LASIK INFORMATION BOOKLET LASER VISION CORRECTION

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1 LASIK INFORMATION BOOKLET LASER VISION CORRECTION

2 TABLE OF CONTENTS WELCOME TO LASIK MD... 2 HOW THE EYE WORKS... 3 HOW WILL SURGERY IMPROVE MY LIFE?... 5 OUR PROCEDURES... 6 WHO IS ELIGIBLE FOR THE PROCEDURE?... 9 LIMITS TO CORRECTION POTENTIAL COMPLICATIONS PATIENT PROCESS AND PROCEDURE ARE THERE ALTERNATIVES? INFORMED CONSENT OUR COMMITMENT TO YOUR VISION CONFIRMATION OF THE PATIENT S UNDERSTANDING OF THE PROCEDURE LIB-A page 1 The infrmatin cntained in this dcument is subject t change withut ntice. Please speak t a member f ur staff fr the mst up t date infrmatin.

3 WELCOME TO LASIK MD ABOUT LASIK MD Thank yu fr chsing LASIK MD fr yur laser visin crrectin. We understand that this is an extremely imprtant decisin that will alter yur life immeasurably. Like many patients, yu may be feeling excited abut the prspect f being freed frm the dependency n glasses r cntacts, but yu may als have questins abut the prcedure that yu will be underging. In this package, we attempt t answer sme f thse questins, prviding yu with infrmatin abut the benefits, ptential cmplicatins, and steps f the prcedure. LASIK MD is a natinal prvider f laser visin crrectin. Our missin is t deliver high quality care, using the highest surgical standards and the latest technlgy, at an affrdable price. EYE CARE PROFESSIONALS At LASIK MD, ur eye care prfessinals are experienced in the pre-perative, perative and pstperative management f LASIK and PRK. Thrughut yur LASIK MD experience, yu will interact with ur highly trained staff, including ur experienced ptmetrists and surgens. Optmetrist Yur ptmetrist has attended fur years f ptmetry schl, has attained a Dctr f Optmetry degree, is trained in diagnsing and treating refractive errrs by nn-surgical means, and has experience in prviding pst-perative care fr LASIK and fr PRK. Yur ptmetrist, wh will cllabrate clsely with yur surgen t ensure the best pssible surgical result, may be able t assume respnsibility fr yur care as early as the day fllwing surgery. Surgen Yur surgen has a Dctr f Medicine (MD) degree and is experienced in the medical and surgical management f refractive errrs and eye diseases. In additin t fur years f university, yur surgen has spent fur years in medical schl, fllwed by a five-year residency in phthalmlgy. LASIK MD surgens have perfrmed ver half a millin laser visin crrectin prcedures, ffering bth LASIK (Laser Assisted In-Situ Keratmileusis) and PRK (Phtrefractive Keratectmy). LASIK and PRK are referred t, cllectively, as the prcedure in the fllwing materials, and are briefly described in the fllwing sectins. Please read all f the material in this package carefully. Remember that we prvide this package in additin t, but nt as a replacement fr direct discussins with yur eye care prfessinal. Yu may als find it helpful t cnsult ur website, at r t cntact ne f ur cnsultants at if yu have any ther questins. Als, please keep in mind that ur patient care representatives are nt trained t give a medical diagnsis r t determine the specific price f a surgery. Pricing will vary depending n yur prescriptin and the cnditin f yur eyes. Specific pricing will be given t yu fllwing a series f tests at yur pre-perative cnsultatin. LIB-A page 2 The infrmatin cntained in this dcument is subject t change withut ntice. Please speak t a member f ur staff fr the mst up t date infrmatin.

4 HOW THE EYE WORKS The eye is like a camera. The crnea is a clear, dme-shaped windw that frms the frnt wall f the eye. The retina is the tissue in the back f the eye that acts like the film in a camera. The crnea at the frnt f the eye acts as a lens that fcuses light nt the retina, prducing an image n the retina that gets transmitted t the brain and interpreted as visin. The curve f the crnea determines the pwer f the crneal lens and whether the incming light rays frm distant bjects fcus directly nt the retina. WHAT IS 20/20 VISION? 20/20 is a measurement f hw clear yur distance visin is. If yur standard visin test reprts 20/20, it means that yu are able t see clearly at 20 feet what a persn with nrmal visin can see clearly at 20 feet. On the ther hand, if yu have 20/40 visin, it means that yu need t stand as clse as 20 feet t see what a persn with nrmal visin can see clearly at 40 feet. If yu have 20/15 visin, it means yu see clearly frm 20 feet what a persn with nrmal visin can see clearly frm 15 feet, in ther wrds, yu see a little better than the typical nrmal persn. REFRACTIVE ERRORS Emmetrpia is the cnditin f the nrmal eye when parallel rays are fcused exactly n the retina and visin is perfect.when light des nt fcus directly n the retina, the eye has a refractive errr. This means that with the apprpriate refractive crrectin lens (i.e., glasses r cntact lenses), incming light rays becme fcused nt the retina prducing clear visin. Mypia (Nearsightedness) In mypia, the eye is lnger than nrmal, preventing light rays frm fcusing directly n the retina. Light rays cme tgether at a pint in frnt f the retina, and are ut f fcus n the retina. Distant bjects are blurred, while nearby bjects can be clear. Hyperpia (Farsightedness) In hyperpia, the eye is shrter than nrmal. Light rays cme tgether at a pint behind the retina, and are therefre ut f fcus n the retina. Nearby bjects can appear blurry, while distant bjects are clearer. Very farsighted patients will reprt that even distant bjects appear blurry. LIB-A page 3 The infrmatin cntained in this dcument is subject t change withut ntice. Please speak t a member f ur staff fr the mst up t date infrmatin.

5 Astigmatism In the nrmal eye, the crnea is curved the same in the hrizntal and vertical directins, like a baseball. When light rays hit the crnea, they fcus at a single pint. In astigmatism, the curve f the crnea is nt the same in the hrizntal and vertical directins. The crnea lks like a ftball, with a steep curve n ne side and a flat surface n the ther. As a result, light rays entering the crnea d nt fcus at a single pint, causing distrted visin. Mst peple with mypia r hyperpia have sme degree f astigmatism. In all f these cnditins, sme type f crrective lens, such as glasses r cntact lenses, is required t fcus the light prperly n the retina. LASIK and PRK are used t change the shape and curvature f the crnea in rder t crrect r reduce these types f refractive errrs. Changing the shape f the crnea changes the directin f light rays entering the eye s that they can fcus crrectly n the retina. Light rays fcused n the retina results in clear visin. O THER COMMON REFRACTIVE ERRORS Presbypia As we age, the natural crystalline lens f the eye may lse sme f its elasticity and thereby its ability t fcus n clse bjects. This cnditin, knwn as presbypia, usually begins arund the age f 40 and can ften be cmfrtably crrected thrugh the use f reading glasses. T learn mre abut treatments fr presbypia, ask ne f ur eye care prfessinals. LIB-A page 4 The infrmatin cntained in this dcument is subject t change withut ntice. Please speak t a member f ur staff fr the mst up t date infrmatin.

6 HOW WILL SURGERY IMPROVE MY LIFE? REDUCED DEPENDENCE ON GLASSES AND CONTACTS There are numerus ptential benefits fr patients wh underg either LASIK r PRK. Almst all f these advantages are assciated with reduced dependence n eyeglasses and/r cntact lenses. While the use f eyeglasses and/r cntact lenses can be an effective methd f crrecting refractive errr, it is als a methd that can place restrictins n nrmal, everyday activities. Fr individuals wh wear cntact lenses, laser eye surgery can als eliminate the time and effrt invlved in cleaning, remving and replacing lenses. In additin, ver time, the csts assciated with maintaining and replacing crrective lenses can be prhibitive. Many peple wh wear eyeglasses als cite csmetic r aesthetic reasns fr wanting t underg the prcedure. ENJOY AN ACTIVE LIFESTYLE Reduced dependence n crrective lenses can result in cnsiderably mre freedm fr patients with active lifestyles. Many recreatinal activities, such as water sprts r cntact sprts, can be much mre enjyable when the necessity f wearing glasses r cntacts is remved. In sme cases, patients chse laser eye surgery fr prfessinal purpses, rather than recreatinal nes. In certain fields f emplyment, crrective lenses are nt permitted. The reasns fr cntemplating laser visin crrectin vary fr every individual. Fr thse wh have required crrective lenses thrughut mst f their lives, the simple prspect f being able t drive withut wearing glasses r cntacts, r f being able t wake up and see withut putting n glasses r cntacts, may be sufficient reasn in itself. The ptential benefits, like the ptential cmplicatins, can vary, and shuld be cnsidered carefully. LIB-A page 5 The infrmatin cntained in this dcument is subject t change withut ntice. Please speak t a member f ur staff fr the mst up t date infrmatin.

7 OUR PROCEDURES LASIK Laser visin crrectin is ne f the mst ppular elective prcedures in Nrth America and the safest in the wrld. LASIK surgery began in 1990 and since that time, ver 35millin peple have undergne LASIK laser eye surgery! Peple are chsing LASIK laser visin crrectin t reduce their dependency n glasses and cntacts and regain an active lifestyle. This safe and painless prcedure generally takes less than ten minutes f perating rm time t treat bth eyes. In fact, the laser is used fr an average f less than 20 secnds per eye. LASIK laser eye surgery can be used t crrect nearsightedness (mypia), farsightedness (hyperpia), and astigmatism. LASIK MD ffers the mst advanced technlgy in laser visin crrectin. We use sphisticated diagnstic imaging t accurately evaluate yur candidacy. During the prcedure, ur advanced laser technlgy allws fr increased accuracy and precisin. LASIK MD clinics are utfitted with the newest generatin laser platfrms including Bausch & Lmb, Visx CustmVue and Wavelight Allegett. Our cmmitment is t ffer prven technlgy t achieve the best pssible results. At LASIK MD, ur experienced team f prfessinals will recmmend treatment ptins best suited t yur needs: LASIK and PRK, including standard and advanced custm wavefrnt technlgies. STANDARD LASIK LASIK is a frm f eye surgery in which a surgen uses a precise flap-making instrument, t create a thin flap f crneal tissue. This flap is raised and laid back while still attached t the crnea. The surgen then uses a state-f-the-art excimer laser t remve a pre-determined amunt f crneal tissue frm the expsed bed f the crnea. The amunt f tissue t be remved is calculated based n the preperatively determined pwer f yur eye; these measurements are usually in agreement with recent prescriptins fr yur glasses and/r cntact lenses. The flap is replaced, and within minutes natural frces hld the flap dwn n the crnea. Usually, within a few hurs, the surface layer f the crnea (epithelium) begins t grw ver the edge f the flap t seal it int psitin. Within days, cllagen bnds frm within the crnea arund the edge f the flap, sealing it. LASIK can be used t crrect nearsightedness (mypia), farsightedness (hyperpia), and astigmatism. Please nte that sme LASIK MD clinics acrss Canada are equipped with a Femtsecnd Laser. This laser is used t create the crneal flap, thereby making Standard LASIK an All-Laser LASIK prcedure. As with all technlgies that LASIK MD ffers, please cnsult yur lcal LASIK MD clinic fr guidance. A cmprehensive cnsultatin will determine what treatment is the best fr yu. LIB-A page 6 The infrmatin cntained in this dcument is subject t change withut ntice. Please speak t a member f ur staff fr the mst up t date infrmatin.

8 ADVANCED CUSTOM WAVEFRONT LASIK Advanced Custm Wavefrnt LASIK allws fr further custmizatin f the standard LASIK prcedure, ften resulting in clearer and sharper visin.if yu have a high prescriptin, thin crneas and larger than average pupils, then Advanced Custm Wavefrnt LASIK may be best suited fr yur eyes and needs. Rest assured that whatever treatment ptin yu chse, yu have the experience and expertise f yur surgen t ensure the best pssible visin results. Please nte that sme LASIK MD clinics acrss Canada are equipped with a Femtsecnd Laser. This laser is used t create the crneal flap, thereby making Advanced Custm Wavefrnt LASIK an All-Laser LASIK prcedure. As with all technlgies that LASIK MD uses, please cnsult yur lcal LASIK MD clinic fr guidance. A cmprehensive cnsultatin will determine what treatment is the best fr yu. THE ADVANCED CUSTOM WAVEFRONT LASIK ADVANTAGES: Mre Patients Are Candidates Advanced Custm Wavefrnt LASIK allws fr the crrectin f mre patients, including thse with higher prescriptins, and even thse wh may have been deemed nn-candidates in the past. Better Quality f Visin This advanced technlgy can, in many cases, imprve the quality f bth day and night visin cmpared t standard treatments. The laser is capable f treating peple with larger pupils and is better fr night time visin quality. It als minimizes the risk f night time glare and hales. Advanced Custm Wavefrnt LASIK results in a crneal shape that is clser t the nrmal curvature f the natural eye, prviding better quality fr bth day and night visin. Increased Accuracy and Safety fr Better Results Advanced Custm Wavefrnt LASIK remves 20%-30% less crneal tissue, which is healthier and safer fr the eye. Advanced Custm Wavefrnt LASIK is als particularly beneficial fr patients with thinner than average crneas, larger pupils and higher prescriptins. LIB-A page 7 The infrmatin cntained in this dcument is subject t change withut ntice. Please speak t a member f ur staff fr the mst up t date infrmatin.

9 STANDARD PRK PRK, first perfrmed in 1987, is a frm f eye surgery in which a surgen remves the surface layer f the crnea (called the epithelium) and then reshapes the crneal bed with the laser in the same way as LASIK. This technique is usually used fr peple whse crnea may be t thin t safely allw fr the creatin f the crneal flap required fr LASIK. PRK may als be recmmended fr patients wh tend t rub their eyes. Frequent eye rubbing can cause the crneas t becme sfter ver time. PRK can be a safer ptin in such circumstances. On the day f yur preperative evaluatin yur Eye Care Prfessinal will determine if yu have sft crneas and recmmend the treatment that is safest fr yu. The prcedure is used t crrect nearsightedness (mypia), farsightedness (hyperpia) and astigmatism. ADVANCED CUSTOM WAVEFRONT PRK Advanced Custm Wavefrnt PRK allws fr further custmizatin f the standard PRK prcedure, ften resulting in even clearer and sharper visin. If yu have a higher prescriptin, thin crneas and largerthan-average pupils, then the Advanced Custm Wavefrnt PRK is prbably the prcedure that is best suited fr yur eyes and needs. Rest assured that whatever yu chse, yu can rely n the experience and expertise f yur surgen t ensure the best pssible visin results. THE ADVANCED CUSTOM WAVEFRONT PRK ADVANTAGES: Mre Patients Are Candidates Advanced Custm Wavefrnt PRK allws fr the crrectin f mre patients, including thse with higher prescriptins, and even thse wh may have been deemed nn-candidates in the past. Better Quality f Visin This advanced technlgy can, in many cases, imprve the quality f bth day and night visin cmpared t standard treatments. The laser is capable f treating peple with larger pupils and is better fr night time visin quality. It als minimizes the risk f night time glare and hales. Advanced Custm Wavefrnt PRK results in a crneal shape that is clser t the nrmal curvature f the natural eye, prviding better quality fr bth day and night visin. Increased Accuracy and Safety fr Better Results Advanced Custm Wavefrnt PRK remves 20%-30% less crneal tissue, which is healthier and safer fr the eye. Advanced Custm Wavefrnt PRK is als particularly beneficial fr patients with thinner than average crneas, larger pupils and higher prescriptins. LIB-A page 8 The infrmatin cntained in this dcument is subject t change withut ntice. Please speak t a member f ur staff fr the mst up t date infrmatin.

10 WHO IS ELIGIBLE FOR THE PROCEDURE? Over 99% f LASIK patients are between 18 and 70 years f age. Patients wh are 17 years ld may be candidates fr the prcedure, but require parental cnsent. In sme cases, patients ver 70 years f age may als be candidates fr laser visin crrectin, but this wuld usually nly fllw cataract surgery. Other factrs such as the general health f yur eyes will be examined at the pre-perative assessment. Certain cnditins may make yu a pr candidate fr the prcedure r cause additinal risks r cmplicatins. At LASIK MD, a thrugh and cmprehensive eye exam is perfrmed at yur pre-p cnsultatin t ensure that yu are a gd candidate. If yu have r may have any f the cnditins listed belw, we suggest that yu discuss them thrughly with yur eye care prfessinal, as they culd interfere with the healing prcess and require additinal care. Thse cnditins include, but are nt limited t: Eye inflammatin r infectin Severely dry eyes Certain rheumatlgical cnditins (e.g. lupus, rheumatid arthritis) Excessive crneal disease r scarring Degenerative disease f the crnea Diabetes with advanced retinal disease Inadequate crneal tissue Please nte that pregnant wmen are NOT eligible fr surgery and that the medicatin used t dilate the pupils is nt recmmended fr administratin t pregnant wmen. If yu are pregnant we ask that yu ntify us upn scheduling yur pre-perative cnsultatin. Wmen wh are breastfeeding ARE eligible fr LASIK. LIB-A page 9 The infrmatin cntained in this dcument is subject t change withut ntice. Please speak t a member f ur staff fr the mst up t date infrmatin.

11 LIMITS TO CORRECTION The prcedure des nt crrect the visin defects listed belw, which d nt arise frm refractive errrs. Patients with such cnditins may be subject t additinal risks and side effects and shuld discuss their cnditin with us befre deciding whether t have the prcedure. Cataracts A cataract is a cnditin that, if nt treated, can cause reduced visin. It is crrectable by cataract surgery. Neither LASIK nr PRK will prevent cataracts, r reverse the effect f a cataract that is beginning t appear. Please refer t fr mre infrmatin n this cnditin. Amblypia Amblypia, r lazy eye, is a medical cnditin that develps in early childhd, where a persn with reduced visin in ne eye relies n the ther eye t fcus. LASIK r PRK will nt reduce r eliminate amblypia. The visin in the amblypic eye will nt becme better than what is achieved with glasses. If the patient experiences side effects r cmplicatins frm the prcedure in the better eye he r she culd experience a lss f visin because the gd eye wuld n lnger be able t cmpensate fr the lazy eye. Strabismus Strabismus is an eye disrder caused by a weakness in the eye muscles, in which the eyes may nt be aligned prperly. LASIK r PRK will nt crrect, reduce, eliminate r prevent strabismus. Patients with certain types f strabismus are nt eligible fr laser visin crrectin. Presbypia As we age, the crystalline lens f the eye lses its ability t change shape r fcus n nearby bjects (prcess called accmmdatin) This cnditin, knwn as presbypia, usually begins arund the age f 40, and can be crrected thrugh the use f reading glasses. When farsighted peple develp presbypia, LASIK r PRK will imprve their near visin, but reading glasses will still be required. LASIK r PRK will nt prevent the need fr reading glasses in patients ver frty years f age. LIB-A page 10 The infrmatin cntained in this dcument is subject t change withut ntice. Please speak t a member f ur staff fr the mst up t date infrmatin.

12 POTENTIAL COMPLICATIONS Like any surgical prcedure, LASIK and PRK invlve the risk f less than perfect results, cmplicatins, r even serius injury frm unfreseen causes. Althugh the vast majrity f ur patients experience a significant imprvement in their visin, we cannt prmise r guarantee that the prcedure will be 100% effective r make yur visin better than it was befre the prcedure. There is a slight pssibility that the prcedure r a cmplicatin arising frm the prcedure culd cause yur visin t be blurred, dubled, distrted, t have hals r ther disturbances, including permanent lss f visin, and that these wuld NOT be crrectable with glasses r cntact lenses. In the event that a cmplicatin ccurs, yur surgen will discuss and ffer yu advice n further treatment, which may invlve medicatin r mre surgery. In sme rare instances, additinal surgery may be needed in the frm f a crneal transplant. In additin, althugh excimer laser eye surgery has nw been perfrmed regularly since 1990, very lngterm effects f the prcedure (greater than 20 years) are unknwn. Althugh it is nt pssible t list every ptential risk r cmplicatin that may result frm the prcedure, the mst imprtant nes are described belw. Please nte that serius cmplicatins are very rare and that the vast majrity f ur patients are highly satisfied with the results f their prcedure. INTRA-OPERATIVE COMPLICATIONS Shrt Flap A shrt (r incmplete) flap ccurs when the precisin flap-making instrument cannt cmplete its mvement. As a result, the flap that is made is t small, leaving insufficient space fr the laser treatment t be perfrmed. The flap is simply repsitined and the laser is nt perfrmed. In the unlikely event that a shrt flap ccurs, the recmmendatin is t wait anywhere frm three (3) t six (6) mnths befre making a new flap. Alternatively, PRK can be safely perfrmed ne (1) mnth after the shrt flap ccurred. Despite a slightly increased risk f a flap prblem in cmparisn t an eye that has never had a shrt flap, the fllw-up prcedure remains very safe. At LASIK MD, the ccurrence f shrt flaps is apprximately 1 in 2,000 prcedures. Thin Flap A thin flap r buttnhle ccurs when the precisin flap-making instrument creates a thinner than nrmal flap. As a result, the flap that is made is t thin t safely perfrm the laser treatment. In the unlikely event that a thin flap ccurs, the recmmendatin is t wait between three (3) and six (6) mnths befre making a new flap. Alternatively, PRK can be safely perfrmed ne (1) mnth after the thin flap ccurred. Despite a slightly increased risk f a flap prblem in cmparisn t an eye that has never had a thin flap, the fllw-up prcedure remains very safe. At LASIK MD, the ccurrence f thin flaps is apprximately 1 in 2,000 prcedures. Free Flap A free flap (r cap) ccurs when the flap becmes detached frm the crnea. This cmplicatin is extremely rare with mdern technlgy. In rder t ensure perfect alignment nce the laser treatment is cmplete, the surgen marks the crnea befre creating the flap. The visual utcmes fr LASIK with a free flap are therefre typically the same as LASIK with a nrmal flap. Depending n the situatin, the surgen may chse t cntinue the laser treatment befre realigning the flap. At LASIK MD, the ccurrence f a free flap is apprximately 1 in 50,000 prcedures. LIB-A page 11 The infrmatin cntained in this dcument is subject t change withut ntice. Please speak t a member f ur staff fr the mst up t date infrmatin.

13 Equipment Malfunctin The precisin flap-making instrument and excimer laser are maintained accrding t the specificatins f the manufacturer. Bth pieces f equipment have emergency battery pwer supplies t cmplete the prcedure if electricity is lst at any time. Despite this regular maintenance, the precisin flap-making instrument r the excimer laser culd malfunctin, requiring the prcedure t be stpped befre cmpletin. In sme instances, this malfunctin may result in a rescheduling f the prcedure, pssible damage t the crnea and/r a lss f visin. This ccurrence is very rare. At LASIK MD, n patient has suffered a lss f visin related t equipment malfunctin. POST-OPERATIVE COMPLICATIONS Flap Wrinkles It is pssible that a flap may disldge r shift slightly in the first few hurs after the peratin. If the flap mves, it can ccasinally leave small wrinkles n the surface. These wrinkles are easily remved by the surgen when they are fund. Abut 1% f patients may need t have wrinkles remved the day after surgery, withut any visual significance. Even if left lng-term, wrinkles rarely becme permanent and visin-affecting. Debris under the Flap A small amunt f debris r particles may be fund under the flap after the surgen has cmpleted the LASIK prcedure. Debris may result frm the instruments used r cnsist f tear-film il r flating material that is usually present in everyne s eyes. The surgen may decide in the immediate pstperative perid t irrigate beneath the flap t remve this debris, which is generally f n visual significance. Flap Inflammatin Apprximately 5-10% f patients experience a very mild t mild, temprary inflammatry reactin beneath the flap. This cnditin is called Diffuse Lamellar Keratitis (als knwn as DLK ). Patients with this type f inflammatin may nt shw any symptms at all r may experience blurred visin. This cnditin can generally be treated successfully with anti-inflammatry medicatin. In certain instances, irrigatin under the flap is necessary, if the inflammatin is severe. Very rarely, if the cnditin is nt treated effectively in a timely fashin, crneal scarring can result in sme lss f visin. At LASIK MD, the incidence f scarring due t DLK is apprximately 1 in 100,000. Infectin As with any surgical prcedure, infectin f the crnea is pssible. Infectins after LASIK prcedures are typically treated with antibitics and usually d nt lead t permanent lss f visin. Severe infectin, even if successfully treated with antibitics, culd lead t permanent scarring and lss f visin that may require crrective laser eye surgery r, if the infectin is very severe, a crneal transplantatin. The chance f this ccurrence is extremely rare. The incidence f infectin at LASIK MD is 1 in 50,000. This incident rate is significantly mre favurable than the knwn incidence f infectin f 1 in 2000 per year with cntact lenses (1% rate ver a 20-year perid f cntact lens wear). Hals, Starbursts After the prcedure, sme patients may experience an ptical effect called a hal r a starburst arund lights at night r in dim light. These effects are fr the mst part temprary, typically lasting between tw (2) weeks t three (3) mnths after surgery. These symptms ccur due t residual water in the eyes that is eventually absrbed. Glare and hals may be permanent in 1-2% f patients and these cmplicatins are mre likely t ccur in patients with high levels f nearsightedness, farsightedness r with larger-thanaverage pupil size. This cmplicatin is rare with mdern technlgy. New lasers allw fr treatment sizes larger than the patient s pupils. LIB-A page 12 The infrmatin cntained in this dcument is subject t change withut ntice. Please speak t a member f ur staff fr the mst up t date infrmatin.

14 Irregular Crneal Shape (Ectasia) Certain crneas are genetically pre-dispsed t be weaker than ther crneas f the same thickness. A minimum amunt f crneal tissue (after the laser treatment remves tissue) is always left under the flap fr the crneal shape t remain stable. In rare instances where the crnea is pre-dispsed t be weaker r sfter than the average crnea, the tissue that is left under the flap is nt strng enugh t maintain stability. This can lead t ectasia, a cnditin characterized by prgressive crneal thinning, and a prgressive change in shape, resulting in astigmatism and blurred visin.the chance f ectasia in a nrmal eye underging laser eye surgery is 1 in 5,000. This rate cmpares favurably with a knwn incidence rate in the ppulatin f sft crneas that bend n their wn (withut surgery) f 1 in 1,000. Histrically, this change in crneal shape required patients t wear a hard cntact lens r in sme cases, underg a crneal transplant. Tday, ectasia is treatable with crneal cllagen crss-linking (CXL) and pssibly a further laser treatment. Due t the develpment f CXL, the pssibility f requiring a crneal transplant due t ectasia after laser visin crrectin is very rare. Light Sensitivity and Fluctuating Visin Patients may be sensitive t light and glare r find that their visual acuity fluctuates after the prcedure. These cnditins are typically temprary and gradually fade with time as the eye heals and stabilizes. These cnditins rarely remain permanent. Fr PRK patients, light sensitivity is cmmn fr a few days and smetimes weeks after surgery and will rarely persist fr lnger than a mnth. Fr All-Laser LASIK patients, there is a slightly higher rate f light sensitivity. Optical Imbalance This prblem can apply if the surgen perfrms the prcedure fr each eye n different days. The eyes may nt be able t balance and fcus prperly until the prcedure is perfrmed n the secnd eye because there will be a prescriptin difference between the tw eyes. Under-crrectin, Over-crrectin and Regressin In sme cases, the exact remval f tissue perfrmed by the laser is verridden by the healing respnse f the eye, which varies frm ne individual t anther. While laser treatment is designed t cmpletely neutralize refractive errrs f the eye (unless therwise discussed with the surgen), a variatin in the healing prcess can affect the treatment accuracy and result in an ver- r under-crrectin. A mre prnunced healing pattern can als cause regressin, which is a partial decrease f the effect f the treatment, as the crnea replaces sme f the tissue remved by the laser. Typically, a maximum f ne (1) t tw (2) dipters can regress, meaning that the patient has a small remaining prescriptin which still blurs the visin. The residual nearsightedness, farsightedness and/r astigmatism can be crrected with glasses, cntact lenses r additinal laser surgery in the majrity f patients. A minrity f patients may nt be able t safely underg laser re-treatment, mst likely due t insufficient crneal tissue (thin crnea befre surgery), r irregular crneal shape. In cases with very small amunts f regressin, the risks f re-treatment may utweigh the ptential visual benefit t the patient. If re-treatment is nt recmmended by the surgen, sme peple may find that a very mild eyeglass prescriptin is necessary fr driving, especially at night. Fragility n Impact The crneal flap is cnsidered fragile t direct trauma fr at least the first three (3) mnths after the prcedure. When participating in sprts r any ther activities invlving pssible cntact with the eye during this perid, yu shuld wear prtective eyewear. It is always advisable t prtect yur eyes frm direct trauma after the prcedure. LIB-A page 13 The infrmatin cntained in this dcument is subject t change withut ntice. Please speak t a member f ur staff fr the mst up t date infrmatin.

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