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chronic stress, and the PI3K-Akt pathway may play an essential role in this effect. To compare the repeatability of keratometry between different instruments in patients with hyperosmolar tear film and a control group. Subjects with tear-film osmolarity of 316 mOsm/L or more in either eye or 308 m/Osm/L or lower in both eyes were assigned to the hyperosmolar and the control group, respectively. The test eye was the eye with higher osmolarity in the hyperosmolar group and randomly chosen in the control group. The repeatability of kerato