CONSENT FOR PHOTOTHERAPEUTIC KERATECTOMY (PTK)
|
|
- Jewel Wilkinson
- 6 years ago
- Views:
Transcription
1 CONSENT FOR PHOTOTHERAPEUTIC KERATECTOMY (PTK) Dr. Penick has described to me a procedure called Phototherapeutic Keratectomy (PTK). PTK is done by using the Excimer Laser, which is used to remove scars, smooth the surface of the cornea, treat cornea erosions, or change the shape of a cornea that has been distorted by injury or surgery. PTK removes the diseased portion of the cornea. This hopefully will improve the vision and comfort of the eye. PTK lasts anywhere from 10 seconds to 5 minutes. I will be given a topical anesthetic to help ensure that there will be little or no discomfort during the procedure. Dr. Penick will put medication in the treated eye and cover it with a contact lens. Following the procedure, there may be some degree of eye pain for a day or two, requiring medication prescribed by Dr. Penick. I understand that I must be examined closely to assure proper healing of the treated eye. Benefits: Benefits can include: relief of pain or restoration of visual function. The benefits of PTK cannot be guaranteed. It is possible the procedure will be of no benefit and may be harmful. Alternatives: Alternatives include: living with my current condition, contact lenses, stromal punctures, or selection of another surgical procedure, such as a corneal transplant. Complications and Risks: I understand that my vision may be made worse by this procedure. Complications could include: loss of sharp vision, increased corneal scarring, increased night glare, or corneal infection. Any pre-existing viral infections may reappear with the use of post-operative drops. If the eye changes such as infections or cataracts, there may be the need for additional surgery. I understand that I must be examined closely to assure proper healing of the treated eye. I understand that I may choose to live with the limitations and symptoms caused by my condition and that other surgical alternatives may be available to me. I further understand that the nature of corneal scars and irregularities are so diverse that it is not possible to go into detail on this form. I have, however, discussed with Dr. Penick the alternatives that may be available. Patient s Initials
2 Patient Consent In giving my permission for excimer laser surgery, I have been advised by Dr. Penick and understand the items listed below: 1. The surgical removal of the superficial layers of my cornea using the excimer laser has been elected by me as an alternative to other forms of corneal surgery. 2. As with all surgery, I understand the results cannot be guaranteed. 3. I understand with Phototherapeutic Keratectomy (PTK) with the excimer laser may increase my need for glasses and may require the use of corrective lenses to achieve my best vision. 4. I understand that although sharper vision and less glare are anticipated, it is possible that glare and clarity may be made worse following this procedure. 5. I understand that for those with severe corneal problems, where the surgical option for me as a corneal transplant, excimer laser PTK may not eliminate the need for a corneal transplant. 6. I understand it is impossible to state every possible complication that may occur as a result of this surgical procedure. 7. I understand that not all the beneficial effects of PTK are currently known. 8. I also understand that all the risks and complications are not known. 9. I acknowledge this disclosure of information has been made to me and that all my questions have been answered to my satisfaction by Dr. Penick. 10. I have read this form (or it has been read to me), and I fully understand the complications, risks, and benefits that can result from PTK surgery. I realize that there are no guarantees with PTK surgery. I still, however, elect to have PTK laser treatment. Patient Signature Date Witness Signature Date Physician Signature Date
3 4942 West Markham Little Rock, AR (501) BRING THIS FORM WITH YOU ON THE DAY OF YOUR SURGERY TO SIGN INFORMED CONSENT FOR PHOTOREFRACTIVE KERATECTOMY (PTK) This information and the excimer laser patient information booklet must be reviewed so that you can make an informed decision regarding PRK surgery to reduce or eliminate your nearsightedness, hyperopia, and/or astigmatism. Only you and your doctor can determine if you should have laser vison correction based on your own visual needs and medical considerations. Any situation and needs should be directed to your doctor. IN GIVING MY PERMISSION FOR PRK SURGERY, I DECLARE THAT I UNDERSTAND THE FOLLOWING INFORMATION: The long-term risks and effects of PRK (Photorefractive Keratectomy) beyond 18 years are unknown. The goals of PRK are to reduce or eliminate the dependence on or need for contact lenses and/or eyeglasses; however, you should understand that with all forms of treatment, the results in each case cannot be guaranteed. For example: 1. There is no guarantee that you will completely eliminate reliance on eyeglasses and/or contact lenses, and it is possible that treatment could result in undercorrection, where some degree of near sightedness, farsightedness, or astigmatism may remain, later requiring the use of glasses or contact lenses. 2. The treatment may also result in overcorrection causing hyperopia (farsightedness), undercorrection (myopia), or astigmatism that may, or may not, later require the use of glasses or contact lenses. 3. If you currently need reading glasses, then you will probably still need reading glasses after this treatment. Discuss the monovision treatment option with your doctor. 4. Further Treatment may be necessary including a variety of eye drops, the wearing of eyeglasses or contact lenses (hard or soft), or additional refractive surgery. 5. Your best vision, even with glasses or contacts, may become worse following surgery. 6. There may be a difference in spectacle (glasses) correction between eyes, making the wearing of spectacles difficult or impossible. 7. Wearing contact lenses may be more difficult following any refractive procedures.
4 Alternatives to PRK Surgery: The alternatives include eyeglasses, contact lenses, and other refractive surgery procedures such as LASIK or Intrastromal Corneal Rings. I have been informed and understand that certain complications and side effects have been reported in the post-treatment period by patients who have had PRK and include the following: Possible short term effects of PRK surgery: the following have been reported in the short-term post-treatment period and are associated with the normal post-treatment healing process: mild discomfort or pain (first 24 to 48 hours), corneal swelling, double vision, feeling like something is in the eye, ghost images, light sensitivity, and tearing. Possible long-term complications of PRK surgery: Haze: loss of perfect clarity of the cornea, usually not affecting vison, which usually resolves over time, but may take months or years to do so. Glare: sensation produced by bright light that is greater than normal and can cause discomfort and annoyance. Halos: hazy rings surrounding bright lights may be seen, particularly at night. Loss of best-corrected vision: an increase in the inner eye pressure due to posttreatment medications, which is usually resolved by drug therapy or discontinuation of post-treatment medications. The following complications have been reported infrequently by those who have had PRK surgery: itching, dryness of the eye, or foreign body sensation of the eye; double or ghost images; eye discomfort, inflammation of the cornea or iris; persistent corneal surface defect, persistent corneal scarring or haze severe enough to effect vision; ulceration/infection; irregular astigmatism (warped corneal surface which causes distorted images); cataract; and drooping of the eyelid. I understand there is a remote change of partial or complete loss of vision in the eye that has PRK surgery. I understand that it is not possible to state every complication that may occur as a result of any of these surgical procedures. I also understand that complications or a poor outcome may manifest weeks, months, or even a year after PRK surgery. I understand that this is an elective procedure and that refractive surgery is not reversible. I understand that I may still require the use of eyeglasses or contact lenses following refractive surgery, either as a result of undercorrection, overcorrection, presboyopia (the need for bifocal or reading lenses after the age of 40), or because of monovision. Monovison correction occurs when the dominate eye is corrected for distance vision, and the non-dominant eye remains slightly undercorrected (nearsighted) in the distance. Monovision can better allow reading (near vision) unaided by using the non-dominant eye, the results being less dependent of the need for reading glasses around the age of 40.
5 The above description of monovision has been adequately explained and demonstrated to me in the advance of surgery, and I give my consent to: HAVE monovision outcome with my refractive surgery. I understand that I might still require the use of corrective eyewear following my surgery, to balance my vision between the two eyes; however, my dependence on reading glasses beyond the age of 40 should be less with this method. (Initial ). Not to have monovision outcome with my refractive surgery, choosing to have both eyes closely matched for distance correction instead. I understand that I will require the use of reading corrections following my surgery from the approximate age of 40 onward. (Initial ). FOR WOMEN ONLY: I am not pregnant or nursing. I understand that pregnancy could adversely affect my treatment results. (Initial ). My personal reasons to have PRK are as follows (i.e., I wish to have less dependence on glasses and contact lenses) I have read and understand the information in the VISX patient information booklet that has been provided to me. I have spoken with my physician who has explained PRK procedures to my satisfaction, their risks and alternatives, and has adequately answered any questions. I therefore give my consent to have PRK surgery on my (circle one) RIGHT/LEFT EYE/BOTH EYES Patient Signature Date Witness Signature Date Physician Signature Date BANDAGE SOFT CONTACT LENS: I understand that occasionally therapeutic use of a soft disposable contact lens is required following laser vision correction. My surgeon has informed me that in the unlikely even my bandage contact lens should for some reason come out of my operative eye, I am NOT to replace it with either the same lens, or any other contact lens back in my eye, as this would cause serious risk for infection. I have been instructed to reach my surgeon immediately in the even my contact comes out of my operative eye. I consent to a therapeutic bandage lens, if appropriate, as recommended, by my surgeon. PRK ON SECOND EYE BEFORE 3-MONTH WAIT RECOMMENDED BY THE FDA: I understand that the time interval between eyes undergoing PRK recommended by the FDA is three (3) months based on studies performed in the United States. I have decided that I would like to have the option of my second eye treated after my first eye has visually healed to a satisfactory level. I understand that the result in my first eye may change before 3 months, and I am willing to accept those risks. My surgeon has recommended my second eye undergo PRK sooner than 3 months after my first eye, depending on healing.
6 To help assure that you understand the information presented, please copy the following statement in your own handwriting: I understand the information presented and am willing to accept the fact that I may need glasses, contact lenses, or further surgery following my refractive eye surgery to achieve my best possible vision level. The cost of post-treatment eyeglasses or contact lenses is my responsibility. POST-OPERATIVE INSTRUCTIONS: Following surgery you will be given medications and instructions to help prevent infection and promote healing. It is imperative that you follow ALL instructions exactly as they are given to you. It is also imperative that all follow-up appointments with your eye doctor be kept as directed. Rest for the first 24 hours after surgery and do not plan any activities for the first evening. No rubbing, poking, or pushing on the eye. No swimming for 2 weeks. No eye cosmetics for 2 weeks after surgery. In signing this form you are stating that you have read this document entirely and although it contains medical terms, which you may or may not completely understand, you have had the opportunity to ask questions and have them adequately answered by your surgeon. You have also read all related materials presented to you by your surgeon. You also give your permission for medical data concerning your operation and related treatment and any video recordings of your surgery to be released to physicians and other demonstrating a need-to-know for clinical study. You are giving your permission to allow the attendance of observers while under the care of your physician, and for the photography or videotaping of your surgery for teaching purposes. I am making an informed decision in giving my permission to have PRK surgery performed on my: (circle one) RIGHT/LEFT/BOTH EYES. Patient Signature Date Witness Signature Date Physician Signature Date
INFORMED CONSENT FOR PHOTOREFRACTIVE KERATECTOMY (PRK) AND ADVANCE SURFACE ABLATION (ASA)
INFORMED CONSENT FOR PHOTOREFRACTIVE KERATECTOMY (PRK) AND ADVANCE SURFACE ABLATION (ASA) This information and the Patient Information booklet must be reviewed so you can make an informed decision regarding
More informationLASER REFRACTIVE CENTER INFORMED CONSENT DOCUMENT PERIPHERAL CORNEAL RELAXING INCISION (PCRI)
INTRODUCTION The purpose of this document is to provide written information regarding the risks, benefits and alternatives of Peripheral Relaxing Corneal Incision. This material serves as a supplement
More informationCLINIQUE LASERVUE. Informed Consent Form for Photo-Refractive Keratectomy (PRK)
CLINIQUE LASERVUE Informed Consent Form for Photo-Refractive Keratectomy (PRK) Please read the following information and consent form very carefully. Your initials indicate that you understand all of the
More informationIntraLASIK Correction Of Nearsightedness, Farsightedness and Astigmatism Using IntraLase TM Technology
IntraLASIK Correction Of Nearsightedness, Farsightedness and Astigmatism Using IntraLase TM Technology INDICATIONS AND PROCEDURE This information is being provided to you so that you can make an informed
More informationInformed Consent for Excimer Laser Surface Ablation Surgery (PRK, LASEK, epi-lasik, and others)
Informed Consent for Excimer Laser Surface Ablation Surgery (PRK, LASEK, epi-lasik, and others) Patient name (printed): Patient date of birth: Please review this information so you can make an informed
More informationPHOTOREFRACTIVE KERATECTOMY (PRK) PATIENT INFORMATION BOOKLET
616.365.5775 www.keillasik.com PHOTOREFRACTIVE KERATECTOMY (PRK) PATIENT INFORMATION BOOKLET Please read this entire booklet. Discuss its contents with your doctor so that questions are answered to your
More informationALTERNATIVES TO PHAKIC IMPLANT SURGERY
Visian ICL Consent INTRODUCTION This information is being provided to you so that you can make an informed decision about having eye surgery to reduce or eliminate your nearsightedness. Only you and your
More informationInformed IntraLASIK Consent
9201 Sunset Boulevard Suite 709 West Hollywood, CA 90069 Informed Intra Consent Phone 310. 275. 5533 Fax 310. 275. 5523 info@benjamineye.com www.benjamineye.com For the Correction of Nearsightedness, Farsightedness,
More information~ 1 ~ CLINIQUE LASERVUE. Informed Consent Form for LASIK
~ 1 ~ CLINIQUE LASERVUE Informed Consent Form for LASIK Please read the following information and consent form very carefully. Your initials indicate that you understand all of the necessary patient information
More informationINFORMED CONSENT FOR CORNEAL COLLAGEN CROSS-LINKING WITH RIBOFLAVIN (C3-R) FOR PATIENTS WITH KERATOCONUS OR CORNEAL ECTASIA
INFORMED CONSENT FOR CORNEAL COLLAGEN CROSS-LINKING WITH RIBOFLAVIN (C3-R) FOR PATIENTS WITH KERATOCONUS OR CORNEAL ECTASIA INTRODUCTION: This information is to help you make an informed decision about
More informationINFORMED CONSENT FOR LASER IN SITU KERATOMILEUSIS ( LASIK )
INFORMED CONSENT FOR LASER IN SITU KERATOMILEUSIS ( LASIK ) This information is to help you make an informed decision about having Laser In Situ Keratomileusis (LASIK), a laser vision correction procedure
More informationLASER REFRACTIVE CENTER INFORMED CONSENT DOCUMENT SMALL INCISION LENTICULE EXTRACTION (SMILE)
GENERAL INFORMATION The purpose of this document is to provide written information regarding the risks, benefits and alternatives of Small Incision Lenticule Extraction. This material serves as a supplement
More informationSAMPLE LASIK. What is LASIK? Eye Words to Know. Who is a good candidate for LASIK?
What is? is a type of refractive surgery. This kind of surgery uses a laser to treat vision problems caused by refractive errors. You have a refractive error when your eye does not refract (bend) light
More informationLASIK. What is LASIK? Eye Words to Know. Who is a good candidate for LASIK?
2014 2015 What is? (laser in situ keratomileusis) is a type of refractive surgery. This kind of surgery uses a laser to treat vision problems caused by refractive errors. You have a refractive error when
More informationPRK Wavefront Guided idesign Photorefractive Keratectomy
PRK Wavefront Guided idesign Photorefractive Keratectomy What is PRK? PRK (photorefractive keratectomy) is the same laser procedure as LASIK. Like LASIK it involves the use of the cool energy of an Excimer
More informationYou will start medications 4 hours after your procedure.
Dear Valued Patient, Dr. Roberts and staff welcome you to Shady Grove Ophthalmology. We appreciate your selection of our office for your refractive procedure. We have prepared this packet to help you make
More informationKNOW THE OPTIONS. Discover how the latest advances in vision correction can improve your sight.
KNOW THE OPTIONS. LASIK VISIAN ICL PRK Discover how the latest advances in vision correction can improve your sight. Today, you can choose from several choices of permanent vision correction procedures
More informationPre-Operative Health Questionnaire. 3. Are you currently taking any of the following medications for. glaucoma: TRAVATAN LUMIGAN XALATAN
Pre-Operative Health Questionnaire 1. Are you Diabetic? YES / NO 2. Are you currently on dialysis? YES / NO 3. Are you currently taking any of the following medications for glaucoma: TRAVATAN LUMIGAN XALATAN
More informationCLINIQUE LASERVUE Informed Consent Form for Photo-Therapeutic Keratectomy (PTK)
1 CLINIQUE LASERVUE Informed Consent Form for Photo-Therapeutic Keratectomy (PTK) Please read the following information and consent form very carefully. Your initials indicate that you understand all of
More informationWANG VISION INSTITUTE INFORMED CONSENT FOR INTACS INSERTS PRESCRIPTION INSERTS FOR TREATMENT OF PATIENTS WITH KERATOCONUS
WANG VISION INSTITUTE INFORMED CONSENT FOR INTACS INSERTS PRESCRIPTION INSERTS FOR TREATMENT OF PATIENTS WITH KERATOCONUS A. INTRODUCTION: You are being offered the opportunity to receive a medical device
More informationALABAMA VISION CENTER
ALABAMA VISION CENTER Price M. Kloess, MD Andrew J. Velazquez, MD Andrew H. Bartlett, MD 7191 Cahaba Valley Road, Suite 203 Birmingham, Alabama 35242 888-841-EYES www.alabamavisioncenter.com LASIK PRE-OPERATIVE
More informationPre-Operative Health Questionnaire. 3. Are you currently taking any of the following medications for. glaucoma: TRAVATAN LUMIGAN XALATAN
Pre-Operative Health Questionnaire 1. Are you Diabetic? YES / NO 2. Are you currently on dialysis? YES / NO 3. Are you currently taking any of the following medications for glaucoma: TRAVATAN LUMIGAN XALATAN
More informationLASIK INFORMED CONSENT INITIAL TREATMENT
LASIK INFORMED CONSENT INITIAL TREATMENT PLEASE READ THE FOLLOWING PAGES CAREFULLY AND INITIAL AND SIGN WHERE INDICATED. PLEASE DO NOT SIGN ANY SECTION THAT YOU HAVE NOT READ OR DO NOT UNDERSTAND. SECTION
More informationInformed Consent For Cataract Surgery. And/Or Implantation of an Intraocular Lens INTRODUCTION
Informed Consent For Cataract Surgery And/Or Implantation of an Intraocular Lens INTRODUCTION This information is given to you so that you can make an informed decision about having eye surgery. Take as
More informationAdvanced Eyecare of Orange County/ Kim T. Doan, M.D.
Patient Information Sheet: Cataract Surgery And/Or Implantation of an Intraocular Lens This information is given to you so that you can prepare for the discussion with your eye surgeon. This document will
More informationLASIK. Lens. Cornea. Iris. Vitreous. Macula. Retina
LASIK Introduction LASIK surgery is a procedure that improves vision and can decrease or eliminate the need for eyeglasses or contact lenses. If you and your doctor decide that LASIK surgery is right for
More informationClear Advantage Vision Correction Center INFORMED CONSENT FOR LASIK AND FEMTOSECOND LASER
Clear Advantage Vision Correction Center INFORMED CONSENT FOR LASIK AND FEMTOSECOND LASER PLEASE READ THE FOLLOWING PAGES CAREFULLY AND INITIAL AND SIGN WHERE INDICATED. PLEASE DO NOT SIGN ANY SECTION
More informationVision Correction Surgery Patient Information Form
! Vision Correction Surgery Patient Information Form The purpose of this Vision Correction Surgery Patient Information Form ( Information Form ) is to help you decide whether vision correction surgery
More informationINFORMED CONSENT FOR CATARACT SURGERY
DESERT OPHTHALMOLOGY 1180 N Indian Canyon Drive W100 Palm Springs CA 92262 35900 Bob Hope Drive Suite 205 Rancho Mirage CA 92270 Phone (760) 320-8497 Fax (760) 320-5444 INFORMED CONSENT FOR CATARACT SURGERY
More informationSAMPLE WHAT LASIK CAN DO
DECIDING ON LASIK Imagine being able to work, drive, and play sports without having to depend on glasses or contact lenses. LASIK (laser in-situ keratomileusis) may make this a reality for you. This laser
More informationDATE MRN NAME. J. Everett, MD SAMPLE. Eye Physician & Surgeon Cataract and Refractive Surgery Specialist
HENRY FORD HOSPITAL DATE Informed Consent For Restor MRN NAME (REFRACTIVE LENSECTOMY WITH A MULTI-FOCAL IMPLANT) PLEASE READ THE FOLLOWING PAGES CAREFULLY AND INITIAL AND SIGN WHERE INDICATED. PLEASE DO
More informationThe pinnacle of refractive performance.
The pinnacle of refractive performance. WaveLight REFRACTIVE PORTFOLIO Advancing REFRACTIVE SURGERY Contoura Vision sets a new standard in LASIK outcomes More than 98% of patients would choose it again.
More informationCataract Surgery: What You Must Know Before Having It Done
DAVID D. RICHARDSON, MD, INC. DAVID RICHARDSON, M.D. SAN MARINO EYE 2020 Huntington Drive San Marino, CA 91108 Telephone: (626) 289-7856 Fax: (626) 284-6532 Cataract Surgery: What You Must Know Before
More informationIS LASIK FOR ME? A Patient s Guide to Refractive Surgery
IS LASIK FOR ME? A Patient s Guide to Refractive Surgery October 2008 IS LASIK FOR ME? A Patient s Guide to Refractive Surgery TABLE OF CONTENTS LASIK: A COMPREHENSIVE GUIDE... 2 Introduction... 2 What
More informationPATIENT COUNSELING. 1
PATIENT COUNSELING www.wv-eye.com 1 Welcome West Virginia Eye Consultants provides you with the most technically advanced and compassionate care at seven convenient locations in Southern West Virginia
More informationPatient Information: laser vision correction
Consultation Document Patient Information: laser vision correction April 2016 Contents Section page 1 What is Laser Vision Correction? 3 2 What are the benefits? 3 3 How much does laser vision correction
More informationCataract Surgery: Patient Information
Cataract Surgery: Patient Information How do the Eyes Work? As light enters the eye, it first passes through the cornea the clear window of the eye. Because the cornea is curved, the light rays bend (refract).
More informationALLEGRETTO WAVE Scanning Spot LASIK Laser System
TM ALLEGRETTO WAVE Scanning Spot LASIK Laser System Patient Information Booklet Information for patients considering Laser Assisted In-Situ Keratomileusis (LASIK) Surgery Information for patients considering
More informationLaser In-situ Keratomileusis (LASIK) For the Correction of Nearsightedness, Farsightedness and Astigmatism I. Introduction II.
REV 011717 PATIENT CONSENT FORM Laser In-situ Keratomileusis (LASIK) For the Correction of Nearsightedness, Farsightedness and Astigmatism I. Introduction Laser-assisted in situ keratomileusis, or LASIK,
More informationInformed Consent For Refractive Lens Exchange (RLE) For the Correction of Hyperopia (Farsightedness) Or Myopia (Nearsightedness)
Informed Consent For Refractive Lens Exchange (RLE) For the Correction of Hyperopia (Farsightedness) Or Myopia (Nearsightedness) INTRODUCTION This surgery, called a refractive lens exchange or RLE, involves
More informationFROM CATARACTS TO CLARITY
Cathy Cataracts FROM CATARACTS TO CLARITY If you re 55 or older, you may have cataracts and not even know it. What You Need to Know Seeing Beyond the Symptoms Cataracts are one of the leading causes of
More informationThe Visian ICL Advantages
The Visian ICL Advantages Many vision correction procedures promise an improved level of vision, but few vision correction alternatives offer the quality and features found with the Visian ICL. These include:
More informationWhat are some common conditions that affect the cornea?
What are some common conditions that affect the cornea? Injuries After minor injuries or scratches, the cornea usually heals on its own. Deeper injuries can cause corneal scarring, resulting in a haze
More informationilasik/prk Experience
1 Preparing for a successful ilasik/prk Experience Our Surgeons and Staff Welcome You!! 2 Bruce J. Ballon,MD Bruce E. Wietharn, MD Natalia V. Bajenova, MD 3 Am I a good candidate for ilasik or PRK? Refractive
More informationFacts You Need to Know About the VisuMax SMILE Procedure for the Correction of Myopia. Patient Information Booklet
Facts You Need to Know About the VisuMax SMILE Procedure for the Correction of Myopia A Surgery to Reduce or Eliminate Myopia Using the Carl Zeiss VisuMax Femtosecond Laser Patient Information Booklet
More informationFacts You Need to Know About IDESIGN System Driven Laser Assisted In-Situ Keratomileusis (LASIK) Procedure for Monovision
Facts You Need to Know About IDESIGN System Driven Laser Assisted In-Situ Keratomileusis (LASIK) Procedure for Monovision Patient Information Booklet For Monovision Treatment of Presbyopic Patients with
More informationYour First Appointment:
Your First Appointment: The Important Questions to Ask When Choosing a Cataract Surgeon www.kremereyecenter.com / 866-270-2773 Cataract 1 Surgery Kremer Eye Center Table of Contents Introduction... 3 Finding
More informationFineVision lets you look at the world with a fresh pair of eyes. Learn how you can enjoy the freedom of vision without spectacles.
FineVision lets you look at the world with a fresh pair of eyes. Learn how you can enjoy the freedom of vision without spectacles. 1 finevision.com.au Iris Optic Nerve Cornea Lens Retina Vision and Ageing
More informationGuide to modern day cataract surgery
Guide to modern day cataract surgery What are Cataracts? What are Cataracts? Cataracts are a natural clouding of the lens of the eye. Cataracts form usually because of age, but there are eye injuries and
More informationALLEGRETTO WAVE TM EYE-Q Scanning Spot LASIK Laser System
ALLEGRETTO WAVE TM EYE-Q Scanning Spot LASIK Laser System Patient Information Booklet Facts You Need to Know About LASIK (Laser Assisted In-Situ Keratomileusis) Laser Treatment Information for patients
More informationCONSENT FOR CATARACT SURGERY REQUEST FOR SURGICAL OPERATION / PROCEDURE AND ANAESTHETIC
CONSENT FOR CATARACT SURGERY REQUEST FOR SURGICAL OPERATION / PROCEDURE AND ANAESTHETIC Your doctor has indicated that the condition of your eye appears stable and your cataract surgery and/or implantation
More informationMedical Affairs Policy
Medical Affairs Policy Service: Corneal Treatments and Specialized Contact Lenses (Corneal remodeling, Corneal transplant, Corneal collagen crosslinking, Intrastromal Rings- INTACS, Keratoconus treatments,
More informationPatient Information Booklet
FACTS YOU NEED TO KNOW ABOUT ADVANCED CUSTOMVUE LASER ASSISTED IN-SITU KERATOMILEUSIS (LASIK) LASER TREATMENT Patient Information Booklet For the reduction or elimination of myopia (nearsightedness) up
More informationEvolution in Visual Freedom.
Evolution in Visual Freedom. The EVO Visian ICL Advantages Many vision correction procedures promise an improved level of vision, but few vision correction alternatives offer the quality and features
More informationVisian ICL (Implantable Collamer Lens) For Nearsightedness. Facts You Need To Know About STAAR Surgical s Visian ICL SURGERY
Visian ICL (Implantable Collamer Lens) For Nearsightedness Facts You Need To Know About STAAR Surgical s Visian ICL SURGERY PATIENT INFORMATION BOOKLET For Nearsightedness (Myopia) between 3 to 20 Diopters
More informationCataract. What is a Cataract?
Cataract What is a Cataract? We all have a lens in our eye. This is positioned just behind the iris, which is the coloured ring in the eye that gives your eye its colour. The lens function is to focus
More informationOphthalmology. Ophthalmology Services
Ophthalmology Ophthalmology Services The Ophthalmology service offers the latest and most comprehensive eye care for patients. With a dedicated team of eye surgeons and consultants, we treat vision problems
More informationSummary Recommendations for Keratorefractive Laser Surgery June 2013
Summary Recommendations for Keratorefractive Laser Surgery June 2013 Background Laser assisted in-situ keratomileusis (LASIK) surgery is the most commonly performed keratorefractive surgery; altering the
More informationCORNEAL CONDITIONS CORNEAL TRANSPLANTATION
GENERAL INFORMATION CORNEAL CONDITIONS CORNEAL TRANSPLANTATION WHAT ARE CORNEAL CONDITIONS? The cornea is the clear outer layer of the eye. Shaped like a dome, it helps to protect the eye from foreign
More informationVisian Toric ICL (Implantable Collamer Lens) For Nearsightedness with Astigmatism
Visian Toric ICL (Implantable Collamer Lens) For Nearsightedness with Astigmatism Facts You Need To Know About STAAR Surgical s Visian Toric ICL SURGERY PATIENT INFORMATION BOOKLET For Nearsightedness
More informationCRESP. Cadet Refractive Eye Surgery Program. Phone COL Ava Huchun, M.D.
CRESP Cadet Refractive Eye Surgery Program Phone 845-938-2207 COL Ava Huchun, M.D. COL Ava Huchun, M.D. University of Hawaii Summa cum laude Creighton Medical School, Magna Cum Laude Madigan Internship
More informationCataract. What is a Cataract?
Cataract What is a Cataract? We all have a lens in our eye. This is positioned just behind the iris, which is the coloured ring in the eye that gives your eye its colour. The lens s function is to focus
More informationFacts You Need to Know About CustomVue Laser Assisted In-Situ Keratomileusis (LASIK) Laser Treatment
Facts You Need to Know About CustomVue Laser Assisted In-Situ Keratomileusis (LASIK) Laser Treatment Patient Information Booklet For Nearsightedness (Myopia) up to -6 D with less than -3 D Astigmatism
More informationLaser Vision Correction
Laser Vision Correction Upcoming Appointments PHONE 605-718-3937 NAME CONSULTATION WITH DOCTOR SCOTT SCHIRBER CONTACT LENSES OUT ON Contact Lenses If you are a contact lens wearer, you should remove your
More informationCataract Surgery Consent Form 1) WHAT IS A CATARACT AND HOW IS IT TREATED?
Cataract Consent Form 1) WHAT IS A CATARACT AND HOW IS IT TREATED? a) The lens in the eye can become cloudy and hard, a condition known as a cataract. Cataracts can develop from normal aging, from an eye
More informationPhone [850] Fax [850] Web Send s to: Search Millseye to download App Page 1 of 5
YAG PC (Posterior Capsulotomy) Consent Form 1) I,, hereby authorize: David M. Mills, MD, FACS and/or whomever he may designate as his assistant(s), to perform upon myself the following operation(s): YAG
More informationCorporate Medical Policy
Corporate Medical Policy Refractive Surgery File Name: Origination: Last CAP Review: Next CAP Review: Last Review: refractive_surgery 4/1981 6/2017 6/2018 6/2017 Description of Procedure or Service The
More informationMEDICAL POLICY No R3 REFRACTIVE KERATOPLASTY / LASIK
REFRACTIVE KERATOPLASTY / LASIK Effective Date: November 10, 2017 Review Dates: 7/07, 6/08, 6/09, 6/10, 8/10, 8/11, 8/12, 8/13, 8/14, 8/15, 8/16, 8/17 Date Of Origin: July 2007 Status: Current Summary
More informationFACTS YOU NEED TO KNOW ABOUT ADVANCED CUSTOMVUE LASER ASSISTED IN- SITU KERATOMILEUSIS (LASIK) LASER TREATMENT. Patient Information Booklet
FACTS YOU NEED TO KNOW ABOUT ADVANCED CUSTOMVUE LASER ASSISTED IN- SITU KERATOMILEUSIS (LASIK) LASER TREATMENT Patient Information Booklet For mixed astigmatism from 1 to 5 diopters Please read this entire
More informationCORNEAL TRANSPLANT CONSENT FORM
CORNEAL TRANSPLANT CONSENT FORM Peninsula Laser Eye Medical Group 1174 Castro Street, Ste. 100 Mountain View, CA 94040 (650) 961-2585 www.lasik2020.com Introduction The cornea is the clear dome-shaped
More informationCATARACT MICROSURGERY. BY Dr. Mark Deist
CATARACT MICROSURGERY BY Dr. Mark Deist INDEX PAGE Introduction 2 What symptoms do cataracts cause? 3 What causes Cataracts? 3 How are Cataracts treated? 3-4 What results can one expect? 4 What side effects
More informationPatient Information Cataract Surgery
Patient Information Cataract Surgery Introduction This leaflet has been written to help you understand more about surgery for a cataract. It explains what the operation involves, the benefits and risks
More informationCataract Surgery: Information for patients. Back of eye. Vitreous. Retina. Lens
Patient information Cataract Surgery: Information for patients Front of eye Cornea Pupil Iris Back of eye Vitreous Retina Lens The anatomy of the eye is illustrated above. Your cataract is a clouding of
More informationLaser Vision Correction
Laser Vision Correction Upcoming Appointments PHONE 605-718-3937 NAME CONSULTATION WITH DOCTOR SCOTT SCHIRBER CONTACT LENSES OUT ON Contact Lenses If you are a contact lens wearer, you should remove your
More informationVISIONCARE S IMPLANTABLE MINIATURE TELESCOPE (by Dr. Isaac Lipshitz)
PATIENT INFORMATION BOOKLET PAGE 1 OF 32 VISIONCARE S IMPLANTABLE MINIATURE TELESCOPE (by Dr. Isaac Lipshitz) AN INTRAOCULAR TELESCOPE FOR TREATING SEVERE TO PROFOUND VISION IMPAIRMENT DUE TO BILATERAL
More informationCataract Surgery. Patient Information. How your care will be organised. Introduction
Patient Information Cataract Surgery If you have any questions regarding your operation please contact Parkerswell Day Case Unit on 01392 406013. They are available between 09:00-17:30, Monday to Friday.
More informationThe Harman Eye Clinic. A Patient Guide To Refractive Surgery
The Harman Eye Clinic A Patient Guide To Refractive Surgery NOTES Our surgeons and many of our staff have had refractive surgery and we understand the choice to proceed is a BIG decision. This guide answers
More informationScrub In. What is the function of vitreous humor? What does the pupil do when exposed to bright light? a. Maintain eye shape and provide color vision
Scrub In What is the function of vitreous humor? a. Maintain eye shape and provide color vision b. Maintain eye shape and refract light rays c. Provide night vision and color vision d. Provide night vision
More informationCataract Surgery Patient Information
Cataract Patient Information 1. Within the human eye, there is a normal structure called the lens. In youth, this lens is clear, and light rays pass through and are focused by this lens as well as the
More informationClinical Policy: Refractive Surgery Reference Number: CP.MP. 391
Clinical Policy: Refractive Surgery Reference Number: CP.MP. 391 Effective Date: November 2007 Last Review Date: January 2016 Coding Implications Revision Log See Important Reminder at the end of this
More informationMore possibilities after.
Many possibilities during cataract surgery. More possibilities after. Knowing your options can help you focus on the breathtaking experiences still to come. AcrySof IQ IOL Family Advancing CATARACT SURGERY
More informationA Patients Guide to Excimer Laser Refractive Surgery
A Patients Guide to Excimer Laser Refractive Surgery March 2006 Contents 1. Introduction 2. Understanding your refractive error 3. Changing the eye s focus by surgery (refractive surgery) 4. Indications
More informationPearls for the Refractive Technician Fadiah Alkhawaldeh, IMBA, COT, ROUB
Pearls for the Refractive Technician Fadiah Alkhawaldeh, IMBA, COT, ROUB Cleveland Clinic Cole Eye Institute OOS, Columbus, OH February, 2014 alkhawf@ccf.org NO FINANCIAL DISCLOSURES A Puzzle of an Eye
More informationInformation for patients considering cataract surgery Castleton Day Surgery Unit, Yeatman Hospital, Sherborne
Information for patients considering cataract surgery Castleton Day Surgery Unit, Yeatman Hospital, Sherborne 01935 384 309 yeovilhospital.nhs.uk This leaflet gives you information that will help you decide
More informationImpairment of functions of daily living attributable to impairment of visual function due to cataract
10 Ophthalmology 10.1 Cataract surgery Cataract is the opacification of the normally transparent lens of the eye. It occurs as a result of denaturation of lens proteins resulting in cloudiness of vision.
More informationVisian ICL (Implantable Collamer Lens) For Nearsightedness. Facts You Need To Know About STAAR Surgical s Visian ICL SURGERY
Visian ICL (Implantable Collamer Lens) For Nearsightedness Facts You Need To Know About STAAR Surgical s Visian ICL SURGERY PATIENT INFORMATION BOOKLET For Nearsightedness (Myopia) between 3 to 20 Diopters
More informationCorneal Transplants. Corneal transplants. What causes cornea problems? Full thickness corneal transplant
Corneal transplants The cornea is the clear, front window of the eye. It helps focus light into the eye so that you can see. The cornea is made of layers of cells. These layers work together to protect
More informationConsent for Cataract Surgery Prepared by Hopewell Lambertville Eye Associates
Consent for Cataract Surgery Prepared by Hopewell Lambertville Eye Associates Note: This is an Informed Consent for the co-management office only, the surgical group tending to your care give you a separate
More informationOphthalmology. Cataract
Ophthalmology Cataract The Ophthalmology service offers the latest and most comprehensive eye care for patients. With a dedicated team of eye surgeons and consultants, we treat vision problems ranging
More informationCorneal transplant (Endothelial graft)
Corneal transplant (Endothelial graft) What is a corneal transplant? The cornea is the transparent window at the front of the eye, and it can become scarred by injury or turn cloudy due to disease, when
More informationInformation for Patients. Deep sclerectomy for the treatment of Glaucoma
Manchester Royal Eye Hospital Glaucoma Services Information for Patients Deep sclerectomy for the treatment of Glaucoma Introduction This leaflet provides information for patients being offered deep sclerectomy
More informationCorneal Transplants. Corneal transplants. What causes cornea problems? Full thickness corneal transplant
2014 2015 Corneal transplants The cornea is the clear, front window of the eye. It helps focus light into the eye so that you can see. The cornea is made of layers of cells. These layers work together
More informationPrecision Focus...From Every Angle. BEFORE & AFTER PRK SURGERY Patient Instruction Booklet.
Precision Focus...From Every Angle. BEFORE & AFTER PRK SURGERY Patient Instruction Booklet www.cascadiaeye.com Welcome To Cascadia Eye! This booklet is here to help you prepare for your PRK surgery and
More informationFacts You Need to Know About INTACS Prescription Inserts for Treatment of Nearsightedness and Astigmatism Associated with Keratoconus.
Facts You Need to Know About INTACS Prescription Inserts for Treatment of Nearsightedness and Astigmatism Associated with Keratoconus HUMANITARIAN DEVICE: Authorized by U.S. Federal law for use in the
More informationNumber 80. Laser Eye Surgery in Myopia. Date of decision October 2017 Date of review October 2020 GUIDANCE
Excluded: Procedure not routinely funded Bedfordshire, Hertfordshire, West Essex, Luton and Milton Keynes Priorities Forum statement - adapted for Bedfordshire CCG Number 80 Subject Date of decision October
More informationPhotochemical corneal collagen cross-linkage using riboflavin and ultraviolet A for keratoconus and keratectasia
Photochemical corneal collagen cross-linkage using riboflavin and ultraviolet A for keratoconus and keratectasia Issued: September 2013 guidance.nice.org.uk/ipg466 NICE has accredited the process used
More informationInterventional procedures guidance Published: 25 September 2013 nice.org.uk/guidance/ipg466
Photochemical corneal collagen cross-linkage using riboflavin and ultraviolet A for keratoconus and keratectasia Interventional procedures guidance Published: 25 September 2013 nice.org.uk/guidance/ipg466
More informationCATARACT & LENS SURGERY CATARACT SURGERY
GENERAL INFORMATION CATARACT & LENS SURGERY CATARACT SURGERY WHAT IS A CATARACT? A cataract is not a growth, but rather a clouding of the normally transparent and flexible lens of the eye. This condition
More informationLASER IN SITU KERATOMILEUSIS (LASIK)
INFORMED CONSENT FOR EXCIMER LASER LASER IN SITU KERATOMILEUSIS (LASIK) Please read the following pages carefully and initial and sign where indicated. Please do not sign any section that you have not
More information4/19/2017 ANATOMY OF THE EYE. THOSE DARN CHEATERS! The Technician s Role in the Care and Management of the Presbyopic Patient
ANATOMY OF THE EYE THOSE DARN CHEATERS! The Technician s Role in the Care and Management of the Presbyopic Patient Nic Jacobs, CCRC, COA, OSA Chu Vision Institute Continuing Education Program for Ophthalmic
More information