Benign Yellow Dot Maculopathy

Benign Yellow Dot Maculopathy is a rare, non-progressive condition characterized by tiny, discrete yellow spots located around the central part of the retina called the macula. These yellow dots are seen in both eyes (bilaterally) in most cases and are usually discovered by chance during a routine eye exam, as they do not affect vision or cause symptoms EyeWiki.

Benign Yellow Dot Maculopathy (BYDM) is a rare, non-progressive retinal phenotype characterized by multiple, discrete yellow dots in the parafoveal macula, typically found bilaterally in asymptomatic patients with normal visual function. First described by Borman et al. in 2017, BYDM presents as tiny, hyperautofluorescent spots on fundus autofluorescence imaging, with largely unremarkable optical coherence tomography and electrophysiological studies, indicating preserved macular and full-field retinal function EyeWikiPubMed.

Although its precise pathophysiology remains unknown, familial cases exhibit an autosomal dominant inheritance pattern without identified pathogenic variants in known macular dystrophy genes PubMed. Because patients maintain 20/20 vision and lack symptoms, BYDM is typically discovered incidentally during routine fundoscopic exams.

First described by Borman and colleagues in 2017, this macular phenotype presents on fundus examination as multiple, symmetric yellow lesions spread evenly or sometimes concentrated just nasal (toward the nose) to the foveal center. Advanced imaging—such as fundus autofluorescence—shows these dots to be hyperautofluorescent, indicating subtle changes in the retinal pigment epithelium (RPE) without frank damage EyeWiki.

On optical coherence tomography (OCT), most eyes appear normal, though about one-third may show very slight irregularities in the inner segment ellipsoid band of the photoreceptors. Electrophysiological testing, including electroretinography (ERG), reveals normal macular and full-field retinal function, confirming that visual processing remains intact PubMed.

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Types

Although Benign Yellow Dot Maculopathy has a uniform presentation, researchers have noted several clinical patterns or “types” based on inheritance and dot distribution:

1. Familial Type
   In some families, the condition follows an autosomal dominant pattern, meaning it appears in successive generations without skipping. Genetic studies have excluded known macular dystrophy genes but point to a hereditary link PubMed.

2. Sporadic Type
   Cases with no family history are called sporadic. These appear in individuals with no known relatives affected and suggest that new genetic changes or entirely unknown factors may play a role EyeWiki.

3. Even Distribution Pattern
   Here, the yellow dots are spread evenly throughout the foveal and parafoveal areas. This is the most common presentation and is typically symmetric between both eyes PubMed.

4. Nasal Parafoveal Pattern
   In a subset of patients, the dots concentrate on the side of the macula nearer the nose (nasal parafoveal). This localized pattern has no known impact on vision or progression EyeWiki.

5. Unilateral Variant
   Very rarely, only one eye shows the yellow dots. Only a single case has been reported; like the bilateral form, it remains benign and asymptomatic EyeWiki.

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Causes (Hypothesized Etiologies and Risk Factors)

The exact cause of Benign Yellow Dot Maculopathy remains unknown. However, researchers have proposed several possible factors and associations. Each hypothesis below represents a potential contributor, though none has been definitively proven.

1. Genetic Predisposition
   Evidence of autosomal dominant inheritance in some families suggests a genetic factor. Whole-exome analysis has yet to pinpoint a specific gene, but familial clustering supports heritable risk PubMed.

2. Retinal Pigment Epithelium (RPE) Metabolic Variation
   The hyperautofluorescent nature of the dots implies altered RPE metabolism, perhaps due to localized differences in lipofuscin handling by pigment cells EyeWiki.

3. Photoreceptor Outer Segment Irregularities
   Subtle OCT changes at the inner segment ellipsoid band suggest that photoreceptor turnover or structure may be slightly altered in dot areas EyeWiki.

4. Lipofuscin Accumulation
   Increased fundus autofluorescence could reflect focal lipofuscin deposits within RPE cells, analogous to early processes in other macular conditions EyeWiki.

5. Oxidative Stress
   Local oxidative damage in the macula might trigger pigment changes visible as yellow dots, though patients lack functional impairment EyeWiki.

6. Minor Inflammatory Events
   Low-grade or past inflammation in the outer retina could leave behind small pigmentary changes, even if not enough to cause vision loss EyeWiki.

7. Phototoxicity
   Chronic exposure to bright light or specific wavelengths might induce subclinical photoreceptor or RPE stress, resulting in dot formation EyeWiki.

8. Vitamin A Metabolism Differences
   Slight variations in the visual cycle—particularly vitamin A recycling—could lead to localized pigment changes without impairing vision EyeWiki.

9. Choroidal Microvascular Anomalies
   Very subtle changes in the blood supply beneath the macula might alter nutrient delivery to RPE cells, causing pigment irregularities EyeWiki.

10. Subclinical Drusen Formation
    Early, tiny drusen-like deposits could appear as yellow dots before larger drusen develop; however, these remain nonprogressive in this condition EyeWiki.

11. Minor Vitreoretinal Interface Changes
    Slight tractional forces at the macula from the vitreous could lead to small pigment disruptions visible as dots EyeWiki.

12. Microglial Activation
    Local immune cell (microglia) activation in the retina could deposit pigment or lipids, seen as hyperautofluorescent spots EyeWiki.

13. Subtle Bruch’s Membrane Thickening
    Early thickening of Bruch’s membrane might influence RPE health and pigment distribution, creating dot patterns EyeWiki.

14. Systemic Metabolic Variants
    Mild systemic disorders—such as lipid or mineral metabolism differences—could manifest subtly in the eye without broader illness EyeWiki.

15. Idiopathic Changes
    In many cases, no clear cause emerges despite extensive testing. These idiopathic changes define the “benign” nature of this maculopathy EyeWiki.

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Symptoms (Clinical Features)

Unlike most macular disorders, Benign Yellow Dot Maculopathy produces no classic symptoms. The following ten clinical features reflect this asymptomatic presentation:

1. Asymptomatic Presentation
   Patients never notice vision changes, floaters, or flashes; the condition remains “silent” EyeWiki.

2. Normal Best-Corrected Visual Acuity
   Most eyes measure 20/20 vision (or equivalent) on standard eye charts, confirming intact central vision EyeWiki.

3. Unchanged Color Vision
   Color testing, such as Ishihara plates, yields normal results, indicating preserved cone function PubMed.

4. No Metamorphopsia
   Grid tests, like the Amsler grid, show straight lines, with no wavy or distorted perception EyeWiki.

5. Normal Contrast Sensitivity
   Patients can distinguish letters or patterns at low contrast levels, reflecting healthy macular function PubMed.

6. No Central Scotoma
   Visual field testing reveals no blind spots in the central vision area PubMed.

7. Absence of Photophobia
   Sensitivity to bright light remains within normal limits, with no discomfort reported in typical conditions EyeWiki.

8. No Nyctalopia (Night Blindness)
   Patients report normal vision in dim or nighttime environments PubMed.

9. No Glare Sensitivity
   Glare testing does not reveal increased difficulty when viewing in bright or oncoming headlights PubMed.

10. Stable Over Time
    Follow-up exams over months to years show the dots remain unchanged, confirming nonprogression EyeWiki.

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Diagnostic Tests

Physical Examination

1. Visual Acuity Test
   Standard eye charts measure central sharpness of vision. In this condition, results are uniformly normal, ruling out functional impairment EyeWiki.

2. Dilated Fundus Examination
   After pupil dilation, an ophthalmologist uses an ophthalmoscope or slit lamp to view the retina. The yellow parafoveal dots are identified without associated hemorrhages or exudates EyeWiki.

3. Slit-Lamp Biomicroscopy
   Coupled with a fundus lens, slit-lamp instruments provide a detailed view of the macula. Clinicians observe discrete, symmetrical yellow spots against a healthy retinal background EyeWiki.

4. Color Vision Testing
   Tools like Ishihara plates assess the ability to distinguish hues. Normal color vision confirms intact cone photoreceptor function despite dot presence PubMed.

Manual Functional Tests

5. Amsler Grid Test
   Patients fixate on a central dot of a grid to detect distortion (metamorphopsia). Straight grid lines indicate no macular distortion EyeWiki.

6. Near Vision Reading
   Reading small-print text or cards at reading distance checks fine-detail vision. Patients demonstrate normal near visual acuity EyeWiki.

7. Pupillary Light Reflex
   A penlight test evaluates pupil constriction. Normal direct and consensual responses confirm healthy retinal-optic input EyeWiki.

8. Cover-Uncover Test
   This screens for ocular alignment issues. Normal alignment indicates that no strabismus or fixation shift contributes to dot appearance EyeWiki.

Lab and Pathological Tests

9. Genetic Panel for Macular Dystrophies
   Although no gene has been linked definitively, panels screen known macular dystrophy genes to exclude other inherited conditions PubMed.

10. Whole-Exome Sequencing
    In research settings, exome sequencing examines all coding genes. Studies have not yet identified a causal variant, supporting the idiopathic label PubMed.

11. Blood Cystine Level
    This test rules out cystinosis, a condition with crystalline deposits that can mimic yellow dots; normal levels exclude this etiology EyeWiki.

12. Urine Oxalate Measurement
    Elevated oxalate can deposit in the retina (oxalosis). Normal urine oxalate excludes this metabolic cause EyeWiki.

Electrodiagnostic Tests

13. Full-Field Electroretinography (ffERG)
    Measures global retinal response to light. Normal waveforms confirm full-retina function PubMed.

14. Multifocal ERG (mfERG)
    Maps localized macular function. Normal mfERG responses across the macula indicate dots do not impair electrical activity PubMed.

15. Electro-oculography (EOG)
    Assesses RPE function by measuring voltage changes with eye movements. Normal Arden ratios indicate healthy RPE despite autofluorescent dots PubMed.

16. Pattern Visual Evoked Potential (PVEP)
    Tests the visual pathway from retina to visual cortex using patterned stimuli. Normal PVEP confirms that dot lesions do not disrupt signal transmission PubMed.

Imaging Tests

17. Optical Coherence Tomography (OCT)
    Provides cross-sectional images of retinal layers. Most eyes appear normal, though some show subtle ellipsoid band irregularities at dot sites EyeWiki.

18. Fundus Autofluorescence (FAF)
    Captures natural fluorescence of retinal pigments. Dots appear bright (hyperautofluorescent), highlighting localized RPE changes EyeWiki.

19. Fluorescein Angiography (FA)
    Dye-based imaging shows retinal circulation. The yellow spots demonstrate early hyperfluorescence without leakage, indicating intact retinal vessels EyeWiki.

20. Fundus Photography
    Color images document the size, number, and distribution of yellow dots over time. High-resolution photos enable consistent monitoring of the benign lesions EyeWiki.,

Non-Pharmacological Treatments

Despite its benign nature, patients often seek ways to support long-term retinal health. The following 20 strategies—grouped into Exercise Therapies, Mind-Body Practices, and Educational Self-Management—focus on optimizing ocular blood flow, reducing oxidative stress, and empowering patients to monitor and maintain retinal function.

A. Exercise Therapies

1. Ocular Muscle Stretching

   • Description: Gentle, sustained stretching of extraocular muscles by looking slowly in extreme gaze positions.

   • Purpose: Maintains muscle flexibility and promotes uniform blood flow across the macula.

   • Mechanism: Enhances microcirculation by periodically increasing perfusion pressure in orbital vessels.

2. Saccadic Tracking Exercises

   • Description: Rapidly shift gaze between two targets at varying distances.

   • Purpose: Boosts neuromuscular coordination and prevents stagnation of ocular microvasculature.

   • Mechanism: Activates the oculomotor system, increasing metabolic demand and therefore blood flow to the macula.

3. Near-Far Focusing Drills

   • Description: Alternate focusing between a near object (15 cm) and a distant object (6 m).

   • Purpose: Reduces accommodation fatigue and supports ciliary muscle function.

   • Mechanism: Stimulates parasympathetic-sympathetic balance, aiding choroidal circulation.

4. Palming Relaxation

   • Description: Cover closed eyes with warmed palms for 2–3 minutes.

   • Purpose: Relieves ocular strain and enhances patient awareness of retinal comfort.

   • Mechanism: Gentle pressure occludes light, promoting relaxation of photoreceptors and choroidal vessel dilation.

5. Blink-Enhancement Routine

   • Description: Consciously perform slow, full blinks every 5 seconds for 2 minutes.

   • Purpose: Maintains tear film stability and prevents surface dryness that can indirectly stress the retina.

   • Mechanism: Stimulates meibomian gland function, preserving ocular surface health and comfort.

6. Guided Eye-Hand Coordination

   • Description: Trace a moving object (e.g., penlight) across a wall while keeping head still.

   • Purpose: Improves fixation stability and saccadic accuracy, reducing micro-trauma.

   • Mechanism: Coordinates cortical and ocular motor neurons to optimize muscular micro-movements.

7. Infrared Heat Lamp Warm-Up

   • Description: Brief exposure (30 seconds) of closed eyes to gentle infrared heat at 40°C.

   • Purpose: Enhances local circulation and metabolic waste clearance in periocular tissues.

   • Mechanism: Vasodilation of superficial vessels increases overall ocular perfusion.

B. Mind-Body Practices

8. Guided Imagery for Eye Comfort

   • Description: Visualize a warm, nourishing light bathing the macula for 5 minutes daily.

   • Purpose: Reduces stress-induced vasoconstriction and promotes patient self-efficacy.

   • Mechanism: Activates parasympathetic pathways, lowering cortisol and preserving choroidal flow.

9. Mindful Breathing with Eye Focus

   • Description: Inhale for 4 seconds, exhale for 6 seconds, while softly gazing at a neutral point.

   • Purpose: Synchronizes respiratory and ocular relaxation to mitigate sympathetic overactivity.

   • Mechanism: Lowers systemic blood pressure and maintains stable retinal perfusion.

10. Progressive Muscle Relaxation Including Orbicularis Oculi

    • Description: Sequentially tense and relax facial muscles, ending with eyelid muscles.

    • Purpose: Relieves periocular muscle tension that can indirectly impair ocular microcirculation.

    • Mechanism: Reduces local muscle spasm, facilitating unobstructed blood flow.

11. Biofeedback-Assisted Retinal Perfusion

    • Description: Use skin sensors to monitor stress indicators and practice relaxation to normalize readings.

    • Purpose: Empowers patients to detect and correct stress-related ocular vasoconstriction.

    • Mechanism: Neurofeedback modulates autonomic input to ocular vessels.

12. Transcendental Meditation (Focused on Visual Field)

    • Description: Silent mantra repetition for 15 minutes with closed eyes.

    • Purpose: Lowers overall oxidative stress and protects photoreceptor integrity.

    • Mechanism: Decreases systemic inflammatory markers that can affect retinal microenvironment.

13. Yoga Nidra (Ocular Release Segment)

    • Description: Guided body scan emphasizing relaxation of head and eyes.

    • Purpose: Promotes deep parasympathetic dominance, enhancing retinal homeostasis.

    • Mechanism: Systemic reduction in sympathetic tone preserves capillary blood flow.

C. Educational Self-Management

14. Symptom and Image Diary Keeping

    • Description: Log any visual changes and optional smartphone fundus imaging weekly.

    • Purpose: Detects subtle shifts in macular presentation early.

    • Mechanism: Encourages active surveillance and timely reporting to clinicians.

15. Blue-Light Reduction Strategy

    • Description: Implement screen-time guidelines (20-20-20 rule) and use blue-light filters.

    • Purpose: Minimizes phototoxic stress on macular photoreceptors.

    • Mechanism: Reduces cumulative retinal oxidative burden from high-energy visible light.

16. Nutrition Label Literacy for Eye Health

    • Description: Learn to identify antioxidant-rich foods and supplements on product labels.

    • Purpose: Ensures adequate intake of key ocular nutrients through diet or supplement.

    • Mechanism: Patients self-manage micronutrient levels critical for macular resilience.

17. Routine Ophthalmic Visit Scheduling

    • Description: Set calendar reminders for annual dilated fundus exams.

    • Purpose: Formalizes follow-up to monitor BYDM stability.

    • Mechanism: Structured check-ins detect any unlikely but possible progression.

18. Environmental UV Awareness

    • Description: Learn local UV index patterns and use protective eyewear when index ≥3.

    • Purpose: Prevents ultraviolet-induced retinal pigment epithelium (RPE) damage.

    • Mechanism: Physical UV filtration reduces photochemical injury in the macula.

19. Ergonomic Workspace Configuration

    • Description: Position screens 50–70 cm away, 10–20° below eye level, with proper lighting.

    • Purpose: Decreases glare-induced squinting and ocular fatigue.

    • Mechanism: Optimal angles and lighting maintain consistent pupil size and macular perfusion.

20. Peer Support Group Participation

    • Description: Join online or local forums for BYDM and macular health discussions.

    • Purpose: Shares coping strategies and reinforces adherence to self-care routines.

    • Mechanism: Social engagement reduces stress hormones that may indirectly affect ocular blood flow.

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Pharmacological Treatments

No specific pharmacological agents are approved or indicated for benign yellow dot maculopathy; management is purely observational, with no evidence-based drugs targeting this benign, non-progressive phenotype EyeWiki.

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Dietary Molecular Supplements

Although no targeted therapies exist for BYDM, the following supplements—proven in age-related macular degeneration (AMD) research—support overall macular resilience.

1. Lutein (10 mg daily)

   • Function: Provides antioxidant protection to macular photoreceptors.

   • Mechanism: Accumulates in the macula as a blue-light filter and free radical scavenger JAMA Network.

2. Zeaxanthin (2 mg daily)

   • Function: Complements lutein in filtering high-energy light.

   • Mechanism: Concentrates in the fovea to absorb blue light and neutralize reactive oxygen species JAMA Network.

3. Omega-3 Fatty Acids (EPA 650 mg + DHA 350 mg)

   • Function: Maintains photoreceptor membrane fluidity.

   • Mechanism: Modulates inflammatory pathways and supports RPE function; AREDS2 showed no overall AMD benefit but subgroup trends suggest potential support PubMed.

4. Vitamin C (500 mg daily)

   • Function: General antioxidant that regenerates vitamin E.

   • Mechanism: Reduces oxidative stress in retinal capillaries.

5. Vitamin E (400 IU daily)

   • Function: Lipid-soluble antioxidant protecting cell membranes.

   • Mechanism: Interrupts lipid peroxidation chains in photoreceptor outer segments.

6. Zinc (80 mg daily)

   • Function: Cofactor for superoxide dismutase in RPE cells.

   • Mechanism: Enhances endogenous antioxidant enzyme activity; must combine with copper to avoid deficiency JAMA Network.

7. Copper (2 mg daily)

   • Function: Prevents zinc-induced copper deficiency.

   • Mechanism: Maintains ceruloplasmin function critical for iron metabolism and retinal health.

8. Astaxanthin (4 mg daily)

   • Function: Potent antioxidant mitigating blue-light damage.

   • Mechanism: Integrates into cell membranes, preventing lipid peroxidation.

9. Alpha-Lipoic Acid (300 mg daily)

   • Function: Regenerates other antioxidants and chelates metal ions.

   • Mechanism: Crosses blood–retinal barrier to reduce oxidative burden.

10. Resveratrol (150 mg daily)

    • Function: Activates sirtuins for cellular stress resistance.

    • Mechanism: Modulates inflammatory cytokines and supports RPE survival.

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Regenerative and Stem Cell-Based Drugs

At present, no regenerative or stem cell therapies are approved or under investigation specifically for BYDM. Research in retinal neuroprotection and RPE transplantation focuses on degenerative diseases, not benign, asymptomatic phenotypes.

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 Surgical Procedures

No surgical intervention is indicated for benign yellow dot maculopathy due to its non-progressive, asymptomatic course. All treatment paradigms emphasize observation alone.

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Preventive Strategies

1. Annual Dilated Fundus Examination: Ensures BYDM stability.

2. Smoking Cessation: Eliminates a key oxidative stressor.

3. UV-Blocking Sunglasses: Filters ≥95% UVA/UVB radiation.

4. Balanced Diet Rich in Leafy Greens: Supplies natural lutein/zeaxanthin.

5. Blood Pressure Control: Prevents choroidal perfusion fluctuations.

6. Regular Physical Activity: Enhances systemic and ocular microcirculation.

7. Hydration Maintenance: Preserves vitreous and retinal health.

8. Screen-Time Moderation: Reduces digital eye strain.

9. Antioxidant-Rich Snacks: Includes berries and nuts for continual free-radical defense.

10. Protective Eyewear in Sports: Prevents traumatic retinal insults.

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When to See a Doctor

• New Visual Symptoms: Any disturbances such as scotomas, flashes, or floaters.

• Changes in Dot Appearance: Enlargement or new lesions on fundus imaging.

• Sudden Onset of Photophobia: Could signal concurrent pathology.

• Unexplained Eye Pain or Redness: May indicate inflammation requiring evaluation.

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 “Do’s and Don’ts”

Do’s:

1. Adhere to annual ocular exams.

2. Practice the 20-20-20 rule for screen use.

3. Incorporate AREDS2-based supplementation.

4. Wear protective eyewear outdoors.

5. Keep blood glucose and pressure within target ranges.

Don’ts:

1. Smoke tobacco or vape.

2. Skip routine checkups due to asymptomatic nature.

3. Expose eyes to direct sunlight without UV protection.

4. Overuse digital devices without breaks.

5. Self-medicate with unverified eye drops or supplements.

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Frequently Asked Questions

1. What causes the yellow dots?
   The precise origin is unknown; hypothesized to be localized deposits in RPE or photoreceptor interface EyeWiki.

2. Does BYDM worsen vision over time?
   No—longitudinal studies show no progression or visual decline EyeWiki.

3. Is family screening necessary?
   In familial cases, first-degree relatives may undergo fundus exam due to autosomal dominant pattern.

4. Can diet change affect BYDM?
   While diet won’t alter the dots, antioxidant-rich foods support overall macular resilience.

5. Should I use blue-light blocking glasses?
   Yes—these can reduce oxidative stress on the macula during screen use.

6. Are there any medical treatments?
   No—observation is the standard of care; no drugs target BYDM specifically.

7. Will my children develop this?
   Genetic predisposition exists; pediatric screening may be considered if a parent is affected.

8. What tests confirm BYDM?
   Fundus autofluorescence showing hyperautofluorescent dots and normal OCT/electrophysiology.

9. Can yellow dots appear elsewhere in the retina?
   BYDM is confined to the parafoveal macula. Other locations suggest different diagnoses.

10. How often should I have eye exams?
    At least annually, or sooner if new symptoms arise.

11. Do supplements cure BYDM?
    No cure exists; supplements only support general macular health.

12. Is surgery ever needed?
    No—surgical risks outweigh any theoretical benefit for this benign condition.

13. Can stress worsen my eyes?
    Chronic stress may impair blood flow; mind-body practices help maintain healthy ocular perfusion.

14. Are there clinical trials for BYDM?
    None currently—research focuses on more disabling retinal diseases.

15. Where can I find reliable information?
    Consult peer-reviewed journals (Ophthalmology, Canadian Journal of Ophthalmology) and EyeWiki for updates.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: July 14, 2025.