Pre-Operative Instructions for LASIK

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1 Pre-Operative Instructions for LASIK Your LASIK has been scheduled for. Please arrive at at TLC Wisconsin Laser Center, 2418 Crossroads Drive, Suite 1900 (1st floor). If you have any questions regarding your procedure, call UW Health Laser Vision Correction at (608) Your Pre-operative appointment has been scheduled for Date Time 1. Discontinue wearing soft contact lenses in the operative eye two weeks before your pre-operative examination. Discontinue wearing gas permeable contact lenses one month prior to your pre-operative examination for every decade the contacts have been worn. The cornea needs this rest period for your treatment to be successful. Do not wear your contact lenses again between your pre-operative examination and the surgery date. 2. Do not wear eye make-up, facial lotions, hairspray, perfume/cologne or aftershave on the day of surgery. Make-up can be a source of infection, and fumes can interfere with the laser. 3. You may receive oral sedation on the day of surgery. Therefore: a. Make arrangements prior to your surgery for someone to drive you home. b. Do not return to work on the day of your procedure. c. Do not plan any activities for the remainder of the day. 4. On the day of surgery, plan to spend two hours with us. 5. The procedure and pre- and post-operative care fees, which total $1,000 per eye, must be paid to UW Health prior to the surgery. The facility fee of $1,100 per eye will be collected at TLC Laser Center upon arrival at TLC on the day of your surgery. 6. The only visit you will have at TLC is for the actual surgery. Your post-operative appointments have been scheduled for One Day After Surgery: One Week After Surgery: One Month After Surgery: OP a

2 Post-Operative Instructions for LASIK Day of Surgery Pred Forte (anti-inflammatory): Shake several times. Use one drop every two hours while awake. Refresh Tears (lubricating drops): Use every hour. Day 1 after Surgery Pred Forte (anti-inflammatory): Shake several times. Use one drop every two hours. Day 2 through 7 Pred Forte (anti-inflammatory): Shake several times. Use one drop every four hours. Day 7 through 14 Pred Forte (anti-inflammatory): Shake several times. Use one drop two times a day until gone (up to 14 days after surgery). Refresh Tears (lubricating drops): Use every four hours Do NOT rub or squeeze your eyes for one week! Avoid touching the tips of solution bottles to your eyes or other surfaces. Only use preservative-free lubricating drops. Do not use contact lens solutions. Allow a minute between drops to avoid washing the previous drop out. No make-up for the first week after surgery. No strenuous workouts during the first week after surgery. Avoid dirty environments for the first week after surgery. No swimming or hot tubs for the first four weeks after surgery. No driving until permitted by your eye doctor. You may shower and bathe but avoid getting water in your eyes. It is normal for your vision to be blurry and fluctuate for the first few days and to gradually improve over the next four weeks. Complete visual recovery takes at least three to six months. I have read and understand my post-operative instructions. OP b

3 Laser Vision Correction Fees: LASIK The total cost of CustomVue IntraLASIK is $2,100 per eye which is divided into three fees one for the refractive surgery procedure performed by your UW Health eye surgeon, one for pre-operative and follow-up care and one for the facility fee. Additional fees for medications may be required, depending on your pharmacy benefits plan. Specific costs and details for each of these areas are covered below: 1. Procedure Fees for CustomVue IntraLASIK $61O/eye The fee for each refractive surgery procedure covers the following: a. Surgeon s fee b. Enhancements needed within two years of initial surgery payment: The procedure fee is paid prior to surgery with cash, check, money order, VISA or MasterCard. A check or money order may be made payable to UW Health. 2. Pre-Operative and Follow-Up Fee $39O/ eye Your pre-operative and follow-up care may be performed by a UW Health eye doctor or by your family eye doctor if pre-operative arrangements are made. Services usually include an initial eye examination, corneal topography and follow-up visits over a 12-month period. payment: This fee is paid directly to the doctor who performs the above services. If this service is performed by a UW Health doctor, this fee is paid prior to surgery with payable to UW Health. If this service is performed by your family eye doctor, payment also needs to be made prior to the surgery date. Please consult with your doctor as to the form of payment required (i.e. cash, check, etc.). 3. Facility Fee $1,1OO/eye The facility fee is for use of the laser at TLC. payment: The facility fee is paid directly to TLC the day of the procedure with payable to TLC. Other Financial Resources Flexible Spending Account Your flexible spending account (pre-tax deduction) may be used to pay for. You can also arrange financing through a variety of area banks and financial institutions if needed. Insurance Coverage Patients with Unity Health Insurance receive $100 per eye discount on IntraLASIK. Most insurance companies consider an elective procedure; and therefore, the cost is not covered. Check with your insurance provider to determine your specific coverage. OP c

4 Pre-Operative Instructions for PRK Your PRK has been scheduled for. Please arrive at at TLC Wisconsin Laser Center, 2418 Crossroads Drive, Suite 1900 (1st floor). If you have any questions regarding your procedure, call UW Health Laser Vision Correction at (608) Your Pre-operative appointment has been scheduled for Date Time 1. Discontinue wearing soft contact lenses in the operative eye two weeks before your pre-operative examination. Discontinue wearing gas permeable contact lenses one month prior to your pre-operative examination for every decade the contacts have been worn. The cornea needs this rest period for your treatment to be successful. Do not wear your contact lenses again between your pre-operative examination and the surgery date. 2. Do not wear eye make-up, facial lotions, hairspray, perfume/cologne or aftershave on the day of surgery. Make-up can be a source of infection, and fumes can interfere with the laser. 3. You may receive oral sedation on the day of surgery. Therefore: a. Make arrangements prior to your surgery for someone to drive you home. b. Do not return to work on the day of your procedure. c. Do not plan any activities for the remainder of the day. 4. On the day of surgery, plan to spend two hours with us. 5. The procedure and pre- and post-operative care fees, which total $795 per eye, must be paid to UW Health prior to the surgery. The facility fee of $900 per eye will be collected at TLC Laser Center upon arrival at TLC on the day of your surgery. 6. The only visit you will have at TLC is for the actual surgery. Your post-operative appointments have been scheduled for One Day After Surgery: One Week After Surgery: One Month After Surgery: OP d

5 Post-Operative Instructions for PRK Day of Surgery Pred Forte (anti-inflammatory): Shake several times. Use one drop every four hours while awake. Ketorolac or Nepafenac: Use one drop every four hours as needed for pain. Refresh Tears (lubricating drops): Use every hour. Vicodin: Take one to two pills every four hours as needed for pain. Day 1 through 3 Pred Forte (anti-inflammatory): Shake several times. Use one drop every two hours. Ketorolac or Nepafenac: Use one drop every four hours as needed for pain. Vicodin: Take one to two pills every four hours as needed for pain. Day 4 through 7 Pred Forte (anti-inflammatory): Shake several times. Use one drop every four hours. Your bandage contact lens will be removed between day five and day seven. Once the contact lens is removed, you will start FML, one drop every four hours for one month. Do NOT rub or squeeze your eyes for one week! Avoid touching the tips of solution bottles to your eyes or other surfaces. Only use preservative-free lubricating drops. Do not use contact lens solutions. Allow a minute between drops to avoid washing the previous drop out. No make-up for the first week after surgery. No strenuous workouts during the first week after surgery. Avoid dirty environments for the first week after surgery. No swimming, hot tubs or Jacuzzis for the first four weeks after surgery. No driving until permitted by your eye doctor. You may shower and bathe but avoid getting water in your eyes. It is normal for your vision to be blurry and fluctuate for the first few days and to gradually improve over the next four weeks. Complete visual recovery takes at least three to six months. I have read and understand my post-operative instructions. OP e

6 Laser Vision Correction Fees: PRK The total cost of CustomVue PRK is $1695 per eye which is divided into three fees one for the refractive surgery procedure performed by your UW Health eye surgeon, one for pre-operative and follow-up care and one for the facility fee. Specific costs and details for each of these areas are covered below: 1. Procedure Fees for CustomVue PRK $495/eye The fee for each refractive surgery procedure covers the following: a. Surgeon s fee b. Enhancements needed within two years of initial surgery payment: The procedure fee is paid prior to surgery with cash, check, money order, VISA or MasterCard. A check or money order may be made payable to UW Health. 2. Pre-Operative and Follow-Up Fee $3OO/ eye Your pre-operative and follow-up care may be performed by a UW Health eye doctor or by your family eye doctor if pre-operative arrangements are made. Services usually include an initial eye examination, corneal topography and follow-up visits over a 12-month period. payment: This fee is paid directly to the doctor who performs the above services. If this service is performed by a UW Health doctor, this fee is paid prior to surgery with payable to UW Health. If this service is performed by your family eye doctor, payment also needs to be made prior to the surgery date. Please consult with your doctor as to the form of payment required (i.e. cash, check, etc.). 3. Facility Fee $9OO/eye The facility fee is for use of the laser at TLC. payment: The facility fee is paid directly to TLC the day of the procedure with payable to TLC. Other Financial Resources Flexible Spending Account Your flexible spending account (pre-tax deduction) may be used to pay for. You can also arrange financing through a variety of area banks and financial institutions if needed. Insurance Coverage Patients with Unity Health Insurance receive $100 per eye discount on PRK. Most insurance companies consider an elective procedure; and therefore, the cost is not covered. Check with your insurance provider to determine your specific coverage. OP f

7 City View Dr U W H e a l t h Location and Directions A LASIK procedure takes just 20 minutes, yet its benefits last for years to come. A full year of follow-up examinations and complimentary surgical enhancements for one year if needed are included with your procedure. Your LASIK surgery will take place at TLC Madison located at 2418 Crossroads Dr., Suite 1900 (1st Floor) Madison, WI Phone: (608) Fax: (608) Directions to TLC Madison Traveling on Interstate 39/90/94 If traveling north on Interstate 39/90/94 toward Wisconsin Dells, exit onto High Crossing Blvd. (Exit #135C) From exit, turn right onto High Crossing Blvd. Proceed one block to Crossroads Dr. and turn right. Continue over the hill. TLC is located in the 2418 Crossroads Building on the right. To Madison E. Washington Ave. Crossroads Dr Wall St High Crossing Blvd To Sun Prairie Nelson Rd TLC Madison 2418 Crossroads Drive If traveling south on Interstate 39/90/94 toward Janesville, exit onto U.S. Hwy. 151 toward Sun Prairie (Exit #135B). Take the first exit, Nelson Rd./High Crossing Blvd. (Exit #98A). At the stoplight, turn right onto High Crossing Blvd. Take the fourth left onto Crossroads Dr. Continue over the hill. TLC is located in the 2418 Crossroads Building on the right. Traveling on U.S. Hwy. 151 If traveling south on U.S. Hwy. 151 from Sun Prairie, exit Nelson Rd./High Crossing Blvd. (Exit #98A). Follow exit to High Crossing Blvd. and continue through the stop light. Take the fourth left onto Crossroads Dr. Continue over the hill. TLC is located in the 2418 Crossroads Building on the right. If traveling north on U.S. Hwy. 151 (E. Washington Ave.) from Madison, after you cross under Interstate 39/90/94, take the first exit, Nelson Rd./High Crossing Blvd. (Exit #98A). At the stoplight, turn right onto High Crossing Blvd. Take the fourth left onto Crossroads Dr. Continue over the hill. TLC is located in the 2418 Crossroads Building on the right. OP g

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