# Lazy Eyes, Eye Exams & Dilation for Toddlers?



## SparklingGemini (Jan 3, 2008)

I think my DD may have a lazy eye of some sort. Or if not that, definitely something "off" with one of her eyes. I'm pretty much the only one who notices, although my DP and dad have both mentioned it a couple of times.

Its hard to explain but its as if one of her eyes doesn't track exactly the same as the other one. Not always though. And its absolutely worse when she's tired.

So, on the advice of our pediatrician(who did NOT see anything wrong)we made an appointment with a pediatric ophthalmologist. I'm totally down with this because I don't like to mess with eyes and, while my vision is excellent, there is a history of eye problems on both sides of the family. Also, if it is a lazy eye, I know that the earlier its caught, the more they can do to strengthen it.

However, when I made the appointment, I was told that my DD would have to have her eyes dilated. And this freaks me out!

I'm sure for some of you, this is no big deal, but at my last eye exam, I had a bad reaction to the dilator and my eyes stayed dilated for a looooooooong time; causes me much distress and discomfort.

This worries me. And even if DD doesn't have that sort of reaction, I'm still concerned about her having to go through this process.

I'd really like some words of encouragement, stories of experiences and just some hugs and support. Truly, this really isn't a big deal in the grand scheme of things and I feel a bit sheepish being so disconcerted. But I don't have to like it.


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## flapjack (Mar 15, 2005)

I have one with a squint, and two others under observation in case they develop a squint- the younger of the two will probably be in glasses by the time he starts school. We've been through patching with Isaac, but honestly, at this point for him it is entirely cosmetic- when his vision is adjusted by glasses, his eyes are straight. He's chosen to reject cosmetic surgery to fix it so far, but obviously may change his mind at some point in the future.

It'll be OK, really. River seemed completely oblivious to the drops when he had them put in at his appointment in February.


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## eepster (Sep 20, 2006)

I took DS for his first eye exam recently, and they dilated him. I, like you, _hate_ the drops, but I tried really hard not to project my own feelings about it on to DS. I just gave him a simple neutral warning that the drops feel "weird." He only disliked them slightly, I think the tilting his head back and having the person holding it bothered him more than the actual dilation. Afterward, I took him straight home, instead to the playground like I originally planned to, though, since it was a bright day and his eyes weren't as protected from the sun.

Flapjack, I'm really glad you realize the surgery is primarily cosmetic, and you have let your DS have a voice.







I had the surgery as a child, and I haven't necessarily had good results. The eye still turns if I'm tired and not wearing my glasses to correct my nearsightedness. I read using the eye that turns, and use the other eye for distance vision. I often wonder if some of the reading fatigue I suffer might be related to the muscle in my reading eye having been deliberately weakened.


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## fairymom (Sep 15, 2008)

My ds4 has a "lazy" eye- which started at bout a year and it looked like he was just crossing his eyes but proceeded to get worse to the point it seemed to be happening all the time. It took his ped almost a year to see it and give us a referal. He has major vision probs in one eye and minor in the other- and now will need glasses for ever- if it had been caught earlier it may never have gotten so bad. But he has had to have his eyes dialated many times and has been fine.

I know you know they have to do this to get a correct dx and rx if your dd needs glasses and it is for the best. the sooner they can start correcting it the easier it can be- we've had problems doing what needs to be done to get his eye stronger. (patching doesn't work well w/my son because he will not leave it on and the other option is dialating only the good eye in the morning and making him have to use the bad eye all day- to strenghen it- not that is a pita and makes him very uncomfortable)

she will be okay. I hated having to do all that to him when he was so little and now I have lots of resistance from him I wish I had stuck it out harder. I'd hoped as he got older it'd get easier but so far this is not the case. I have learned what to watch for thou and am now watching my lo closer and may even ask for him to have an appt w/a ped opth. around a year.

I can totally understand about having to go thru this whole processes w/los I hated it and hate having to go in still. Hugs mama- she and you will get thru it and it will turn out for the best in the long run.


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## srs (Nov 8, 2007)

I hear you. My DD has congenital ptsosis, which is a drooping eyelid caused by the muscle never developing properly in the womb. We took her to the ped. opthamologist at 4 months, and they want us to return once a year to monitor it, as one of the side effects can be developing a lazy eye, but I've been procrastinating on the appointment because I know taking a doctor phobic two year old to see the eye doctor is going to be no fun at all, especially the dilation part, and there's nothing they can do at this age but monitor anyway. But I guess it really should be done.

And thanks to the posters who mentioned the side effects/consequences of surgery. That is an option for DD when she is a bit older, and I'm not sure what we (especially she) will want to do about it, because in her case it would be primarily a cosmetic procedure. But it's good to hear others' experiences.


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## sunnmama (Jul 3, 2003)

My dd was diagnosed with strabismus at 10 mo. She was monitered for this condition over the years, and had successful surgical correction this year, at the age of 8.

I definitely encourage you to take your dc to the opthalmalogist. Yes, the drops are unpleasant (my dd HATES them, and always has....it has always been the worst part of an opth appt), but, in our situation, the dilation is only done once a year. We usually went to 4-6 appts a year, and her eyes were only dilated once a year.

Just as a point of clarification, my dd had strabismis, but not "lazy eye" (amblyopia). The difference is that, while my dd's eyes would drift outward, they were equally strong. She had/has perfect vision in each, and has always been able to draw them together for 3-d vision. When she is not concentrating, however, they would drift out and she would see double. The surgical correction was not purely cosmetic (although that is an added benefit), as she can now use her eyes together without the extra effort/concentration of holding them together. She has much less eye fatigue, fewer headaches, greater reading stamina, etc. (and, speaking of drops....the 4x/day drops were, in dd's opinion, the worst part of surgical recovery, lol. The child really hates drops).

Anyway, that is our experience. Good luck!


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## fairymom (Sep 15, 2008)

i am finding this all so interesting- the dr has not mentioned surgery as being cosmetic for my ds but is pushing for it. they are waiting to see if patching and daily dialation will help strengthen his really bad eye first and get him into a different rx. now i am wondering if its cosmetic or not for him. if so i'll probably wait till he's alot older to go ahead. the surgery they talk about does not include streching the good good but tightening the bad eye up?- does that make sense to anyone- i don't know a whole lot except what the dr tells me- i have perfect vision and so do my odc.


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## sunnmama (Jul 3, 2003)

Quote:


Originally Posted by *fairymom* 
the surgery they talk about does not include streching the good good but tightening the bad eye up?- does that make sense to anyone-.

In my dd's surgery, they operated on both eyes (even though one was predominantly the one to "go out"). Her dr chose to weaken muscles on both eyes. It sounds like your dr is talking about strengthening muscles on the bad eye.

The muscles attach to the cornea, and can be moved to attach to a different part of the cornea. "Weakening" my dd's eye muscles meant detaching the muscles pulling too hard (pulling them out of alignment) and reattaching them a few millimeters back. "Strengthening", from what I understand, can involve shortening the muscle before reattaching. While the surgeon can put the eyes in the correct position, ultimately the brain must "click" and keep them there for the surgery to work. It took a couple months for us to see the final position of my dd's eyes post-surgery.

My dd has a good friend who also had strabismus and amblyopia, with a presentation similar to what you (fairymom







) describe in your son. Her eye turned dramatically into her nose when not wearing her glasses, and she had poor vision in that eye. She had the surgery at 6 yo (same surgeon as my dd), and the results have been amazing. Her eyes are straight even when not wearing her glasses, and her glasses prescription has gotten weaker because her vision has improved since the surgery.

I'm not pushing surgery, lol....dd was diagnosed as an infant and didn't have the surgery until she was 8. But I have seen some fabulous results. In our case, at least, it was the best decision.


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## eepster (Sep 20, 2006)

Quote:


Originally Posted by *srs* 
And thanks to the posters who mentioned the side effects/consequences of surgery. That is an option for DD when she is a bit older, and I'm not sure what we (especially she) will want to do about it, because in her case it would be primarily a cosmetic procedure. But it's good to hear others' experiences.

Is that the same surgery we were talking about? We are talking about a surgery where the muscles at the side of the eye are deliberately weakened, so the eye won't drift off in that direction.


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## eepster (Sep 20, 2006)

Quote:


Originally Posted by *sunnmama* 
Just as a point of clarification, my dd had strabismis, but not "lazy eye" (amblyopia). The difference is that, while my dd's eyes would drift outward, they were equally strong. She had/has perfect vision in each, and has always been able to draw them together for 3-d vision. When she is not concentrating, however, they would drift out and she would see double. The surgical correction was not purely cosmetic (although that is an added benefit), as she can now use her eyes together without the extra effort/concentration of holding them together. She has much less eye fatigue, fewer headaches, greater reading stamina, etc. (and, speaking of drops....the 4x/day drops were, in dd's opinion, the worst part of surgical recovery, lol. The child really hates drops).

This sounds like a fairly different situation from what Flapjack' DS and I have going on, even though the optometrists call it by the same name. In both my case and FJ's DS's case the lazy eye functions if the vision in it is corrected. Though I don't know if FJ's DS also has this, another component to my situation is that I use my "lazy" eye exclusively when I'm reading. It is very very near sighted, and I just take off my glasses when I read. My father, who never got DX'd with this till adulthood, does the same thing.

The optometrist seem to have the same treatment for all these situations, even though they are not really the same if you delve deeper into why an eye is turning outward. That's why it's important, to listen to what your DC is telling you. Here on MDC, we fortunately do tend to do this, but many parents just go along with what the Dr says without questioning, researching, or thinking.


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## Mrs-Mama (Jul 2, 2007)

Quote:


Originally Posted by *SparklingGemini* 
However, when I made the appointment, I was told that my DD would have to have her eyes dilated. And this freaks me out!

I'm sure for some of you, this is no big deal, but at my last eye exam, I had a bad reaction to the dilator and my eyes stayed dilated for a looooooooong time; causes me much distress and discomfort.

This worries me. And even if DD doesn't have that sort of reaction, I'm still concerned about her having to go through this process.

My son has had many eye exams (including dilation) and he has light blue eyes so his eyes stay dilated a LONG time. (Light colored eyes dilate quicker and stay dilated longer...something about the amount of pigment.) There is a weaker formula that they use for babies < 6 months old, but I still request the weaker formula b/c the one time they used the regular drops, his eyes stayed dilated for 36-48 hours. The weaker drops sting, so they have to use numbing drops as well, so two drops instead of one, but my son has never had any adverse reaction to them.

Good luck!


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## SparklingGemini (Jan 3, 2008)

Aaack! SURGERY!!







So even though I've thought about this, I haven't really thought about it, you know? I know it can be successful. My nephew had a progressively getting worse lazy eye and had the surgery when he was about 10. They did both his eyes to make it even, I guess. His eyes are fabulous and he has zero problems(outside of his poor eyesight)now. I just don't want DD to have to go through this. I mean, we all want there to be nothing wrong with our babies, right?

Quote:


Originally Posted by *Mrs-Mama* 
My son has had many eye exams (including dilation) and he has light blue eyes so his eyes stay dilated a LONG time. (Light colored eyes dilate quicker and stay dilated longer...something about the amount of pigment.) There is a weaker formula that they use for babies < 6 months old, but I still request the weaker formula b/c the one time they used the regular drops, his eyes stayed dilated for 36-48 hours. The weaker drops sting, so they have to use numbing drops as well, so two drops instead of one, but my son has never had any adverse reaction to them.

Good luck!

Thanks for letting me know about this. I have very, very light blue eyes and so does DD. I guess that's why my dilation was soooo bad last time. I will definitely be asking the doctor about this and perhaps shop around to find a doctor who is willing to work with this scaredy cat mama.









One thing I did do was schedule her appointment for right before her nap, so hopefully, she'll crash and have to deal with less of the discomfort.

Can I ask something else? How do they discern eye issues in little ones? Its not like the kiddos are exactly accurate in letting us know how clear things are and so on. I mean, I know they can look in the eye and see some things but still.

Also, those of you with kiddos with lazy eye/s and other associated issues, does this mean an automatic vision problem? DD seems to have fantastic eyesight, so I'm curious.


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## sunnmama (Jul 3, 2003)

Quote:


Originally Posted by *SparklingGemini* 
One thing I did do was schedule her appointment for right before her nap, so hopefully, she'll crash and have to deal with less of the discomfort.

Can I ask something else? How do they discern eye issues in little ones? Its not like the kiddos are exactly accurate in letting us know how clear things are and so on. I mean, I know they can look in the eye and see some things but still.

Also, those of you with kiddos with lazy eye/s and other associated issues, does this mean an automatic vision problem? DD seems to have fantastic eyesight, so I'm curious.

1. the appt can be LONG....waiting room, initial exam, drops, 45 minute wait for drops to take effect and another exam room to become available, second exam. We have often been there 2-3 hours and examined by 3 people, all total. I personally would make the appt when she is well rested and happy.

2. When they dilate and look into the eye, they can tell by the shape if the child is near or farsighted. Dd didn't participate in the exam through speech until she was preschool age.

3. My dd has perfect vision in both eyes, and always has, despite having eyes that were misaligned--so it is possible.


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## flapjack (Mar 15, 2005)

Quote:


Originally Posted by *fairymom* 
i am finding this all so interesting- the dr has not mentioned surgery as being cosmetic for my ds but is pushing for it. they are waiting to see if patching and daily dialation will help strengthen his really bad eye first and get him into a different rx. now i am wondering if its cosmetic or not for him. if so i'll probably wait till he's alot older to go ahead. the surgery they talk about does not include streching the good good but tightening the bad eye up?- does that make sense to anyone- i don't know a whole lot except what the dr tells me- i have perfect vision and so do my odc.

In Isaac's case, eye strain probably made him squint, rather than the other way around. He has a strong prescription- varies from 4.0 to 6.5 in the weak eye, and 3.5-4.0 in the stronger one, so part of his problems were caused not only by being far-sighted, but by one of his eyes being so much better than the other. Also, his was late-occurring, and didn't get diagnosed until well into his full term of proper school. And yes, with glasses both eyes work together. He's looking forward to being big enough for contact lenses though.

It might be worth looking for an orthoptist rather than an optometrist, btw. Their training is all specifically geared to the mechanics of how eyes work, and the muscles, and some of the diagnostic techniques they use are brilliant. It's fascinating.


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## srs (Nov 8, 2007)

Quote:


Originally Posted by *eepster* 
Is that the same surgery we were talking about? We are talking about a surgery where the muscles at the side of the eye are deliberately weakened, so the eye won't drift off in that direction.

No, in our case it's a different procedure, one that shortens the muscle of the eyelid to prevent the drooping. Unless in the time it takes for DD to mature enough for this surgery, she develops a severe enough lazy eye to necessitate that surgery (due to uneven pressure on her eyes right now by the difference of the two lids).

Mostly It was reading about the cosmetic v. medical effects that got me thinking. On some level the cosmetic is important, if it effects one's self esteem, but there are obviously medical risks as well. In our case, random strangers ask us on the street what is wrong with DD's eye, which I hope is not happening to the other posters.

And to answer the OP's follow up question, at our appointment the ophthalmologist looked in then 4 month old DD's dilated eyes and said immediately that she would need glasses in the future, because she was nearsighted. When that is or why he was so certain I'm not sure. We'll get there when we get there. For now she seems to be able to see everything fine.


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## eepster (Sep 20, 2006)

Quote:


Originally Posted by *srs* 
And to answer the OP's follow up question, at our appointment the ophthalmologist looked in then 4 month old DD's dilated eyes and said immediately that she would need glasses in the future, because she was nearsighted. When that is or why he was so certain I'm not sure. We'll get there when we get there. For now she seems to be able to see everything fine.

Children typically start out slightly farsighted, as they grow the eyeball lengthens and the farsightedness will often correct itself. Sometimes one then goes on to be nearsighted. If she is already nearsighted, even if only slightly, if her eye continue to follow a typical growth pattern and lengthen, then it will just get worse.

DS at 3yo, is still slightly farsighted, but I expect him to be at least slightly nearsighted by adulthood, since DH and I (as well as my entire family) are all nearsighted.


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## shanniesue2 (Jul 4, 2007)

I have to admit, I get really confused by the diagnoses (strabismus,/amblyopia/lazy eye)... but my mom's side of the family has a very strong history of cross-eyes. My mom had it, about half her her siblings had it, I have many cousins who have it. And I have it. I started seeing a pediatric opthamologist when I was 2 and had surgery to correct the cross eyes in my right eye (my left didn't need it). The surgery kept my eye from straying, but I still had major issues with farsightedness. I started wearing glasses full time when I was about 5 or so. I still do (my prescription is +4.0 in one eye and +4.5 in the other). As a kid I had check ups with my opthamologist every 6 months. Had my eyes dilated annually (I have very blue eyes). And you know what? I LOOOOOOOOOOOOVED my "eye doctor." He was so much fun to go to. Had these funny sesame street characters to put over the lights, he spoke in cartoon voices, and was just over all very silly and non-threatening. I actually looked forward to my visits with him. He agreed to treat me until I graduated college. Then I had to find a different "eye doctor"







I was very bummed and went through a string of doctors that I really didn't like.

The cool thing is that he is still in practice and has opened an office in the suburb that we live in. So we have DS established with him. DS is not currently showing any problems, but there is such a strong family history that we are keeping a close eye on it (no pun intended). The other bonus is that they now have an optometrist in their practice who will treat adults, so I got to go back to his practice (even if I wasn't with him).

Anywho, the point of my post is that, if you find a good pediatric opthamologist, it does not have to be a scary or threatening thing for your child. It can actually be sort of fun (I'm sorry, I know that sounds kind of nerdy).

My one piece of advice, coming from personal experience, is that, if you know your child is going to be picking out glasses on a day that she needs to have her eyes dilated, let her pick out the frames BEFORE they put the drops in her eyes. I ended up with an awful pair of glasses for thrid grade because my parents didn't do this--then they simply gave me the option of blue with red stripes or red with blue stripes! I couldn't see what they looked like at all! yikes!


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## XanaduMama (May 19, 2006)

Can I ask a somewhat OT question? I'm interested in this topic, bc I just started noticing that ds (3.5) has an eye that tracks out sometimes, esp when he's tired or late in the day. So I've been thinking about taking him to a ped ophthalmologist.

Here's the question: does your insurance pay for this? I'm pretty sure our vision plan won't, because it's not a vision thing, and I suspect our regular health ins won't, because it's an eye issue. I haven't really investigated this yet, but would be interested in how you've paid for this. TIA.


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## sunnmama (Jul 3, 2003)

It is covered under our medical insurance.
We pay our "specialist" copay for visits to the opthalmologist.


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## SubliminalDarkness (Sep 9, 2009)

Quote:


Originally Posted by *XanaduMama* 
Can I ask a somewhat OT question? I'm interested in this topic, bc I just started noticing that ds (3.5) has an eye that tracks out sometimes, esp when he's tired or late in the day. So I've been thinking about taking him to a ped ophthalmologist.

Here's the question: does your insurance pay for this? I'm pretty sure our vision plan won't, because it's not a vision thing, and I suspect our regular health ins won't, because it's an eye issue. I haven't really investigated this yet, but would be interested in how you've paid for this. TIA.

It's considered medical and your health insurance should cover it. Vision coverage is only about corrective lenses, not actual eye problems.


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## Mrs-Mama (Jul 2, 2007)

Quote:


Originally Posted by *SparklingGemini* 

Can I ask something else? How do they discern eye issues in little ones? Its not like the kiddos are exactly accurate in letting us know how clear things are and so on. I mean, I know they can look in the eye and see some things but still.

Also, those of you with kiddos with lazy eye/s and other associated issues, does this mean an automatic vision problem? DD seems to have fantastic eyesight, so I'm curious.

No idea how they do this, but ds's eye dr told us when he was 2 months old that he had an astigmatism. We started patching his "good" eye to prevent lazy eye. I have a friend right now whose child has a lazy eye and they're attempting to treat it by patching the good eye several hours per day. This way the brain has to depend on the lazy eye in order to see...prevents the lazy eye from losing vision altogether when the brain starts depending only on the good eye to see. Don't start freaking out about surgery just yet







.


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## SparklingGemini (Jan 3, 2008)

Quote:


Originally Posted by *sunnmama* 
1. the appt can be LONG....waiting room, initial exam, drops, 45 minute wait for drops to take effect and another exam room to become available, second exam. We have often been there 2-3 hours and examined by 3 people, all total. I personally would make the appt when she is well rested and happy.

Oh yeah. The receptionist I spoke with told me the appointment was approximately one hour and no longer than 1.5 hours. DD usually goes down for a nap sometime around noon and our appointment is for 9:45, so this should work out well.

DD is pretty mellow, even when she hasn't napped, so I'm not too worried. She's always happy.







I just figure if she gets worked up at all then all I have to do is nurse her and put her to bed and she'll sleep through the prime part of the discomfort.


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## SparklingGemini (Jan 3, 2008)

Quote:


Originally Posted by *flapjack* 
It might be worth looking for an orthoptist rather than an optometrist, btw. Their training is all specifically geared to the mechanics of how eyes work, and the muscles, and some of the diagnostic techniques they use are brilliant. It's fascinating.


I think the little girl I used to nanny for went to an orthoptist. Are they the ones who used colored paddles and different shapes and instruments and such to do eye exercises? I'll definitely look into that once she's been evaluated by this first ophthalmologist. Thanks for the reminder!

Quote:


Originally Posted by *shanniesue2* 
Anywho, the point of my post is that, if you find a good pediatric opthamologist, it does not have to be a scary or threatening thing for your child. It can actually be sort of fun (I'm sorry, I know that sounds kind of nerdy).

My one piece of advice, coming from personal experience, is that, if you know your child is going to be picking out glasses on a day that she needs to have her eyes dilated, let her pick out the frames BEFORE they put the drops in her eyes. I ended up with an awful pair of glasses for thrid grade because my parents didn't do this--then they simply gave me the option of blue with red stripes or red with blue stripes! I couldn't see what they looked like at all! yikes!


I'm really adamant about finding healthcare providers that work well for our family. I think this is really important. Thanks for letting me that there are some good ones out there. Hopefully, this one will work out because she came highly recommend by our pediatrician, whom we absolutely love!

Quote:


Originally Posted by *XanaduMama* 
Here's the question: does your insurance pay for this? I'm pretty sure our vision plan won't, because it's not a vision thing, and I suspect our regular health ins won't, because it's an eye issue. I haven't really investigated this yet, but would be interested in how you've paid for this. TIA.

Our insurance covers ophthalmologist visits because they are health related. We have no vision coverage though. So, we'll see how this works out.

Quote:


Originally Posted by *Mrs-Mama* 
Don't start freaking out about surgery just yet







.

I'm not. Well, not really. Its just that little niggling in the back of my mind! You know? I'm guessing they'll do the patch before anything.


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