often the main deterrent for patients considering the procedures.
Lasik Complications 2001 Striae by Dr. Jeffery MachatMachat LASIK
The document discusses three primary post-operative complications of corneal refractive surgery: corneal striae, epithelial ingrowth, and diffuse lamellar keratitis. It focuses on corneal striae, outlining the pattern and presence of fibrosis in long-standing cases. Various techniques for managing corneal striae are presented, including re-floating the corneal flap, using hypotonic saline or phototherapeutic keratectomy to smooth striae, and epithelial debridement.
Lasik Complications 2001 Epithelial Ingrowth by Dr. Jeffery MachatMachat LASIK
The document discusses three primary post-operative complications: epithelial ingrowth, corneal striae, and diffuse lamellar keratitis. It focuses on epithelial ingrowth, describing Machat's grading system of 1 to 3 based on appearance and severity, with grade 3 having gray necrotic geographic cell nests and potential flap melting. Treatment involves cleaning the corneal interface.
Lasik Complications 2001 Diffuse Lamellar Keratitis by Dr. Jeffery MachatMachat LASIK
Three primary post-operative complications of LASIK surgery are discussed: Diffuse Lamellar Keratitis (DLK), Epithelial Ingrowth, and Corneal Striae. DLK is an inflammatory reaction in the corneal interface that can range from mild to severe, affecting vision and refractive error. It is graded on a scale of 1 to 3 based on its severity and treated with topical steroids. Epithelial Ingrowth involves the growth of epithelial cells into the interface, while Corneal Striae are lines in the cornea caused by melting during DLK.
Refractive Surgery Complication Management by Dr. Jeff MachatMachat LASIK
This document discusses various complications that can occur after refractive surgery procedures like LASIK and surface ablation. It describes conditions like keratoconus, corneal haze and scarring, infiltrates, epithelial ingrowth, and diffuse lamellar keratitis. Grading scales are provided for classifying the severity of haze, epithelial ingrowth, and treatment approaches are outlined for different complication scenarios.
Patient Expectations and Satisfaction after LASIK by Dr. Jeff MachatMachat LASIK
J. Machat. All rights reserved. Unauthorized use is prohibited.
§ LASIK satisfaction has improved dramatically since the 1990s due to faster recovery times, improved safety profiles, and technology like wavefront-guided treatments. However, some patients still experience serious adverse effects.
§ While LASIK is life-changing for most, with results exceeding glasses and contacts, surgeons must not minimize potential risks and must properly evaluate candidates to avoid issues like chronic dry eye or ectasia.
§ Continued technological advances have allowed for higher quality vision and retreatment of side effects, but the stories from adverse events remind surgeons to carefully consider each patient's suitability for the procedure
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We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Mississauga Lasik CE 2008 by Dr. Jeff MachatMachat LASIK
The document discusses laser refractive surgery. It notes that over 12 million North Americans have had laser vision correction in the past 20 years. It describes the two main procedures as PRK/LASEK where laser pulses are applied to the front of the eye, and LASIK where a corneal flap is created and laser pulses are applied underneath. It emphasizes that fear is often the main deterrent for patients considering the procedures.
Lasik Complications 2001 Striae by Dr. Jeffery MachatMachat LASIK
The document discusses three primary post-operative complications of corneal refractive surgery: corneal striae, epithelial ingrowth, and diffuse lamellar keratitis. It focuses on corneal striae, outlining the pattern and presence of fibrosis in long-standing cases. Various techniques for managing corneal striae are presented, including re-floating the corneal flap, using hypotonic saline or phototherapeutic keratectomy to smooth striae, and epithelial debridement.
Lasik Complications 2001 Epithelial Ingrowth by Dr. Jeffery MachatMachat LASIK
The document discusses three primary post-operative complications: epithelial ingrowth, corneal striae, and diffuse lamellar keratitis. It focuses on epithelial ingrowth, describing Machat's grading system of 1 to 3 based on appearance and severity, with grade 3 having gray necrotic geographic cell nests and potential flap melting. Treatment involves cleaning the corneal interface.
Lasik Complications 2001 Diffuse Lamellar Keratitis by Dr. Jeffery MachatMachat LASIK
Three primary post-operative complications of LASIK surgery are discussed: Diffuse Lamellar Keratitis (DLK), Epithelial Ingrowth, and Corneal Striae. DLK is an inflammatory reaction in the corneal interface that can range from mild to severe, affecting vision and refractive error. It is graded on a scale of 1 to 3 based on its severity and treated with topical steroids. Epithelial Ingrowth involves the growth of epithelial cells into the interface, while Corneal Striae are lines in the cornea caused by melting during DLK.
Refractive Surgery Complication Management by Dr. Jeff MachatMachat LASIK
This document discusses various complications that can occur after refractive surgery procedures like LASIK and surface ablation. It describes conditions like keratoconus, corneal haze and scarring, infiltrates, epithelial ingrowth, and diffuse lamellar keratitis. Grading scales are provided for classifying the severity of haze, epithelial ingrowth, and treatment approaches are outlined for different complication scenarios.
Patient Expectations and Satisfaction after LASIK by Dr. Jeff MachatMachat LASIK
J. Machat. All rights reserved. Unauthorized use is prohibited.
§ LASIK satisfaction has improved dramatically since the 1990s due to faster recovery times, improved safety profiles, and technology like wavefront-guided treatments. However, some patients still experience serious adverse effects.
§ While LASIK is life-changing for most, with results exceeding glasses and contacts, surgeons must not minimize potential risks and must properly evaluate candidates to avoid issues like chronic dry eye or ectasia.
§ Continued technological advances have allowed for higher quality vision and retreatment of side effects, but the stories from adverse events remind surgeons to carefully consider each patient's suitability for the procedure
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Tests for analysis of different pharmaceutical.pptx
Presbytrials by Dr. Jeffery Machat
1. Visx Presbyopia trial
TLC Toronto
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2. Study Centers and
Investigators
• University of Ottawa Eye Institute
– W. B. Jackson, MD
– G. Mintsioulis, MD
• TLC, Toronto
– J. Machat, MD
• Image Plus Laser Eye Center
– J. Wiens, MD
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3. Multifocality – What Does it Mean?
• Optics before hyperopic presbyopia treatment
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4. Multifocality – What Does it Mean?
• Modify optics for long depth of focus
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5. VISX Multifocal Treatment
Design
– Central zone provides near correction
– The diameter of the central zone is proportional to the pupil
size (wavefront driven)
– The combination of the central zone, peripheral zone, and
the LASIK flap produces an aspheric curve that expands
the depth of focus
near correction distance correction
25
20
Depth [um]
15
10
5
0
-3 -2 -1 0 1 2 3
Diameter [millimeter]
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6. VISX® Hyperopic Presbyopia
Ablation Profile
Hyperopic-Presby
+2D Hyperope
15
Ablation Profile
10
5
0
-3.5 -2.5 -1.5 -0.5 0.5 1.5 2.5 3.5
Diameter
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7. Corneal Topography Case
Study
• ID#14115: OS
• Pre-Op
– 20/50 uncorrected distance
– J7 uncorrected near
– J5 distance corrected near
• At 3 months
– 20/20 uncorrected distance
– J1 uncorrected near
– J1 distance corrected near
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11. Baseline Characteristics
• 75 eyes of 43 hyperopic presbyopic subjects
– Ottawa Eye Institute: 54 eyes of 27 subjects
– TLC, Toronto: 16 eyes of 12 subjects
– Image Plus Laser Eye Center: 5 eyes of 4 subjects
• Pre-Op Refractions
– Sphere: 1.70 D ± 0.58 (range 0.5 to 3.5 D)
– Cylinder: 0.43 D ± 0.35 (range 0.00 to 1.5 D)
• Age: 56 ± 5 (range 47 to 68)
• 60% Female
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12. Monocular Uncorrected
Distance Vision
100 100 100
100 94
92
Percent of Eyes
82
79 79
80
61
60 54
49
44
40 33
20
7
1
0
Pre-Op (n=75) 1 Month (n=71) 3 Months (n=63)6 Months (n=56) 12 Months
(n=34)
20/20 or better 20/25 or better 20/40 or better
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13. Binocular Uncorrected
Distance Vision
100 100 100 100
100 100 100
100 96
Percent of Subjects
88
82 79
80
65
60 56
40
19
20
5
0
Pre-Op (n=37) 1 Month (n=34) 3 Months (n=29) 6 Months (n=24) 12 Months (n=11)
20/20 or better 20/25 or better 20/40 or better
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14. Monocular Uncorrected
Near Vision
100 98
100 97
92 94 91 93
85
Percent of Eyes
80
71
68
64 62
60
40
20
3
0 0
0
Pre-Op 1 Month 3 Months 6 Months 12 Months
(n=75) (n=71) (n=63) (n=56) (n=34)
J1 or better J3 or better J5 or better
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15. Binocular Uncorrected
Near Vision
100 100 100 100 100 100 100 100
97 100
92
Percent of Subjects
100
82
80
60
40
20
8
3
0
0
Pre-Op (n=37) 1 Month (n=34) 3 Months (n=29) 6 Months (n=24) 12 Months (n=11)
J1 or better J3 or better J5 or better
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16. Reading Performance Test
• Functional vision test
measured monocularly
Endpoints:
– Reading Acuity - based on
number of words read
correctly
– Maximum Reading Speed
– Critical print size – smallest
font at which maximum
speed is possible
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17. Reading Performance Results
Pre-op distance-corrected vision compared to post-op
uncorrected vision
Reading Acuity Critical Print Size
98 100
100 100 100
92
Percent of Eyes
Percent of Eyes
100 86 76 68
80
80 48
56 60
60
40
40 8
16 20
20
0
0 Pre-Op w/ 3M w/o
Pre-Op w/ 3M w/o correction correction
correction correction
(n=63) (n=51)
(n=63) (n=51)
J1 or better J3 or better J5 or better
J1 or better J3 or better J5 or better
Maximum Reading Speed was maintained post-operatively
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18. MRSE Over Time
2.50 ± 0.59 Upper 95% CI
1.91 MRSE
MRSE (Diopters)
2.00
Lower 95% CI
1.50
1.00
± 0.71 ± 0.38
0.50 -0.19 ± 0.54 ± 0.41 0.12
± 0.55 -0.04 -0.05
-0.13
0.00
-0.50
-1.00
Pre 1M 3M 6M 9M 12M
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19. 6M Intended vs. Achieved
4.00
Achieved MRSE
3.00
2.00
1.00
0.00
0 1 2 3 4 5
Intended MRSE
73% of eyes are within ±0.5 D of emmetropia at 6M Post-op
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20. 12M Intended vs. Achieved
4.00
3.00
Achieved MRSE
2.00
1.00
0.00
0.00 1.00 2.00 3.00 4.00 5.00
Intended MRSE
82% of eyes are within ±0.5 D of emmetropia at 12M Post-op
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21. Monocular Simultaneous Uncorrected
Distance and Near Vision @ 6 month
1.30
1.10
0.90
0.70
Pre-op (n=56 eyes)
0.50
6 M (n=56 eyes)
J3 or better
0.30
0.10
-0.10
-0.20 -0.10 0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 0.80 0.90
20/25 or better 77% of eyes achieve both 20/25
distance and J3 near or better
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22. Binocular Simultaneous Uncorrected
Distance and Near Vision @ 6 mth
1.30
1.10
0.90
0.70
J3 or better
0.50 Pre-op (n=24 subjects)
6 M (n=24 subjects)
0.30
0.10
-0.10
-0.20 -0.10 0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 0.80 0.90
20/25 or better 96% of subjects achieve both 20/25
distance and J3 near or better
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23. Functional Near Vision Scores
Near Score Functional Equivalent
J1+ Medicine Bottle fine print
J1 Street Map Legend
J3 STOCK QUOTES
J5 Newspaper Text
J7 Business Letter (10 pt)
J10 Newspaper Headlines
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24. Questionnaire Results
Satisfaction with Overall Visual Sharpness & Clarity
100
79 80
77
80
Percent of Eyes
60
40
16 17
20 13
8 8
3
0
Satisfied/ Very Not Sure Somewhat/ Very
Satisfied Dissatisfied
Pre-op w/ correction (n= 64) 6M w/o correction (n=53) 12M w/o correction (n=35)
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25. Questionnaire Results
Satisfaction with Distance Vision (Bright)
100 94
89
85
80
Percent of Eyes
60
40
15
20 11
6
0 0
0
0
Satisfied/Very Satisfied Not Sure Somewhat/Very Dissatisfied
Pre-op w/ correction (n=64) 6M w/o correction (n=53) 12M w/o correction (n=35)
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26. Questionnaire Results
Satisfaction with Near Vision (Bright)
100 91
83
Percent of Eyes
80
66
60
40 29
13
20 9
0 4 6
0
Satisfied/Very Satisfied Not Sure Somewhat/Very
Dissatisfied
Pre-op w/ correction (n=64) 6M w/o correction (n=53) 12M w/o correction (n=35)
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27. Questionnaire Results
Satisfaction with Vision at Night
100
85
77
80
Percent of Eyes
67
60
40 30
17
20 11
4 6
3
0
Satisfied/ Very Not Sure Somewhat/ Very
Satisfied Dissatisfied
Pre-op w/ correction(n=64) 6M w/o correction (n=53) 12M w/o correction (n=35)
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28. Questionnaire Results
Spectacle Use
100 100
100
84
Percent of subjects
78 78
80
63
58
60
51
40
20
20
4
0 0 0 0 0
0
Reading Computer Driving Day Driving Night Recreation
Pre-op (n=32) 6 Months (n=27) 12 Months (n=18)
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29. Best Corrected Visual Acuity *
• Distance: loss of > 2 lines
– 3 eyes of 2 subjects at 6M, associated w/ SPK
– 1 eye of 1 subject at 12M
– No eye worse than 20/25-2
• Near: loss of > 2 lines
– 3 eyes of 3 subjects at 6M, associated w/ dry eye
– 2 eyes of 2 subjects at 12M
– No eye worse than J1+
*Under Photopic conditions
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30. 2.50
Dim Contrast Sensitivity
2.00
Pre-Op
1.50
Log Level
1 Month
3 Months
1.00 6 Months
12 Months
0.50
0.00
3 6 12 18
Cycles per Degree
Contrast sensitivity scores are within population norms
for 50-75 year age group (shown in gray)
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31. Summary of Long Term Results
• 96% of subjects achieve simultaneous 20/25
distance vision and J3 near vision at 6M
• Spectacle independence is achieved and
maintained
• Patient satisfaction is good
• Loss of contrast sensitivity within normal limits
• 73% of eyes at 6M and 82% of eyes at 12M
within ±0.5 D of emmetropia
• Follow-up is ongoing
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trials now being conducted
32. Toronto Case Study
S.A.-54 yo
• Pre-op Rx:
O.D. +2.50/-0.50 x 120 20/20
O.S. +2.25/-0.50 x 067 20/20
+2.00 add
Successful bifocal SCL wearer
Surgery done Sept 13/04
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use
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33. Bilateral presbyopic ablation
1 year results
UCVA:
O.D. 20/20-1
plano/-0.25 x 20 20/20
O.S. 20/20+
plano/-0.25 x 180 20/20+
@ 40cm UCVA
O.D.: J3
O.S.: J3
negative SA
O.U.: J1
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Jeffery
J.
Machat.
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rights
reserved.
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use
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34. The information provided in this PowerPoint presentation is
for your personal informational purposes only. It is not
medical advice, medical diagnosis or treatment, or
recommendation for medical care or treatment. All medical
questions or concerns about a medical condition, care,
diagnosis or treatment should be presented to a medical
physician, health care provider, or health care professional.
You acknowledge that your use of this information is at your
sole risk, and that you assume and accept full responsibility
for all risk associated with any reliance upon the information
presented.
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Jeffery
J.
Machat.
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rights
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