Instructions Before LASIK Surgery

Size: px
Start display at page:

Download "Instructions Before LASIK Surgery"

Transcription

1 Your Surgery is scheduled for: D. Shawn Parker, M.D., F.A.C.S. Custom LASIK Corneal Surgery Glaucoma Cataract Instructions Before LASIK Surgery q Wednesday q Thursday q Friday at please arrive at Instructions: Bring signed consent form on the day of surgery. (The entire document is considered part of the consent form, please do not separate the last page from the document) Bring a driver with you on the day of surgery and the following morning for your first postoperative visit. An appointment will be given to you the day of surgery. Do not use cologne, perfume, makeup, or hair products such as hairspray, gel, etc., the day of surgery (deodorant is permitted). Head bands and hair bands will need to be removed before your procedure and cell phones and other electronics left in the waiting area. If you received artificial tears at your full-dilated exam, use the drops 3-4 per day in the operated eye(s) until surgery and once the morning of your surgery. (You may not receive these drops until the day before surgery, depending on when your pre-operative exam is scheduled). The three prescriptions you have filled prior to your surgery (the antibiotic drops, steroid drops and Restoril sleep tablets) are for use AFTER your surgery. You will receive preservative-free artificial tears in your kit the day of surgery. If you have any questions, please contact our office. rev u A LAS_PKT_PreOp_MK

2 D. Shawn Parker, M.D., F.A.C.S. Custom LASIK Corneal Surgery Glaucoma Cataract Day of Your Procedure: Care For Your Eye After LASIK Go directly home to relax. Try to sleep or rest with the eyes closed for at least 2 hours. You do not need to be awakened to use your drops. Sleeping medication should be taken if needed, as directed. Do not remove your goggles until you get up in the morning after your procedure. You do not need to wear the shield to your appointment the next day. No water should get in the eye for one week. You may shower, but keep your eyes closed when washing hair and rinsing so that the water runs towards the back of your head. Also, try to aim the flow of water lower than your eyes. Gently pat-wash with a clean cloth around the eyes. Wear no eye make-up or mascara for 1 week. After 1 week, you may wear make-up that is easily removed with soap and water. No motorcycling, bicycling, boating, horseback riding, swimming or tanning bed for 2 weeks. Avoid getting dust or dirt in the eye. This will irritate the eye as well as increase your risk of infection. If dust does get in your eye, use preservative-free artificial tears to flush out the debris. Wear safety glasses or sports goggles when participating in contact sports or doing work during which foreign matter may get into your eyes. Do not rub or push on your eye. First Day After Your Procedure: The eye may be sensitive to touch, scratchy, and light sensitive; the eye may be red. This will subside as the eye heals. Vision may be blurry after surgery and may fluctuate. This usually improves as the eye heals over the next week. If you notice occasional blurriness, it helps to use artificial tears to keep the eye well lubricated. rev 0212 These symptoms and any discomfort you might have should improve each day. CALL IMMEDIATELY if you experience any pain after the initial surgical discomfort has subsided u B LAS_PKT_PreOp_MK

3 D. Shawn Parker, M.D., F.A.C.S. Custom LASIK Corneal Surgery Glaucoma Cataract Medication Instructions CustomVue and Traditional LASIK Procedures Sleep: The prescription you had filled, Restoril, can be used as needed. When you get home, take one tablet and go to bed. If you are not asleep after one hour, take the second sleeping pill. If the first one is sufficient, take the second sleeping pill when you go to bed for the night. Drops: To start after your 2 hour nap the day of surgery: Antibiotic Prescription 1 drop after your nap and again before you go to bed for the night Pred Forte or Prednisolone Acetate Prescription Preservative-Free Artificial Tears: To start the first day after surgery: Antibiotic Prescription: 1 drop 4 times a day for 6 days Pred Forte or Prednisolone Acetate Prescription: Drop Usage Preservative-Free Artificial Tears: 1 drop after your nap and again before you go to bed for the night 1 drop after your nap and then every 2 hours until bedtime or as needed. Preservative-free artificial tears are the artificial tears you received on the day of surgery, not the bottle of drops you may have received at your pre-op exam. You can purchase more artificial tears over the counter. Please ensure they are preservative-free. 1 drop 4 times a day for 6 days 1 drop at least every 2 hours while awake or as needed up to every 15 minutes. NOTE: These individual vials are good for 12 hours after opening. Create a pocket by pulling down your lower lid and place one drop into the pocket Do not pull on the upper lid! Wait 5 minutes between all drops. It does not matter which drop you use first, but shake the bottles very well before you use them. Refrigerating your drops helps ensure the drop actually went into the eye and not down your cheek. The preservative-free artificial tears may be used every 15 minutes if needed. rev 0212 Clear goggles are to be worn when you sleep for 5 days after sugery u C LAS_PKT_PreOp_MK

4 D. Shawn Parker, M.D., F.A.C.S. Custom LASIK Corneal Surgery Glaucoma Cataract LASIK Consent Form INFORMED CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK) FOR THE CORRECTION OF HYPEROPIA (FARSIGHTEDNESS), MYOPIA (NEARSIGHTEDNESS), AND ASTIGMATISM. This information is to help you make an informed decision about having Laser-Assisted In-Situ Keratomileusis surgery to treat your farsightedness, nearsightedness, or astigmatism. Take as much time as you wish to make a decision about signing this form. You are encouraged to ask any questions and have them answered to your satisfaction before you give your permission for surgery. Every surgery has flaws as well as benefits and each person must evaluate this risk/benefit ratio for himself/herself in light of the information presented by your doctor and the information which follows. Spectacles and contact lenses are the most common method of correcting nearsightedness (myopia), farsightedness (hyperopia), and astigmatism. When tolerated well, they are likely to be a good alternative to LASIK surgery. Refractive surgery is continually evolving and other refractive procedures may be available as an alternative to LASIK. You should also be aware that having any refractive procedure could potentially disqualify you from some professions, including the military and employment with certain law enforcement. LASIK permanently changes the shape of the cornea. The surgery is performed under a topical anesthetic (drops in the eye). A corneal flap is created with either a microkeratome or a laser. The flap is replaced and bonds back into place without the need for stitches. The result of removing these layers of tissue causes the center of the cornea to: flatten in the case of nearsightedness; steepen in the case of farsightedness; or, become more rounded in the case of astigmatism (which changes the focusing power of the cornea). Although the goal of LASIK is to improve vision to the point of not being dependent on glasses or contact lenses, or to the point of wearing thinner (or weaker) glasses, this result is not guaranteed. You should understand that LASIK surgery will not prevent you from developing naturally occurring eye problems such as glaucoma, retinal degeneration or detachment. After the procedure, you should avoid rubbing the eye. Your eyes may be more susceptible to traumatic injury after LASIK and protective eye wear is recommended for all contact and racquet sports where a direct blow to the eye could occur. Also, LASIK does not correct the condition known as presbyopia (or aging of the eye) which occurs in most people around age 40 and may require them to wear reading glasses for close-up work. People over age 40 that have their nearsightedness corrected may find that they need reading glasses for clear, close-up vision. rev u D LAS_PKT_PreOp_MK

5 LASIK Consent Form Continued 2 During pregnancy or nursing, your refractive error can fluctuate which could influence your results. If you know you are pregnant or attempting to become pregnant within the next three months, it is important you advise your doctor immediately. LASIK is an elective procedure. There is no emergency condition or other reason that requires or demands that you have it performed. You could continue wearing contact lenses or glasses and have adequate visual acuity. This procedure, like all surgery, presents some risks, many of which are listed below. You should also understand that there might be other risks not known to your doctor which may become known later. Despite the best of care, complications and side effects may occur; should this happen in your case, the result might be affected even to the extent of making your vision worse. ALTERNATIVES TO LASIK If you decide not to have LASIK, there are other methods of correcting your vision. These alternatives include, among others, eyeglasses, contact lenses, and other refractive surgical procedures. POTENTIAL RISKS OF LASIK INCLUDE: 1. LOSS OF VISION: LASIK surgery can possibly lead to loss of vision or loss of best corrected vision. This can be due to infection or irregular scarring or other causes. Unless successfully controlled with antibiotics, steroids, or other necessary treatment, vision loss can ensue. Vision loss can also be due to the cornea healing irregularly which could result in irregular astigmatism and make wearing glasses or contact lenses necessary. Furthermore, it is possible you may not be able to successfully wear contacts after LASIK. 2. VISUAL SIDE-EFFECTS: Other complications and conditions that can occur with LASIK surgery include: a. anisometropia (difference in power between the two eyes) b. aniseikonia (difference in image size between the two eyes) c. double vision d. hazy vision e. fluctuating vision during the day and from day to day f. increased sensitivity to light which may be incapacitating for some time and may not completely go away g. glare and halos around lights which may not completely go away h. severe dry eye or worsening of dry eye either of which may cause decreased vision quality Some of these conditions may affect your ability to drive and judge distances and driving should only be done when you are certain your vision is adequate. 3. OVER CORRECTION AND UNDER CORRECTION: It may be that LASIK surgery will not give you the result you desire. Some procedures result in the eye being under corrected in which case, it may be possible or necessary to have additional surgery to fine tune or enhance the initial result. These results can not be guaranteed. It is also possible that your eye may be over corrected to the point of remaining

6 POTENTIAL RISKS OF LASIK Continued: LASIK Consent Form Continued 3 farsighted. It is also possible that your initial results could regress over time. In some, but not all cases, retreatment could be considered. 4. OTHER RISKS: Additional reported complications include: a. corneal ulcer formation b. epithelial healing defects c. ptosis (droopy eyelid) d. corneal swelling e. retinal detachment and hemorrhage Complications could also arise requiring further corrective procedures including a partial (lamellar) or full corneal transplant using a donor cornea. These complications include: f. loss of corneal flap g. damage to the flap h. flap decentration i. progressive corneal thinning (ectasia) Sutures may also be required which could induce astigmatism. It is also possible that the microkeratome or the laser could malfunction necessitating that the procedure be stopped. Since it is impossible to state all potential risks of any surgery, this form is incomplete. 5. FUTURE COMPLICATIONS: You should also be aware that there are other complications that could occur that have not been reported before the creation of this consent form as LASIK surgery has been performed only since the mid 1990s. PATIENT CONSENT In giving my permission for LASIK, I declare that I understand the following: The long-term risks and effects of LASIK are unknown. I have received no guarantee as to the success of my particular case. I understand that the following risks are associated with the procedure: Vision Threatening Complications 1. I understand that the microkeratome or the laser could malfunction, requiring the procedure to be stopped before completion. Depending on the type of malfunction, this may or may not be accompanied by visual loss. 2. I understand that, if using the microkeratome, instead of making a flap, an entire portion of the central cornea could be cut off, and very rarely could be lost. If preserved, I understand that my doctor would put this tissue back on the eye after the laser treatment, using sutures, according to the ALK procedure method. It is also possible that the flap incision could result in an incomplete flap, or

7 LASIK Consent Form Continued 4 Vision Threatening Complications Continued a flap that is too thin. If this happens, it is likely that the laser part of the procedure will have to be postponed until the cornea has a chance to heal sufficiently to try to create the flap again. 3. I understand that irregular healing of the flap could result in a distorted cornea. This would mean that glasses or contact lenses might not correct my vision to the level possible before undergoing LASIK. If this distortion in vision is severe, a partial or complete corneal transplant might be necessary to repair the cornea. 4. I understand that mild or severe infection is possible. Mild infection can usually be treated with antibiotics and usually does not lead to permanent visual loss. Severe infection, even if successfully treated with antibiotics, could lead to permanent scarring and loss of vision that may require corrective laser surgery or, if very severe, corneal transplantation. 5. I understand that other very rare complications threatening vision include, but are not limited to, corneal swelling, corneal thinning (ectasia), retinal detachment, hemorrhage, venous and arterial blockage, cataract formation, loss of best corrected vision, decrease in quality of vision, total blindness and even loss of my eye. Non-Vision Threatening Side Effects 1. I understand that there may be increased sensitivity to light, glare, and fluctuations in the sharpness of vision. I understand these conditions usually occur during the normal stabilization period of from one to three months, but they may also be permanent. 2. I understand that there is an increased risk of eye irritation related to drying of the corneal surface following the LASIK procedure. These symptoms may be temporary or, on rare occasions, permanent, and may require frequent application of artificial tears and/or closure of the tear duct openings in the eyelid. 3. I understand that at night there may be a star bursting or halo effect around lights. I understand that this condition usually diminishes with time, but could be permanent. I understand that my vision may not seem as sharp at night as during the day and that I may need to wear glasses at night. I understand that I should not drive until my vision is adequate both during the day and at night. 4. I understand that I may not get a full correction from my LASIK procedure and this may require future enhancement procedures, such as more laser treatment or the use of glasses or contact lenses. 5. I understand that there may be a balance problem between my two eyes after LASIK has been performed on one eye, but not the other. This phenomenon is called anisometropia. I understand that would cause eyestrain and make judging distance or depth perception more difficult. I understand that my first eye may take longer to heal than is usual, prolonging the time I could experience anisometropia.

8 LASIK Consent Form Continued 5 Non-Vision Threatening Side Effects Continued 6. I understand that, after LASIK, the eye may be more fragile to trauma from impact. Evidence has shown that, as with any scar, the corneal incision will not be as strong as the cornea originally was at that site. I understand that the treated eye, therefore, is somewhat more vulnerable to all varieties of injuries, at least for the first year following LASIK. I understand it would be advisable for me to wear protective eyewear when engaging in sports or other activities in which the possibility of a ball, projectile, elbow, fist or other traumatizing object contacting the eye may be high. 7. I understand that there is a natural tendency of the eyelids to droop with age and that the eye surgery may hasten this process. 8. I understand that there may be pain or foreign body sensation, particularly during the first 48 hours after surgery. 9. I understand that temporary glasses either for distance or reading may be necessary while healing occurs and that more than one pair of glasses may be needed. 10. I understand that the long-term effects of LASIK are unknown and that unforeseen complications or side effects could possibly occur. 11. I understand that visual acuity I initially gain from LASIK could regress, and that my vision may go partially back to a level that may require glasses or contacts lens use to see clearly. 12. I understand that the correction that I can expect to gain from LASIK may not be perfect. I understand that it is not realistic to expect that this procedure will result in perfect vision, at all times, under all circumstances, for the rest of my life. I understand I may need glasses to refine my vision for some purposes requiring fine detailed vision after some point in my life, and that this might occur soon after surgery or years later. 13. I understand that I may be given medication in conjunction with the procedure and that my eye may be patched afterward. I, therefore, understand that I must not drive the day of surgery and not until I am certain that my vision is adequate for driving. 14. I understand that if I currently need reading glasses, I will still likely need reading glasses after this treatment. It is possible that dependence on reading glasses may increase or that reading glasses may be required if I have this surgery. 15. I understand that even 90% clarity of vision is still slightly blurry. Enhancement surgeries can be performed when vision is stable UNLESS it is unwise or unsafe. If the enhancement is performed, there generally is no need to make another cut. The original flap can usually be lifted with specialized techniques, although I understand a new flap may need to be made or surface treatment performed. In order to perform an enhancement surgery, there must be adequate tissue remaining. If there is inadequate tissue, it may not be possible to perform an enhancement. An Non-

9 LASIK Consent Form Continued 6 Non-Vision Threatening Side Effects Continued assessment and consultation will be held with the surgeon at which time the benefits and risks of an enhancement surgery will be discussed. 16. I understand that, as with all types of surgery, there is a possibility of complications due to anesthesia, drug reactions or other factors that may involve other parts of my body. I understand that, since it is impossible to state every complication that may occur as a result of any surgery, the list of complications in this form may not be complete. POST-OPERATIVE INSTRUCTIONS With this consent, you have been given medications and written instructions to help prevent infection and control healing. It is imperative that you follow all instructions exactly as they are given to you. It is also imperative that all follow-up visits be kept as directed. Failure to follow-up as indicated can result in visual loss. In signing this form, you are stating that you have read this consent form, and you have had the opportunity to ask questions and have had them answered to your satisfaction. Please answer the following questions: q True q False I may need to wear glasses or contact lenses after the procedure to achieve my best potential vision. I may completely lose my vision or experience a decrease in my quality of vision. q True q False I may have glare or other visually impairing symptoms in the evening which may make it difficult for me to function at night. q True q False I may not be able to have 20/20 vision after the procedure even with glasses or contact lenses. q True q False I may need further surgery if certain complications arise. q True q False LASIK does not eliminate the need for reading glasses if they are normally needed with presbyopia.

10 LASIK Consent Form Continued 7 PATIENT S STATEMENT OF ACCEPTANCE AND UNDERSTANDING The details of the procedure known as LASIK have been presented to me in detail in this document and explained to me by my ophthalmologist. My ophthalmologist has answered all my questions to my satisfaction. I, therefore, consent to LASIK surgery. I give permission for my ophthalmologist to record on video or photographic equipment my procedure, for purposes of education, research or training of other health care professionals. I also give my permission for my ophthalmologist to use data about my procedure and subsequent treatment to further understand LASIK. I understand that my name will remain confidential, unless I give subsequent written permission for it to be disclosed outside my ophthalmologist s office or other center where my LASIK procedure will be performed. I am making an informed decision in giving my permission to have LASIK utilizing the following technology: ilasik surgery using the FDA approved Advanced CustomVue WaveScans, FS60 IntraLase Laser and the VISX Star S4 Active Trak excimer laser performed on my: q Right Eye q Left Eye q Both Eyes. This option includes post-operative visits for 1 year and a 2-year retreatment period Advanced CustomVue LASIK surgery using the FDA approved Advanced CustomVue WaveScans, the Bausch and Lomb Hansatome Microkeratome and the VISX Star S4 Active Trak excimer laser performed on my: q Right Eye q Left Eye q Both Eyes. This option includes post-operative visits for 1 year and a 1-year retreatment period Traditional LASIK surgery using the FDA approved Bausch and Lomb Hansatome Microkeratome and the VISX Star S4 Active Trak excimer laser performed on my: q Right Eye q Left Eye q Both Eyes. This option includes post-operative visits for 1 year and a 1-year retreatment period Signature of Patient: Date: Signature of Witness: Date:

INFORMED CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK)

INFORMED CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK) Lasik Center 2445 Broadway Quincy, IL 62301 217-222-8800 INFORMED CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK) INTRODUCTION This information is being provided to you so that you can make an informed

More information

ALTERNATIVES TO LASIK

ALTERNATIVES TO LASIK EYE PHYSICIANS OF NORTH HOUSTON 845 FM 1960 WEST, SUITE 101, Houston, TX 77090 Office: 281 893 1760 Fax: 281 893 4037 INFORMED CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK) INTRODUCTION This information

More information

INFORMED CONSENT FOR LASIK SURGERY

INFORMED CONSENT FOR LASIK SURGERY IMPORTANT: READ EVERY WORD! This information is to help you make an informed decision about having laser assisted in-situ keratomileusis (LASIK) surgery to treat your nearsightedness, farsightedness and/or

More information

Eye Associates Custom LASIK With IntraLASIK Correction Of Nearsightedness, Farsightedness, and Astigmatism Using IntraLase TM Technology

Eye Associates Custom LASIK With IntraLASIK Correction Of Nearsightedness, Farsightedness, and Astigmatism Using IntraLase TM Technology Eye Associates Custom LASIK With IntraLASIK Correction Of Nearsightedness, Farsightedness, and Astigmatism Using IntraLase TM Technology INDICATIONS AND PROCEDURE This information is being provided to

More information

IntraLase and LASIK: Risks and Complications

IntraLase and LASIK: Risks and Complications No surgery is without risks and possible complications and LASIK is no different in that respect. At Trusted LASIK Surgeons, we believe patients can minimize these risks by selecting a highly qualified

More information

INFORMED CONSENT TO HAVE LASIK

INFORMED CONSENT TO HAVE LASIK A Division of Scott & Christie and Associates INFORMED CONSENT TO HAVE LASIK This information is to help you make an informed decision about having Laser Assisted Intrastromal Keratomileusis (LASIK), an

More information

INFORMED CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK) USING INTRALASE TM BLADE-FREE TECHNOLOGY

INFORMED CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK) USING INTRALASE TM BLADE-FREE TECHNOLOGY EYE PHYSICIANS OF NORTH HOUSTON 845 FM 1960 WEST, SUITE 101, Houston, TX 77090 Office: 281 893 1760 Fax: 281 893 4037 INFORMED CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK) USING INTRALASE TM BLADE-FREE

More information

Consent for Bilateral Simultaneous Refractive Surgery

Consent for Bilateral Simultaneous Refractive Surgery Consent for Bilateral Simultaneous Refractive Surgery Please sign and return Patient Copy While many patients choose to have both eyes treated at the same surgical setting, there may be risks associated

More information

INFORMED CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK)

INFORMED CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK) Drs. Fine, Hoffman and Packer, LLC PHYSICIANS AND SURGEONS, EyeMDs OPHTHALMOLOGY I. Howard Fine, M.D. Richard S. Hoffman, M.D. Mark Packer, M.D. 1550 Oak Street, Suite 5 www.finemd.com Eugene, OR 97401-7701

More information

INFORMED CONSENT FOR LASER ASSISTED SUBEPITHELIAL KERATOMILEUSIS (LASEK)/PHOTO-REFRACTIVE KERATECTOMY (PRK)

INFORMED CONSENT FOR LASER ASSISTED SUBEPITHELIAL KERATOMILEUSIS (LASEK)/PHOTO-REFRACTIVE KERATECTOMY (PRK) INFORMED CONSENT FOR LASER ASSISTED SUBEPITHELIAL KERATOMILEUSIS (LASEK)/PHOTO-REFRACTIVE KERATECTOMY (PRK) Please read the following consent form very carefully. Please initial each page where indicated.

More information

Associated Eye Surgeons

Associated Eye Surgeons Associated Eye Surgeons 45 Resnik Road, Suite 301 Plymouth, MA 02360 Henry J Kriegstein MD, FACS Board Certified Lois M. Townshend, MD, FRCSC Board Certified Kristin S. Kenney, OD LASIK CONSENT FORM I.

More information

LASIK PATIENT PACKET

LASIK PATIENT PACKET LASER CENTER LASIK PATIENT PACKET PLEASE BRING BACK WITH YOU THE DAY OF YOUR SURGERY PRE-OPERATIVE INSTRUCTIONS PLEASE REVIEW CAREFULLY WHAT TO EXPECT THE DAY OF YOUR SURGERY POST-OPERATIVE INSTRUCTIONS

More information

CONSENT FOR INTRALASIK CORRECTION OF NEARSIGHTEDNESS, FARSIGHTEDNESS, AND ASTIGMATISM USING INTRALASE TM TECHNOLOGY BY AMJAD KHOKHAR, M.D.

CONSENT FOR INTRALASIK CORRECTION OF NEARSIGHTEDNESS, FARSIGHTEDNESS, AND ASTIGMATISM USING INTRALASE TM TECHNOLOGY BY AMJAD KHOKHAR, M.D. CONSENT FOR INTRALASIK CORRECTION OF NEARSIGHTEDNESS, FARSIGHTEDNESS, AND ASTIGMATISM USING INTRALASE TM TECHNOLOGY BY AMJAD KHOKHAR, M.D. INDICATIONS AND PROCEDURE This information is being provided to

More information

We look forward to see you & thanks for trusting us your eyes to us.

We look forward to see you & thanks for trusting us your eyes to us. MEDICATIONS VIGAMOX (OCUFLOX) PURPOSE PREVENTS INFECTION DOSAGE USE 1 DROP 4 TIMES DAILY STARTING 1 DAY PRIOR TO SURGERY VALIUM (Diltiazem 5 mg) AMBIEN (ZOLPIDEM) RESTASIS (if prescribed) Provides relaxation

More information

Shawn R. Klein, MD Klein & Scannapiego MD PA

Shawn R. Klein, MD Klein & Scannapiego MD PA Shawn R. Klein, MD Klein & Scannapiego MD PA Patient Authorization for Laser Vision Correction Surgery 1. General information The following information is intended to help you make an informed decision

More information

LASIK Consent Form. Diagnosis: You have been diagnosed with myopia (nearsightedness) or hyperopia (farsightedness), with or without astigmatism.

LASIK Consent Form. Diagnosis: You have been diagnosed with myopia (nearsightedness) or hyperopia (farsightedness), with or without astigmatism. 2305 GENOA BUSINESS PARK DR. SUITE 250, BRIGHTON, MI 48114 (810) 494-2020 (OFFICE), (810) 494-0127 (FAX) LASIK Consent Form 1. General Information The following information is intended to help you make

More information

TABLE OF CONTENTS: LASER EYE SURGERY CONSENT FORM

TABLE OF CONTENTS: LASER EYE SURGERY CONSENT FORM 1 BoydVision TABLE OF CONTENTS: LASER EYE SURGERY CONSENT FORM Risks and Side Effects... 2 Risks Specific to PRK... 3 Risks Specific to LASIK... 4 Patient Statement of Consent... 5 Consent for Laser Eye

More information

LASEK / PRK Consent Form

LASEK / PRK Consent Form 2305 GENOA BUSINESS PARK DR. SUITE 250, BRIGHTON, MI 48114 (810) 494-2020 (OFFICE), (810) 494-0127 (FAX) LASEK / PRK Consent Form 1. General Information The following information is intended to help you

More information

790 Montclair Road Suite 100 Birmingham, Alabama 35213 P. 205.592.3911 www.alabamavisioncenter.com

790 Montclair Road Suite 100 Birmingham, Alabama 35213 P. 205.592.3911 www.alabamavisioncenter.com ALABAMA VISION CENTER PRICE M. KLOESS, M.D. ANDREW J. VELAZQUEZ, M.D. 790 Montclair Road Suite 100 Birmingham, Alabama 35213 P. 205.592.3911 www.alabamavisioncenter.com PHOTOREFRACTIVE KERATECTOMY PRE-OPERATIVE

More information

ALABAMA VISION CENTER

ALABAMA VISION CENTER ALABAMA VISION CENTER Price M. Kloess, MD Andrew J. Velazquez, MD 7191 Cahaba Valley Road, Suite 203 Birmingham, Alabama 35242 888-841-EYES www.alabamavisioncenter.com LASIK PRE-OPERATIVE INSTRUCTIONS

More information

INFORMED CONSENT FOR PHAKIC IMPLANT SURGERY

INFORMED CONSENT FOR PHAKIC IMPLANT SURGERY INFORMED CONSENT FOR PHAKIC IMPLANT SURGERY INTRODUCTION This information is being provided to you so that you can make an informed decision about having eye surgery to reduce or eliminate your nearsightedness.

More information

Consent for LASIK (Laser In Situ Keratomileusis) Retreatment

Consent for LASIK (Laser In Situ Keratomileusis) Retreatment Consent for LASIK (Laser In Situ Keratomileusis) Retreatment Please read the following consent form very carefully. Please initial at the bottom of each page where indicated. Do not sign this form unless

More information

PATIENT CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK)

PATIENT CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK) INTRODUCTION: You have been diagnosed with myopia (nearsightedness) or hyperopia (farsightedness) with or without astigmatism, or astigmatism alone. Myopia is a result of light entering the eye and focusing

More information

Long Island Vision Experts

Long Island Vision Experts GENERAL INFORMATION Long Island Vision Experts 2 Lincoln Avenue, Suite 401 Rockville Centre, NY 11570 (516) 763-4106 INTACS INFORMED CONSENT Intacs (Keratoconus) The following information is intended to

More information

INFORMED CONSENT FOR LASER REFRACTIVE EYE SURGERY

INFORMED CONSENT FOR LASER REFRACTIVE EYE SURGERY INFORMED CONSENT FOR LASER REFRACTIVE EYE SURGERY INTRODUCTION LASER IN-SITU KERATOMILEUSIS (LASIK) and PHOTOREFRACTIVE KERATECTOMY (PRK) This information is being provided to you so that you can make

More information

INFORMED CONSENT FOR PRK SURGERY

INFORMED CONSENT FOR PRK SURGERY INFORMED CONSENT FOR PRK SURGERY Please read the following consent form carefully. Please initial each page where indicated. Do not sign this from unless you read and understand each page. Patient s Name:

More information

Explanation of the Procedure

Explanation of the Procedure Informed Consent Cataract Surgery with Intraocular Lens Implant Please initial below indicating that you have read and understand each section Introduction The internal lens of the eye can become cloudy

More information

INFORMED CONSENT FOR PHAKIC LENS IMPLANT SURGERY

INFORMED CONSENT FOR PHAKIC LENS IMPLANT SURGERY INTRODUCTION INFORMED CONSENT FOR PHAKIC LENS IMPLANT SURGERY This information is being provided to you so that you can make an informed decision about having eye surgery to reduce or eliminate your nearsightedness.

More information

Congratulations! You have just joined the thousands of people who are enjoying the benefits of laser vision correction.

Congratulations! You have just joined the thousands of people who are enjoying the benefits of laser vision correction. Dear Valued Patient, Thank you for choosing Shady Grove Ophthalmology for your laser vision correction procedure. Our excellent staff is committed to offering you the highest quality eye care using state

More information

Excimer Laser Eye Surgery

Excimer Laser Eye Surgery Excimer Laser Eye Surgery This booklet contains general information that is not specific to you. If you have any questions after reading this, ask your own physician or health care worker. They know you

More information

INFORMED CONSENT FOR LASIK AND PRK SURGERY

INFORMED CONSENT FOR LASIK AND PRK SURGERY INFORMED CONSENT FOR LASIK AND PRK SURGERY Please read the following very carefully. Please initial each page where indicated. Do not sign this form unless you read and understand each page. Patient s

More information

UCLA LASER REFRACTIVE CENTER INFORMED CONSENT

UCLA LASER REFRACTIVE CENTER INFORMED CONSENT UCLA LASER REFRACTIVE CENTER INFORMED CONSENT LASER ASSISTED IN SITU KERATOMILEUSIS (LASIK) GENERAL INFORMATION The following information is intended to help you make an informed decision about having

More information

INFORMED CONSENT LASER IN SITU KERATOMILEUSIS (LASIK)

INFORMED CONSENT LASER IN SITU KERATOMILEUSIS (LASIK) Edward C. Wade, M. D Christopher D. Allee, O. D. Ting Fang-Suarez, M. D. Jill Autry, O. D. Mark L. Mayo, M. D. Amanda Bachman, O. D. Randall N. Reichle, O. D Julie Ngo, O. D. INFORMED CONSENT LASER IN

More information

INFORMED CONSENT FOR PHOTOREFRACTIVE KERATECTOMY (PRK)

INFORMED CONSENT FOR PHOTOREFRACTIVE KERATECTOMY (PRK) INFORMED CONSENT FOR PHOTOREFRACTIVE KERATECTOMY (PRK) This information and the Patient Information booklet must be reviewed so you can make an informed decision regarding Photorefractive Keratectomy (PRK)

More information

On Your Day of Surgery:

On Your Day of Surgery: Please review all instructions for your Lasik/ASA procedure carefully. Call our office (425-899-2020) with any questions you may have before the day of your procedure. If you are a gas permeable or hard

More information

Informed Consent Enhancement Laser In Situ Keratomileusis (Lasik)

Informed Consent Enhancement Laser In Situ Keratomileusis (Lasik) Edward C. Wade, M. D Christopher D. Allee, O. D. Ting Fang-Suarez, M. D. Jill Autry, O. D. Mark L. Mayo, M. D. Amanda Bachman, O. D. Randall N. Reichle, O. D. Julie Ngo, O. D. 6565 West Loop South Suite

More information

Risks and Limitations of LASIK Procedure

Risks and Limitations of LASIK Procedure Drs. Fine, Hoffman & Packer, LLC 1550 Oak Street, Suite #5 Eugene, OR 97401 541-687-2110 From Drs. Fine, Hoffman, & Packer Risks and Limitations of LASIK Procedure Infection, serious injury, or even death,

More information

INFORMED CONSENT FOR PHOTOREFRACTIVE KERATECTOMY (PRK)

INFORMED CONSENT FOR PHOTOREFRACTIVE KERATECTOMY (PRK) 1550 Oak St., Suite 5 1515 Oak St., St Eugene, OR 97401 Eugene, OR 97401 (541) 687-2110 (541) 344-2010 INFORMED CONSENT FOR PHOTOREFRACTIVE KERATECTOMY (PRK) This information is to help you make an informed

More information

PATIENT CONSENT FORM LASER VISION CORRECTION GENERAL

PATIENT CONSENT FORM LASER VISION CORRECTION GENERAL PATIENT CONSENT FORM LASER VISION CORRECTION GENERAL I. Introduction This Patient Consent Form is provided to help you to make an informed decision about the following types of laser vision correction

More information

Refractive errors are caused by an imperfectly shaped eyeball, cornea or lens, and are of three basic types:

Refractive errors are caused by an imperfectly shaped eyeball, cornea or lens, and are of three basic types: Tips on Lasik Eye Surgery If you re tired of wearing glasses or contact lenses, you may be considering Lasik eye surgery one of the newest procedures to correct vision problems. Before you sign up for

More information

LASIK CONTRAINDICATIONS:

LASIK CONTRAINDICATIONS: Left Eye Right Eye INFORMED CONSENT FOR LASER IN-SITU KERATOMILEUSIS (LASIK) FOR THE CORRECTION OF NEARSIGHTEDNESS, FARSIGHTEDNESS, AND ASTIGMATISM ** Please don t sign this until you are asked to by our

More information

LASIK. What is LASIK? Eye Words to Know. Who is a good candidate for LASIK?

LASIK. What is LASIK? Eye Words to Know. Who is a good candidate for LASIK? 2014 2015 LASIK What is LASIK? LASIK (laser in situ keratomileusis) is a type of refractive surgery. This kind of surgery uses a laser to treat vision problems caused by refractive errors. You have a refractive

More information

Vision Correction Surgery Patient Information

Vision Correction Surgery Patient Information Vision Correction Surgery Patient Information Anatomy of the eye: The eye is a complex organ composed of many parts, and normal vision requires these parts to work together. When a person looks at an object,

More information

Bladeless LASIK and PRK

Bladeless LASIK and PRK Bladeless LASIK and PRK Bladeless LASIK and PRK The specialists at North Shore-LIJ Laser Vision Correction understand how valuable your sight is to you, which is why we use the safest, most advanced technology

More information

Consent for Bilateral Simultaneous Refractive Surgery PRK

Consent for Bilateral Simultaneous Refractive Surgery PRK Consent for Bilateral Simultaneous Refractive Surgery PRK Please sign and return Patient Copy While many patients choose to have both eyes treated at the same surgical setting, there may be risks associated

More information

WAKE FOREST BAPTIST HEALTH EYE CENTER. LASIK Consent Form

WAKE FOREST BAPTIST HEALTH EYE CENTER. LASIK Consent Form 1 WAKE FOREST BAPTIST HEALTH EYE CENTER LASIK Consent Form 1. GENERAL INFORMATION The following information is intended to help you make an informed decision about having Laser In-Situ Keratomileusis (LASIK).

More information

Is LASIK for Me? A Patient s Guide to Refractive Surgery

Is LASIK for Me? A Patient s Guide to Refractive Surgery Is LASIK for Me? A Patient s Guide to Refractive Surgery October 2008 Is LASIK for Me? A Patient s Guide to Refractive Surgery Table of Contents LASIK: A COMPREHENSIVE GUIDE... 2 Introduction... 2 What

More information

LASIK EPILASIK FEMTOSECOND LASER. Advantages

LASIK EPILASIK FEMTOSECOND LASER. Advantages LASIK EPILASIK FEMTOSECOND LASER Advantages There are many advantages to having laser vision correction. Laser vision correction gives most patients the freedom to enjoy their normal daily activities without

More information

Tucson Eye Care, PC. Informed Consent for Cataract Surgery And/Or Implantation of an Intraocular Lens

Tucson Eye Care, PC. Informed Consent for Cataract Surgery And/Or Implantation of an Intraocular Lens Tucson Eye Care, PC Informed Consent for Cataract Surgery And/Or Implantation of an Intraocular Lens INTRODUCTION This information is provided so that you may make an informed decision about having eye

More information

LASIK What is LASIK? Am I a good candidate for LASIK? What happens before surgery? How is LASIK done?

LASIK What is LASIK? Am I a good candidate for LASIK? What happens before surgery? How is LASIK done? LASIK What is LASIK? Laser assisted in situ keratomileusis, or LASIK, is an outpatient surgical procedure used to treat myopia (nearsightedness), hyperopia (farsightedness), and astigmatism. With LASIK,

More information

PRK CONTRAINDICATIONS:

PRK CONTRAINDICATIONS: Left Eye Right Eye INFORMED CONSENT FOR PHOTOREFRACTIVE KERATECTOMY (PRK) FOR THE CORRECTION OF NEARSIGHTEDNESS, FARSIGHTEDNESS, AND ASTIGMATISM WITH OR WITHOUT MITOMYCIN ** Please don t sign this until

More information

Informed Consent For Photorefractive Keratectomy (PRK)

Informed Consent For Photorefractive Keratectomy (PRK) Edward C. Wade, M. D Christopher D. Allee, O. D. Ting Fang-Suarez, M. D. Jill Autry, O. D. Mark L. Mayo, M. D. Amanda Bachman, O. D. Randall N. Reichle, O. D Julie Ngo, O. D. 6565 West Loop South Suite

More information

LASER VISION CORRECTION SURGERY A GUIDE FOR PATIENTS. Professional care for your eye health

LASER VISION CORRECTION SURGERY A GUIDE FOR PATIENTS. Professional care for your eye health LASER VISION CORRECTION SURGERY A GUIDE FOR PATIENTS Professional care for your eye health Contents About Dr John Males... 1 COMMON QUESTIONS How does an eye work?... 2 What is Myopia (short sightedness)...

More information

ROCKWALL EYE ASSOCIATES

ROCKWALL EYE ASSOCIATES ROCKWALL EYE ASSOCIATES Edward P. Hurst, M.D. Claire Y. Chu, M.D. PHOTO-REFRACTIVE KERATOMILEUSIS (PRK) SECTION 1: GENERAL INFORMATION It is our intention to fully inform you concerning side effects, limitations,

More information

LASIK. Cornea. Iris. Vitreous

LASIK. Cornea. Iris. Vitreous LASIK Introduction LASIK surgery is a procedure that improves vision and can decrease or eliminate the need for eyeglasses or contact lenses. If you and your doctor decide that LASIK surgery is right for

More information

WHAT IS A CATARACT, AND HOW IS IT TREATED?

WHAT IS A CATARACT, AND HOW IS IT TREATED? 4089 TAMIAMI TRAIL NORTH SUITE A103 NAPLES, FL 34103 TELEPHONE (239) 262-2020 FAX (239) 435-1084 DOES THE PATIENT NEED OR WANT A TRANSLATOR, INTERPRETOR OR READER? YES NO TO THE PATIENT: You have the right,

More information

Important Information

Important Information Important Information CONDUCTIVE KERATOPLASTY (Also Known as CK) FOR THE CORRECTION OF HYPEROPIA (FARSIGHTEDNESS) AND/OR PRESBYOPIA (NEED FOR READING GLASSES AFTER 40) AND/OR ASTIGMATISM ON-LABEL USE and

More information

Daniel F. Goodman, M.D. 2211 Bush Street, 2nd Floor San Francisco, CA 94115 Phone: 415-474-3333 Fax: 415-474-3939

Daniel F. Goodman, M.D. 2211 Bush Street, 2nd Floor San Francisco, CA 94115 Phone: 415-474-3333 Fax: 415-474-3939 Daniel F. Goodman, M.D. 2211 Bush Street, 2nd Floor San Francisco, CA 94115 Phone: 415-474-3333 Fax: 415-474-3939 INFORMED CONSENT FOR LASIK (LASER IN SITU KERATOMILEUSIS) and PRK (PHOTOREFRACTIVE KERATECTOMY)

More information

PLACE LETTERHEAD HERE AND REMOVE NOTE. VERISYSE TM PHAKIC IMPLANT SURGERY Anne M. Menke, R.N., Ph.D. OMIC Risk Manager

PLACE LETTERHEAD HERE AND REMOVE NOTE. VERISYSE TM PHAKIC IMPLANT SURGERY Anne M. Menke, R.N., Ph.D. OMIC Risk Manager PLACE LETTERHEAD HERE AND REMOVE NOTE Note: This form is intended as a sample form of the information that you as the surgeon should personally discuss with the patient. Please review and modify to fit

More information

Informed Consent for Refractive Lens Exchange (Clear Lens Extraction)

Informed Consent for Refractive Lens Exchange (Clear Lens Extraction) Informed Consent for Refractive Lens Exchange (Clear Lens Extraction) This form is designed to ensure that you have all the information you need to make a decision about whether or not you wish to undergo

More information

Wang Vision Institute 1801 West End Avenue Nashville, TN 37203 615/321-8881

Wang Vision Institute 1801 West End Avenue Nashville, TN 37203 615/321-8881 Wang Vision Institute 1801 West End Avenue Nashville, TN 37203 615/321-8881 The purpose of this consent for is to educate you on the Phototherapeutic Keratectomy (PTK) and Photorefractive Keratectomy (PRK)

More information

Dr. Booth received his medical degree from the University of California: San Diego and his bachelor of science from Stanford University.

Dr. Booth received his medical degree from the University of California: San Diego and his bachelor of science from Stanford University. We've developed this handbook to help our patients become better informed about the entire process of laser vision correction. We hope you find it helpful and informative. Dr. Booth received his medical

More information

LASIK FAQ Prepared by Mulqueeny Eye Centers: mulqueenyeyecenters.com

LASIK FAQ Prepared by Mulqueeny Eye Centers: mulqueenyeyecenters.com LASIK FAQ Prepared by Mulqueeny Eye Centers: mulqueenyeyecenters.com Is LASIK surgery safe? Next to cataract surgery, LASIK surgery is fast becoming the most performed eye procedure in the world and today

More information

Informed Consent for Cataract Surgery and/or Implantation of an Intraocular Lens (IOL)

Informed Consent for Cataract Surgery and/or Implantation of an Intraocular Lens (IOL) Bruce H. Brumm, MD, PC 6751 North 72 nd Street, Ste 105 Omaha, NE 68122 (402) 572-2020 800-775-5909 www.brummeye.com Informed Consent for Cataract Surgery and/or Implantation of an Intraocular Lens (IOL)

More information

1801 West End Avenue Suite 1150 Nashville, TN 37203, USA Office: 615.321.8881 Fax: 615.321.8874

1801 West End Avenue Suite 1150 Nashville, TN 37203, USA Office: 615.321.8881 Fax: 615.321.8874 1801 West End Avenue Suite 1150 Nashville, TN 37203, USA Office: 615.321.8881 Fax: 615.321.8874 T he purpose of this consent form is to educate you on the bladeless (Intralase) LASIK procedure. It is not

More information

CATARACT AND LASER CENTER, LLC

CATARACT AND LASER CENTER, LLC CATARACT AND LASER CENTER, LLC Patient Information Date: Patient Name: M F Address: Street City State Zip Home Phone: Work Phone: Cell Phone: E-Mail : Referred by: Medical Doctor: Who is your regular eye

More information

LASIK or PRK, the identified surgery, is referred to as the Procedure in the following:

LASIK or PRK, the identified surgery, is referred to as the Procedure in the following: At LASIK MD, we strongly believe that you should have all of the necessary information on-hand in order to make an informed decision about your procedure. The content of this consent form is not intended

More information

The LASIK experience WHO CAN HAVE LASIK? SELECTING A SURGEON

The LASIK experience WHO CAN HAVE LASIK? SELECTING A SURGEON The LASIK experience I WHO CAN HAVE LASIK? To be eligible for LASIK you should be at least 21 years of age, have healthy eyes and be in good general health. Your vision should not have deteriorated significantly

More information

LASER CENTER PRK PATIENT PACKET PLEASE BRING BACK WITH YOU THE DAY OF YOUR SURGERY PRE-OPERATIVE INSTRUCTIONS PLEASE REVIEW CAREFULLY

LASER CENTER PRK PATIENT PACKET PLEASE BRING BACK WITH YOU THE DAY OF YOUR SURGERY PRE-OPERATIVE INSTRUCTIONS PLEASE REVIEW CAREFULLY LASER CENTER PRK PATIENT PACKET PLEASE BRING BACK WITH YOU THE DAY OF YOUR SURGERY PRE-OPERATIVE INSTRUCTIONS PLEASE REVIEW CAREFULLY WHAT TO EXPECT THE DAY OF YOUR SURGERY POST-OPERATIVE INSTRUCTIONS

More information

LASIK. clipboar calculat creditca eye check camera location PATIENT INFO PACKET. Patient Info. Fee Schedule. Payment Policy.

LASIK. clipboar calculat creditca eye check camera location PATIENT INFO PACKET. Patient Info. Fee Schedule. Payment Policy. LASIK PATIENT INFO PACKET Patient Info Fee Schedule Payment Policy What to Expect Informed Consent Photo Permission Our Location clipboar calculat creditca eye check camera location clipboar Patient Info

More information

SMILE SURGERY A GUIDE FOR PATIENTS. Professional care for your eye health

SMILE SURGERY A GUIDE FOR PATIENTS. Professional care for your eye health SMILE SURGERY A GUIDE FOR PATIENTS Professional care for your eye health Contents About Dr John Males... 1 Our Commitment to Our Patients... 2 COMMON QUESTIONS How Does an Eye Work?... 3 What is Myopia

More information

I have read and understood this page. Patient Initials

I have read and understood this page. Patient Initials INFORMED CONSENT FOR PHOTOREFRACTIVE KERATECTOMY (PRK) AND ADVANCE SURFACE ABLATION (ASA) This information and the Patient Information booklet must be reviewed so you can make an informed decision regarding

More information

Blade-Free Custom ilasik vision correction

Blade-Free Custom ilasik vision correction Blade-Free Custom ilasik vision correction WORLD CLASS VISION CORRECTION WORLD CLASS VISION CORRECTION WORLD CLASS VISION CORRECTION welcome to eisner laser center leading the way to better vision Imagine

More information

LASIK or PRK, the identified surgery, is referred to as the Procedure in the following.

LASIK or PRK, the identified surgery, is referred to as the Procedure in the following. Consent Form 1. I understand that I am a candidate for LASIK (LASER IN SITU KERATOMILEUSIS) SURGERY, a form of outpatient laser surgery where a surgeon will anesthetize my eye with a topical anesthetic,

More information

Blade-Free ilasik vision correction

Blade-Free ilasik vision correction Blade-Free ilasik vision correction welcome to spivack vision center leading confidence you deserve spivack vision center The Exclusive Spivack 20/20 LASIK Lifetime Commitment 20/20 commitment The Exclusive

More information

PRESBYLASIK INFORMED CONSENT FOR NEAR VISION MULTIFOCAL LASIK (LASER ASSISTED IN-SITU KERATOMILIEUSIS)

PRESBYLASIK INFORMED CONSENT FOR NEAR VISION MULTIFOCAL LASIK (LASER ASSISTED IN-SITU KERATOMILIEUSIS) !!!!!!! PRESBYLASIK INFORMED CONSENT FOR NEAR VISION MULTIFOCAL LASIK (LASER ASSISTED IN-SITU KERATOMILIEUSIS) The intent of this document is to inform you as to the nature, risks and complications of

More information

Blade-Free ilasik vision correction

Blade-Free ilasik vision correction Blade-Free ilasik vision correction welcome to spivack vision center leading confidence you deserve spivack vision center The Exclusive Spivack 20/20 LASIK Lifetime Commitment 20/20 commitment The Exclusive

More information

Informed Consent for Refractive Lens Exchange (Clear Lens Replacement)

Informed Consent for Refractive Lens Exchange (Clear Lens Replacement) Mark Packer, M.D. Informed Consent for Refractive Lens Exchange (Clear Lens Replacement) This surgery involves the removal of the natural lens of my eye, even though it is not a cataract. The natural lens

More information

Advanced Eyecare of Orange County Kim Doan, M.D. Eye Physician & Surgeon

Advanced Eyecare of Orange County Kim Doan, M.D. Eye Physician & Surgeon Advanced Eyecare of Orange County Kim Doan, M.D. Eye Physician & Surgeon Patient Information Sheet: Cataract Surgery And/Or Implantation of an Intraocular Lens This information is given to you so that

More information

...You Need to know about

...You Need to know about What......You Need to know about LASIK Our Eyes Eyes are the windows to our world. They are so important to us that for many years we have looked for better ways to fix visual problems and improve our

More information

Excimer Laser Refractive Surgery

Excimer Laser Refractive Surgery Excimer Laser Refractive Surgery In the field of ophthalmology has achieved great technological advances and, undoubtedly, the most representative have focused on refractive surgery, which aims to eliminate

More information

A Patient Guide to Cataracts and Cataract Surgery

A Patient Guide to Cataracts and Cataract Surgery A Patient Guide to Cataracts and Cataract Surgery Kelly D. Chung, M.D. Oregon Eye Specialists To schedule surgery, contact our St. Vincent Clinic: (503) 292-0848 If you would like to help save trees and

More information

INFORMED CONSENT FOR CATARACT AND LENS IMPLANT SURGERY

INFORMED CONSENT FOR CATARACT AND LENS IMPLANT SURGERY INFORMED CONSENT FOR CATARACT AND LENS IMPLANT SURGERY 1. GENERAL INFORMATION This information is given to you to help you make an informed decision about having cataract and/or lens implant surgery. Once

More information

The New Vision Confidence

The New Vision Confidence At New Vision Laser Center you get our Unlimited LASIK 20/20 Plan! The Clear Choice for Laser Vision Correction We focus on results! Our exclusive Unlimited LASIK 20/20 Money Back Guarantee Plan provides

More information

PRE-SURGERY INSTRUCTIONS

PRE-SURGERY INSTRUCTIONS Tripler Army Medical Center Refractive Surgery Center LASIK: Pre-surgery and Day of Surgery Instructions Patient Name: Preop Counseling Date: Visual Field Date: Surgery Date: Post-Op Visit: PRE-SURGERY

More information

ADVANCED SURFACE ABLATION (ASA) PRK / LASEK I.

ADVANCED SURFACE ABLATION (ASA) PRK / LASEK I. PATIENT CONSENT FORM ADVANCED SURFACE ABLATION (ASA) PRK / LASEK I. Introduction Advanced Surface Ablation, or ASA, is a permanent vision correction procedure in which tissue is removed from the surface

More information

Intended Benefits. Who Is Not Eligible For the Procedure? (Intralase Sub-Bowman s Keratomileusis)

Intended Benefits. Who Is Not Eligible For the Procedure? (Intralase Sub-Bowman s Keratomileusis) PATIENT CONSENT FORM Intralase SBK / WGA SBK (Intralase Sub-Bowman s Keratomileusis) Intralase Sub-Bowman s Keratomileusis (SBK) is a term used to describe a Laser Vision Correction procedure where a laser

More information

Please list any: allergies to medications: previous surgeries: diseases or medical conditions: medications you are currently taking:

Please list any: allergies to medications: previous surgeries: diseases or medical conditions: medications you are currently taking: 4909 S. 118th St. Omaha, NE 68137 ( 402) 397-2010 (800) 433-2015 (402) 397-8439 fax www.nebraskaeye.com Eval Meas date time Location: Omaha Sioux City Surgery date Arrival time SX time Location: Omaha

More information

Again, thank you for trusting Shady Grove Ophthalmology!

Again, thank you for trusting Shady Grove Ophthalmology! Dear Valued Patient, Thank you for choosing Shady Grove Ophthalmology for your Cataract procedure. Our excellent staff is committed to offering you the highest quality eye care using state of the art technologies.

More information

Information For Consent For Cataract Surgery

Information For Consent For Cataract Surgery Information For Consent For Cataract Surgery Your Ophthalmologist has diagnosed you with a visually significant cataract. The following handout will explain your condition and give you the information

More information

Alexandria s Guide to LASIK

Alexandria s Guide to LASIK Alexandria s Guide to LASIK A Community Service Project sponsored by: Wallace Laser Center Your Guide To A Successful LASIK Procedure The word LASIK is actually an acronym for Laser Assisted In-Situ Keratomileusis.

More information

Cataract Information for Patients

Cataract Information for Patients Cataract Information for Patients http://www.gov.pe.ca/health and click on Wait Times tab Page 1 What is a Cataract? A cataract is a clouding of the eye s naturally clear lens. When the lens becomes cloudy,

More information

PRK Wavefront Guided idesign Photorefractive Keratectomy

PRK Wavefront Guided idesign Photorefractive Keratectomy PRK Wavefront Guided idesign Photorefractive Keratectomy What is PRK? PRK (photorefractive keratectomy) is the same laser procedure as LASIK. Like LASIK it involves the use of the cool energy of an Excimer

More information

excellence innovation service collaboration compassion

excellence innovation service collaboration compassion Our Company NVISION is easily defined by its core values. We relentlessly pursue the best vision correction for our patients. NVISION understands that this is a big decision. We help you to be informed

More information

Refractive Surgery Education and Informed Consent

Refractive Surgery Education and Informed Consent Refractive Surgery Education and Informed Consent Tripler Army Medical Center Refractive Surgery Center Warfighter Refractive Eye Surgery Program (WRESP) Goals of this Briefing To explain the Warfighter

More information

Consumer s Guide to LASIK

Consumer s Guide to LASIK Consumer s Guide to LASIK A Community Service Project brought to you by Price Vision Group Your Guide To A Successful LASIK Procedure The purpose of this educational guide is to help prospective patients

More information

INFORMATION FOR PATIENTS

INFORMATION FOR PATIENTS INFORMATION FOR PATIENTS Here is a list of common questions relating to the ilasik procedure. For more information regarding safety and effectiveness, please refer to the patient information brochure at

More information

Informed Consent For Cataract Surgery And/Or Implantation of an Intraocular Lens

Informed Consent For Cataract Surgery And/Or Implantation of an Intraocular Lens Informed Consent For Cataract Surgery And/Or Implantation of an Intraocular Lens INTRODUCTION This information is given to you so that you can make an informed decision about having eye surgery. Take as

More information