LASIK INFORMATION BOOKLET LASER VISION CORRECTION

Transcription

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.

15 Strabismus Patients with pre-existing eye balance prblems (the tw eyes are nt aligned) may have a deteriratin f their symptms, smetimes even resulting in duble visin. This cmplicatin is rare and ccurs nly in patients with pre-existing balance prblems. Surface Skin Ersin When making the crneal flap, an abrasin might ccur n the uter surface f the crnea. This abrasin means that the surface skin has been scratched ff. Patients with crneal abrasins may experience mre discmfrt, and a lnger recvery perid. They may als be at higher risk fr further cmplicatins, including inflammatin, recurrent ersins r flap wrinkles. Depending n the size and severity f the abrasin, the surgen might delay the surgery in the ther eye. A cntact lens may be placed in the eye t help with the healing. Mst abrasins heal within ne (1) t three (3) days. With the newer Zer Cmpressin Keratme (ZCK), this cmplicatin ccurs in less than 1 in 1,000 cases. Surface Skin Cells under the Flap Crneal surface skin cells can smetimes grw under the edge f the flap, a cnditin knwn as epithelial ingrwth. The vast majrity f these cells reabsrb and disappear n their wn. Hwever, if the cells cntinue t grw, they may affect visin. The surgen may decide t lift the flap and remve these unwanted cells. This cmplicatin is very rare after a first prcedure. It is mre cmmnly seen after an enhancement (3%), when the flap is lifted a secnd time. Dry Eyes Dry eyes are a cmmn, yet typically temprary cmplicatin arising frm LASIK r PRK. This cnditin can usually be treated with lubricating eye drps and ccasinally with temprary inserts r Cmfrt Plugs that prevent the nrmal drainage f tears int the nse. Dry eyes generally imprve within a few mnths after surgery, but in rare instances can cntinue fr lnger perids f time, and may require lngterm use f lubricant drps and Cmfrt Plugs. Patients wh have dry eyes prir t LASIK r PRK are mre likely t experience dry eyes after the prcedure. Excessive Crneal Scarring Called Haze (fr PRK patients) After PRK, a mild crneal scarring reactin is part f the nrmal healing prcess. It gradually subsides with little r n permanent effect n visin. Hwever, if the scarring is excessive r des nt g away, it can affect visin. The patient may need additinal surface treatment t remve the scar. Excessive scarring is usually assciated with higher levels f crrectin. This cmplicatin is much less cmmn tday as medicatins are used t prevent it. At LASIK MD, the incidence f significant scarring that affects visin is under 1 in 1,000. Other Side Effects Other pssible side effects include drug reactin and the appearance f flaters in the visin. Anther side effect that is f n visual cnsequence is that red areas may appear n the white part f the eye, due t bruising that may last fr tw (2)t fur (4) weeks after surgery. Other Extremely Rare Cmplicatins Other risks include retinal bleeding and crnea perfratin. Althugh extremely rare, blindness resulting frm laser visin crrectin is theretically pssible in cases invlving a severe eye infectin that is nt cntrlled with antibitics. These cmplicatins have never ccurred at any LASIK MD centre and are nt knwn t have ccurred since mdern LASIK techniques were develped (1997). Apprximately 1.4 millin laser visin crrectin prcedures were perfrmed just last year alne, in Nrth America. Fr cmparative purpses, the risk f infectin frm daily sft cntact lens wear is 1 in 100 ver a 20-year perid f lens use. Thus, the risk f infectin frm cntact lens use is 500 times greater than that f LASIK, which has an infectin rate f 1 in prcedures (LASIK MD rate ). LIB-A page 14 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.

16 PATIENT PROCESS AND PROCEDURE STEP 1 PREPARING FOR YOUR PRE-OPERATIVE ASSESSMENT IMPORTANT INFORMATION FOR INDIVIDUALS WHO WEAR CONTACT LENSES Cntact lenses can mld the crneal surface, which changes the crneal curvature and may lead t a change in yur refractin (prescriptin). In rder t prperly calculate the treatment t crrect yur refractive errr, yu will have t stp wearing cntact lenses at sme stage prir t yur appintments. In time, the crnea will return t its natural shape and size. LASIK MD is dedicated t prviding yu with the mst accurate treatment, which can nly be achieved if the crneal surface is stable and back t its natural shape. Fr the vast majrity f patients, the minimum recmmended length f time fr the remval f cntact lenses shuld suffice. Hwever, the individual rate f crneal adjusting may vary. If yur crnea is still adjusting at the pre-perative appintment, yu will be required t reschedule yur surgery appintment fr a later date. LASIK MD cannt reimburse fr time ff wrk, htel, airline tickets r any ther expenses incurred due t rescheduling. Remval f Cntact Lenses Prir t the Pre-Operative Evaluatin and Surgery Appintments TYPE OF LENS WORN Lcal Patient Out-f-Twn Patient Sft Lenses 1 (daily wear, extended and tric) Rigid Gas Permeables (wrn fr less than 20 years) Rigid Gas Permeables (wrn fr years) Rigid Gas Permeables (wrn fr mre than 30 years) Hard Lenses (tric and true/ Plymethyl methacrylate) Minimum 24 hurs* Minimum 4 weeks Minimum 4 weeks Minimum 4 weeks Minimum 4 weeks Minimum 24 hurs* Minimum 6 weeks Minimum 8 weeks Minimum 12 weeks Minimum 12 weeks D nt sleep with cntact lenses fr (ne) 1 week befre the pre-perative evaluatin. The difference in the lengths f time t remve cntact lenses listed in the chart ensures that mst ut-f-twn patients are nt incnvenienced by rescheduling f appintments if crneal mlding is apparent. Medical evidence suggests that the likelihd f an enhancement is reduced the lnger a patient has had their cntact lenses ut. 1 A minimum f 24 hurs f sft cntact lenses remval is adequate fr the majrity f patients. On ccasin, hwever, we find that the eyes are red and irritated with sme inflammatin, during the pre-perative exam. These symptms are due t wearing cntact lenses fr lng perids f time. The dctr may advise t have a secnd evaluatin with cntact lenses remved fr ne week befre surgery is bked. The dctr may als prescribe anti-inflammatry drps befre surgery can be perfrmed. This ccurrence is nt cmmn. Hwever it is imprtant that patients are aware f this pssible cnditin. LIB-A page 15 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.

17 HOW TO PREPARE Cnsult the Cntact Lens Plicy t determine the minimum length f time cntact lenses need t be remved. A dilatin f the pupils may be perfrmed. Eyes may be sensitive t light, s please bring a pair f sunglasses. It may als result in blurred visin, particularly fr near wrk, fr fur (4) t six (6 hurs afterwards. Please nte 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 preperative cnsultatin. In cnsideratin f ther patients and t ensure yur visit is as cmfrtable as pssible, please d nt bring children with yu t the centre. The duratin f yur stay will be apprximately tw (2) t three (3) hurs. Yu may nt be able t return t wrk after the evaluatin. Yu may have a pre-perative evaluatin dne with yur wn eye care prfessinal at yur expense. Hwever, if yu are having a pre-perative evaluatin dne with yur wn dctr, yu are still required t have a cmplete pre-perative assessment at ur centre befre yur surgery. We are unable t cnfirm yur candidacy fr LASIK r PRK until ur tests are cmpleted. LASIK MD will nt be held respnsible fr any additinal csts incurred as a result f a lngerthan-planned stay. This can include, but is nt limited t: any csts fr travel and r accmmdatin; lst emplyment incme; expenses incurred due t the patient being deemed a nn-candidate; requiring enhancements; additinal fllw-ups r delays; rescheduling due t surgen availability; equipment malfunctin; acts f Gd, etc. STEP 2 DAY OF THE PRE-OPERATIVE ASSESSMENT PATIENT INFORMATION When yu arrive at LASIK MD, ur receptinist will greet yu and ask yu t fill ut a patient infrmatin sheet. This sheet cntains questins pertaining t yur health, t medicatins that yu may be taking, and ther useful infrmatin that will help us create yur prfile. THE PRE-OPERATIVE EXAM Yu will be taken t ur pre-perative rm where we will cnduct a series f simple tests. There is n discmfrt r pain. Depending n yur prescriptin, we may need t dilate yur pupils. If s, yur eyes will be sensitive t light. Please bring a pair f sunglasses with yu t the appintment. We recmmend that yu d nt drive lng distances immediately after the appintment. Please nte that the majrity f patients have their eyes dilated. Based n this infrmatin, we will then cnduct a cmplete eye exam, the results f which will enable us t determine yur candidacy. At this time, we will als determine the best treatment fr yu and will further explain the recmmended visin crrectin prcedure, and prvide yu with precise, surgeryspecific pricing. LIB-A page 16 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.

18 STEP 3 PREPARING FOR SURGERY Yu can expect t feel nervus, anxius r excited prir t yur prcedure. This is a cmpletely natural, nrmal respnse. Cnsult the Cntact Lens Plicy t determine the minimum length f time cntact lenses must be remved. On yur surgery date, please refrain frm wearing perfume, clgne r any prduct cntaining heavy fragrances (ltin, cream, fabric sftener, etc.). Please d nt use any prduct that cntains alchl such as hair spray, musse, perfume and after-shave. Wear cmfrtable clthing n yur surgery day. Please d nt wear clthing such as wl r fleece that may generate lint in the surgical suite. There are generally n restrictins n eating r taking medicatins befre r n yur surgery day, hwever, please advise us f any medicatins yu are taking. There are n restrictins n having a pacemaker during yur surgery. It is imprtant nt t wear eye make up fr at least 24 hurs befre and fr ne week after surgery. Fr yur security, the prcedure may be pstpned if makeup is detected. We recmmend that yu avid cnsuming alchl n the day f yur surgery, as this tends t dehydrate the tissues and can delay the healing prcess. In cnsideratin f thers, and t ensure that yur visit is as cmfrtable as pssible, we ask that yu nt bring children t the centre. The duratin f yur visit will be apprximately (fur) 4 hurs. Please be aware that yur eyes will be irritated and light sensitive fllwing the prcedure. This usually diminishes within 24 hurs after surgery. We d nt advise driving shrt distances fr at least 24 hurs and lng distances fr apprximately three (3) days after LASIK and seven (7) days after PRK. Please arrange alternative transprtatin fr after yur surgery. Depending upn yur ccupatin, yu may need t arrange t be away frm wrk fllwing yur surgery. Cnsult ur Time Off Wrk infrmatin sheet fr a detailed list f expected times fr different ccupatins. If traveling frm utside Canada, please remember t carry prper identificatin such as yur passprt and/r ther prf f citizenship. Laser visin crrectin is a medical prcedure and, as such, there is a pssibility that yu might need t extend yur stay due t the healing prcess f yur eyes. In this case, any additinal travel and/r accmmdatin fees will be yur respnsibility. If yu chse t have pst-perative care with yur wn eye care prfessinal at yur expense, please bk yur appintments prir t yur surgery date, and be prepared t give ur centre the name f the eye care prfessinal respnsible fr yur fllw-up care. Yur fllw-up visits shuld take place at ne (1) t tw (2) weeks, and ne (1) t three (3) mnths fllwing LASIK, with additinal visits required fr PRK. Patients having their prcedure in British Clumbia are required by the prvincial Cllege f Physicians and Surgens t have a respnsible adult accmpany them, as well as prvide transprtatin t and frm bth the surgery day appintment and the 24 hur appintment. LASIK MD will be bligated t reschedule the surgery appintment if this requirement is nt met. Our Patient Care Centre will be happy t prvide yu with referrals fr travel and accmmdatins, althugh these remain yur respnsibility. LIB-A page 17 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.

19 STEP 4 DAY OF SURGERY VERIFICATION OF PRESCRIPTION Befre yu underg yur laser eye surgery, we will verify yur eye prescriptin and measure yur pupils t ensure the accuracy f results. If yu wear cntact lenses, please refer t ur Cntact Lens Plicy abut hw lng befre the visin crrectin surgery yu shuld remve yur cntact lenses SURGICAL COUNSELLING Prir t surgery, we will explain the different steps yu are abut t g thrugh, prviding yu with all f the necessary pst-perative instructins, such as hw t use the eye drps, etc. Yu will als be asked t sign a cnsent frm (please refer t ur Infrmed Cnsent sectin fr mre infrmatin n the infrmed cnsent prcess). Finally, we will ensure that payment has been made and will schedule an appintment fr yur mandatry 24-hur pst-perative assessment. T help yu relax befre yur surgery, yu can request a mild sedative which is cmmnly used fr shrt term management f nervusness. If yu request this sedative, the length f yur surgery day visit will increase slightly. *Please nte that fr US LASIK MD lcatins, patients will be ffered a prescriptin fr a mild sedative during the pre-perative evaluatin prir t the day f surgery. THE SURGERY Yu will be escrted t the perating rm and prepped fr the prcedure. Yu and yur surgen will again discuss the prcedure yu are abut t underg. Feel free t ask yur surgen any additinal questins. Finally, the surgery takes place. The prcedure generally requires ten minutes f perating rm time fr bth eyes, during which the laser is used n average fr less than 20 secnds n each eye. Still, the actual duratin f the prcedure may vary accrding t the type and amunt f crrectin needed. LASIK PROCEDURE (STANDARD AND ADVANCED CUSTOM WAVEFRONT) The LASIK prcedure utilizes a precisin flap-making instrument, in additin t a device called an excimer laser. The prcedure reshapes the crnea by remving tissue frm its middle layer. Befre the prcedure begins, eye drps are used t numb yur eyes. While yu relax n the treatment bed, yur eyelids are gently held pen and the precisin instrument is carefully psitined. Yu will be asked t fcus n a special fixatin light. The surgen activates a precisin instrument electrnically and secnds later is able t fld away a crneal flap, revealing the middle layer f the crnea. The crnea is reshaped by the laser and the crneal flap is then repsitined. Natural frces hld the flap in place until surface healing is cmplete. The LASIK prcedure ffers extremely fast recvery: within hurs f the surgery, the flap has usually begun t heal. Mst patients are able t resume day-t-day activities just 24 hurs after the surgery. Yu will receive a prescriptin fr eye drps t use fr five (5) days after surgery. Yu must als wear sunglasses at night t prevent rubbing yur eyes fr the first tw nights after surgery. LIB-A page 18 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.

20 PRK PROCEDURE (STANDARD AND ADVANCED CUSTOM WAVEFRONT) The PRK technique is used fr peple whse crnea may be t thin r t sft t allw fr the creatin f the crneal flap required fr the LASIK prcedure. During PRK, a small area n the crneal uter surface is gently plished away, renewing skin cells n the surface. The laser reshapes the crneal surface in exactly the same way as the LASIK prcedure. In very few cases, smene may chse the PRK prcedure if their prfessin causes them t be at much greater risk f getting hit in the eye and causing a LASIK flap mvement (e.g. bxers, martial artists, wrestlers). After the PRK prcedure, yur surgen will place a sft cntact lens n the crnea t prtect the eye and reduce discmfrt while healing. The cntact lens will be remved after the initial surface healing is cmplete, usually within five days f the prcedure. Yur visin will gradually imprve during the first tw weeks, and in mst patients, stabilizes between fur t eight weeks after surgery. The surgen will prescribe eye drps t take during this perid. Fr the first few days after either prcedure, yu are likely t experience sme degree f discmfrt. During this time, yur visin may be blurry and/r may fluctuate between being clear and being blurry. In sme cases, a patient s visin imprves immediately after the prcedure, but later becmes blurry. These cnditins affect patients differently. The final utcmes f PRK and LASIK are very similar; the difference is the healing time. Yu shuld nt drive fr at least 24 hurs after either prcedure and in n event shuld yu drive until yur visin is clear. LIB-A page 19 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.

21 AFTER THE PROCEDURE Frty-five minutes t an hur after yur surgery, we will examine yur crnea. After surgery, yu will be given a plastic, blue LASIK MD card with all yur pre-perative infrmatin. Please keep this card as it may be imprtant in the future. Wear the sunglasses prvided. Fllw the eye drp regimen recmmended by the surgen. Please refer t the Activity Schedule given t yu at the clinic. It is very imprtant nt t rub r squint yur eyes fr a full week after surgery. In rder t allw adequate time fr yur eyes t recver, we recmmend that yu anticipate taking the fllwing number f days ff wrk fllwing yur surgery. Please nte that these are recmmended guidelines and that it is pssible t return t wrk earlier if yur visin is gd enugh. Sme patients return as early as the next day! LOW RISK (N dust r irritants, n risk f eye trauma, i.e. any type f ffice wrk) MEDIUM RISK (Mild dust r irritants, mild risk f eye trauma) HIGH RISK (Mderate dust r irritants, mderate risk f eye trauma) Up t Tw (2) days Fur (4) days One (1) week STEP 5 POST-OPERATIVE CARE Please remember that yur fllw-up care is as imprtant as the actual prcedure. LASIK (STANDARD AND ADVANCED CUSTOM WAVEFRONT) Fllwing yur LASIK prcedure, yu will be required t attend the fllwing pst-perative examinatins: 1) 24 hrs (must be dne at LASIK MD) 2) 1 t 2 weeks 3) 1 mnth 4) Any additinal pst-p visits we determine t be necessary PRK (STANDARD AND ADVANCED CUSTOM WAVEFRONT) Fllwing yur PRK prcedure, yu will be required t attend the fllwing pst-perative examinatins: 1) 24 hrs (must be dne at LASIK MD) 2) Every ther day fr the first 4 t 5 days fllwing yur surgery 3) 1 t 2 weeks 4) 1 mnth 5) Any additinal pst-p visits that we determine t be necessary The first mnth f pst-perative examinatins are cvered in the cst f surgery. Additinal appintments may be required. Please ask abut ur Visin Care Plans. If yu chse t use yur wn eye care prfessinal, yur dctr will require pst-perative frms. After yur 24-hur pst-perative appintment yu will receive, via fax r mail r in persn, yur refractive surgical reprt and pst-p frm fr yur wn eye care dctr. Fr patients wh chse t have pst-perative care with their wn eye care prfessinal, LASIK MD will nt be respnsible fr any additinal charges. LASIK MD will nt reimburse either the patient r dctr fr any additinal charges. LIB-A page 20 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.

22 ARE THERE ALTERNATIVES? LASIK and PRK are elective surgical prcedures. There is n medical cnditin r emergency cnditin requiring that yu have LASIK r PRK. They d nt crrect all levels f refractive errr and are nt fr everyne. We cannt guarantee that LASIK r PRK will imprve yur visin, r that they will eliminate yur need fr glasses r cntact lenses. After the prcedure, yu may still need glasses r cntact lenses fr sme purpses, either immediately after the prcedure r years later. It is als remtely pssible that yur visin will nt remain stable, either because the prcedure leads t shrt-term and lng-term changes in the crnea r because yur eyes may change ver time. There are alternative methds f crrectin available, including the fllwing: Eyeglasses Eyeglasses are safe and mst peple can wear them reasnably well. Hwever, depending n the nature f the crrectin, the lenses may be thick, reduce r increase the size f the visual image, and impair peripheral visin. Als, patients usually begin t experience the need fr reading glasses as they age. The mst cmmn slutin t this prblem is bifcal lenses, which can be suitable fr sme patients, but can create a difficult transitin fr thers. Cntact Lenses Cntact lenses are anther nn-surgical alternative. Cntact lenses cme in a variety f materials. Cmfrt, effectiveness, and ease f use varies. Since cntact lenses rest directly n the crnea, nt everyne is able t tlerate them. If fitted and used prperly, cntact lenses are effective, relatively safe and easy t use. Cmplicatins arising frm the use f cntact lenses include allergic reactins, infectins, scratches, ulcers, ther injuries t the crnea, and even blindness. RLE Refractive Lens Exchange is fr individuals aged between 45 and 75 years ld. This prcedure is a pssible alternative fr nearsighted and farsighted patients. It can als be used t crrect lens pacities, and, in certain cases, sme astigmatism and presbypia. RLE invlves the remval f the internal lens f the eye. This lens is then replaced by an implanted ne f crrect refractive pwer t eliminate the need fr glasses. PRESBYOPIA PROCEDURES Presbypia prcedures are perfrmed in rder t imprve clse visin after the age f frty (40) Multifcal Intracular Lenses Multifcal Intracular Lenses are used t crrect presbypia thrugh the RLE prcedure. These state-fthe-art intracular lenses allw the patient t see bth near and far, significantly reducing and ften eliminating the need fr reading glasses. This special type f lens mimics the functin f the natural lens in yung peple (under age 40), simulating "accmmdatin". Mnvisin Mnvisin is a frm f treatment fr presbypia. One eye is fully crrected fr distance visin, while the ther is under crrected. This will leave the under-crrected eye with a mildly mypic prescriptin (nearsighted) fr near visin. This small amunt f mypia allws a presbypia patient t see clearly up clse, and therefre can avid r reduce the need fr reading glasses. LIB-A page 21 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.

23 INFORMED CONSENT Yu have the right t cnsent t r refuse any treatment r prcedure at any time prir t its perfrmance. Cnsent is a prcess that invlves many steps. Please remember that we are available t help address yur cncerns, s d nt hesitate t ask questins. STEPS OF THE CONSENT PROCESS Eye Exam During yur pre-perative evaluatin, we will examine yur eyes t determine if yu are a candidate fr LASIK r PRK, accrding t criteria set by the surgen. We will then prvide yu with an explanatin f the prcedure, including the risks, cmplicatins, expected benefits, alternatives (if applicable), and any particular cnditins that might affect yur decisin t underg the prcedure. Surgical Cunselling Befre yur surgery, we will ensure that yu have a cpy f the LASIK Infrmatin Bklet and the cnsent frm(s). We will ask that yu review these dcuments while we are present t address any questins that yu have. After this, we will cmplete much f the infrmatin n the cnsent frm(s) with yu in preparatin fr the signing and witnessing f yur signature. Surgen T assist yu in making an infrmed decisin, yur surgen will help yu review the risks and cmplicatins specific t yu. Please ensure that yur surgen is aware if yu have unanswered questins r if yu d nt understand any tpic. Yu will als be given a specific pst-perative plan, fr which yu will als need t prvide cnsent. Yur surgen is nt required t explain risks that are extremely remte, r thse that yur surgen des nt knw abut, even if these becme knwn at a later time. Yur surgen will prvide yu with infrmatin and materials that wuld be cnsidered reasnably necessary fr a persn in yur psitin t use in deciding whether r nt t underg the prcedure. Patient Cnsent Frm If yu decide t underg the prcedure after reading this material and speaking with us, yu will need t sign the Patient Cnsent Frm(s). These specify that yu have been advised f the nature f the prcedure (its risks, benefits, alternatives), and that in deciding t have it dne, yu are making an infrmed decisin. Yu can request a cpy f yur Cnsent Frm(s). LIB-A page 22 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.

24 OUR COMMITMENT TO YOUR VISION LASIK MD ffers the ptin f purchasing several Visin Care Plans which cver the cst f enhancements and pst-perative services fr the duratin f yur plan. Criteria fr Enhancement Eligibility We recmmend that patients cmplete their pst-perative and annual exams as utlined in the LASIK Infrmatin Bklet at a LASIK MD centre, with a LASIK MD-affiliated dctr, r with yur eye care prfessinal. It is the patient s respnsibility t maintain and frward prf f these exams t the LASIK MD lcatin where they had the prcedure dne. WE LOOK FORWARD TO SEEING YOU SOON! At LASIK MD, we understand that underging laser visin crrectin is a very imprtant decisin. We are devted t helping yu and making yu feel at ease thrughut the entire prcess. Our centres are brimming with new generatin technlgy and ur dctrs have years f experience in the industry. If yu have any questins, r if yu wuld like t schedule an appintment, please cntact ur Patient Care Centre at A Patient Care Representative is available t assist yu seven days a week, and will be mre than happy t help yu. Imprve yur quality f life tday. With LASIK MD, yu will see a wrld f difference! LIB-A page 23 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.

25 CONFIRMATION OF THE PATIENT S UNDERSTANDING OF THE PROCEDURE Please circle either True r False t the statements belw t ensure that yu understand the infrmatin explained in the LASIK Infrmatin Bklet r n the LASIK MD website. 1. True False LASIK surgery will permanently change the shape f my crnea. 2. True False There are n guarantees abut the visual utcmes f the prcedure. 3. True False LASIK surgery is the nly methd t crrect my visin. 4. True False I may experience visin irregularities such as haze, hals and glare that may be permanent in certain cases. 5. True False After the prcedure, fllw-up visits are imprtant. 6. True False I may experience mild t mderate discmfrt fr fur (4) hurs after the prcedure 7. True False LASIK surgery will eliminate the need fr reading glasses when I am ver 40 years f age. 8. True False If I elect t have LASIK surgery, it is pssible t experience cmplicatins when creating the flap. Please verify yur answers with the crrect answers at the bttm right f this bx. Nte any that yu have missed. If yu wuld like t knw why yu missed any f these questins, please ask yur eye care prfessinal fr clarificatins. Answers: 1. T 2.T 3.F 4.T 5.T 6.T 7.F 8.T LIB-A page 24 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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