DATE MRN NAME. J. Everett, MD SAMPLE. Eye Physician & Surgeon Cataract and Refractive Surgery Specialist

Size: px
Start display at page:

Download "DATE MRN NAME. J. Everett, MD SAMPLE. Eye Physician & Surgeon Cataract and Refractive Surgery Specialist"

Transcription

1 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 NOT SIGN ANY SECTION THAT YOU HAVE NOT READ OR DO NOT UNDERSTAND. Patient Name: Surgeon Name: Date: Kevin J. Everett, MD Treatment: (circle) Right Eye Left Eye Both Eyes Doctor Comments: Kevin J. Everett, MD Eye Physician & Surgeon Cataract and Refractive Surgery Specialist Hall Road Sterling Heights, MI (586) Office (586) Technician (586) Fax Patient Initials: Witness Initials:

2 SECTION 1: GENERAL INFORMATION ON INFORMED CONSENT It is our hope to fully inform you concerning the side effects, limitations and complications of the RESTOR procedure. We continually strive to balance the benefits of the RESTOR procedure with the known and unknown risks. It is important to understand that it is impossible to perform any vision correction procedure without the patient accepting a certain degree of risk and responsibility. This consent form in combination with the educational materials provided and the entire consultation process is designed so that you can make an informed decision about the RESTOR procedure. The consent form is also used to enhance your understanding of the potential for difficulties that may be encountered during both the RESTOR procedure and the healing process. Many of our patients are surprised and some are upset by the extent to which we attempt to inform them of the potential for complications. It is not our intention to frighten or dissuade someone from pursuing the RESTOR procedure. Most of our patients will never encounter any serious complications, and the vast majority is thrilled with the results they achieve. It is our intention to accurately outline the associated risks to all candidates so that they may make an informed decision regarding the procedure risks and benefits. Furthermore, in the event of complications, informed patients may be better prepared to deal with the situation. RESTOR is an elective vision correction procedure. There is no emergency condition or other reason that requires or demands that you have the procedure performed. You could continue to wear glasses or contact lenses and have adequate visual acuity. This procedure, like all vision correction procedures, presents some risks, many of which are listed in this consent form. You should also understand that there might be other risks not known, which may become known later. The only way to avoid all risk is to avoid doing the procedure. SECTION 2: ALTERNATIVES TO RESTOR If you decide not to have RESTOR, there are other methods of correcting your vision. These alternatives include, among others, eyeglasses, contact lenses and other refractive surgical procedures. SECTION 3: PRESBYOPIA CORRECTION BACKROUND SUMMARY The RESTOR procedure is a vision correction option for patients who are totally dependent on bifocal glasses, contact lenses or reading glasses. This implant technology is safe and FDA approved to permanently improve distance and near vision in those who have advanced presbyopia, myopia or hyperopia. RESTOR requires the removal of the natural lens followed by the insertion of a psuedo-accommodative intraocular lens. The RESTOR intra-ocular lens uses sophisticated multifocal optics to simulate the natural accommodation of the eye. Having the RESTOR procedure may not completely eliminate your need for reading glasses for fine print, but it is useful for reading your watch, opening your mail or reading a newspaper. In other words, the goal of RESTOR is to reduce your dependence on bifocal glasses, contact lenses and reading glasses. RESTOR is performed on an outpatient basis and takes only minutes to complete. Although patients often feel some pressure sensation, the procedure is painless. Topical anesthetic drops (freezing drops) are used to thoroughly numb the eye and a lid spectrum (eyelid holder) is used to prevent blinking. The presbyopia correction you achieve with the RESTOR is permanent. 2

3 SECTION 4: RESTOR INDICATIONS, CONTRADICTIONS AND WARNINGS INDICATIONS: The RESTOR procedure is indicated for the correction of presbyopia and other focusing errors such as myopia and hyperopia. The candidate s decision on whether to have the RESTOR procedure must depend on his or her assessment of visual disability (e.g. impact on driving, reading, watching television and special occupational or vocational needs) and the perception of the impact of wearing glasses or contact lenses on lifestyle. Candidates must be aware that RESTOR is an outpatient, elective procedure. WARNINGS: Candidates must make their surgeon aware of certain health problems including uncontrolled diabetes, autoimmune or collagen vascular disease, any medication or condition that renders the patient immunocompromised. Candidates must make their surgeon aware of certain eye problems including amblyopia (lazy eye), strabismus (muscle imbalance), dry eyes, or any recurrent, residual or active eye condition, which may affect healing. Candidates must make their surgeon aware of unstable high blood pressure and/or angina. Candidates must make their surgeon aware of certain general health conditions including keloid scarring with previous surgical healing, back problems, claustrophobia or other psychological problems, which may affect the surgery or recovery. Candidates must make their surgeon aware of medication allergies and any medications they are taking to avoid potential drug interactions and allergic reactions. SECTION 5: PRE-PROCEDURE and POST-PROCEDURE CARE: PRE-PROCEDURE CARE: The screening examination performed by an surgeon is intended to assess a patient s suitability for the RESTOR procedure based upon a patient s visual acuity and other factors, but not to identify or treat ocular (eye) disease. Ocular disease may be present prior to RESTOR surgery or may develop after surgery, but it is unrelated to the surgical procedure. RESTOR surgery will not treat other ocular diseases. You should have a complete eye examination with retinal evaluation prior to RESTOR surgery and annually thereafter to identify and treat ocular diseases. In general, patients with higher degrees of myopia have a higher risk of retinal problems and reducing the degree of myopia with RESTOR surgery does not lower the risk. If you have had any heart problems in the past such as a heart attack, angina, heart failure or high blood pressure, it is recommended that you see your primary physician between 2 to 3 weeks prior to RESTOR procedure to ensure your condition is compatible with the surgical procedure. Lung disease, such as asthma, emphysema, and chronic bronchitis are three respiratory ailments that can complicate RESTOR surgery. Should you have one of these conditions, you should see your primary physician. Furthermore, patients with other diseases (diabetes, kidney, bowel disorder, etc) that require regular visits and/or long term medications should see their primary physician prior to RESTOR surgery to ensure your condition is compatible with the surgical procedure. 3

4 POST-PROCEDURE CARE: Post-operative follow-up care with an eye care professional is required. In most cases patients are seen again by their surgeon at post-op day one (+/- 1 day), post-op day 7 (+/- 3 days), post-op month one (+/- 7 days) and at post-op month 3, (+/- 7 days) to monitor healing. More visits may be required depending on your healing status. It is recommended yearly visits to your eye doctor for routine eye care. It is important to remember that right after RESTOR surgery not to touch the eye in any way and not to squeeze it tightly shut. If sutures were used in your eye, they often cause a gritty sensation as if something was in the eye. This is expected and will gradually resolve as the sutures are absorbed. You will require various drops placed in your eye after RESTOR surgery. Instructions for the use of various drops will be reviewed with you before surgery. Your operated eye will continue to require special care and attention. Instructions for care of your operated eye will be reviewed with you before surgery. You also will be given general instructions on activities that will be restricted during the post-operative period. If an additional procedure is needed or a complication occurs, a patient may be required to return to the surgery center or lengthen their stay at their expense. In some circumstances, a patient may have to travel for an additional procedure at their expense. The final clinical results are dependant upon how your body heals in response to the RESTOR procedure on your eye and upon properly following your post-operative care instructions. Due to individual healing patterns, it is impossible to guarantee exact results in individual cases. Some patients either over or under respond to the RESTOR surgical procedure and thus may have some residual focusing errors as a final result. SECTION 6: PRESBYOPIA AND RESTOR Presbyopia is the Greek word for aging eyes, and is the most prevalent eye condition in North America, affecting most people by the age of 40 and everyone by the age of 51. Presbyopia causes the natural lens of the eye to become less flexible. This lack of flexibility compromises the eye s ability to switch from one focal point to another focal point. You will usually notice presbyopia when it becomes more difficult to read or see things at close range. It is important to note that our eyes continue to change with age, and to understand that the presbyopia you have now will potentially worsen over time. At this time, there is no cure for presbyopia. The typical solutions are all to some extent, a compromise of one form or another. For many people, wearing reading glasses for near vision correction is troublesome enough, and wearing bifocals or progressive lenses is even less pleasant. The RESTOR procedure is designed to permanently correct presbyopia by replacing the aging lens with a sophisticated multi-focal lens implant that has the ability to focus light at both near and far. The intra-ocular lens is implanted in essentially the same location previously occupied by your natural lens. You will not be able to feel the intra-ocular lens and it never has to be handled, adjusted or cleaned. RESTOR is a procedure designed to functionally restore distance and near vision, but it may not completely eliminate your need for reading glasses for fine print. In other words, the goal of RESTOR is to reduce your dependence on bifocals or reading glasses. 4

5 SECTION 7: RISKS AND COMPLICATIONS As discussed earlier, all forms of vision correction surgery carry a certain degree of risk for adverse effects and complications. Problems can be related to the surgical component of the procedure or the healing component. Most surgical problems are associated with the healing process that takes place after the procedure and are usually resolved within one to three months after the procedure. However, it is possible that some of these reactions or complications could be longer-term or permanent. Most complications improve or resolve within 6-12 months or with retreatment, but some surgical or healing complications may result in permanent visual blurring, glare, discomfort or need for corrective contact lenses. In general, there is a small risk in the range of 1/1000 of experiencing a significant complication and a very small risk in the range of 1/3000 of a severe sight-threatening complication. Please read and initial this section carefully for a better understanding and initial below. The risks of the RESTOR PRESBYOPIA procedure revolve around 4 primary areas: 1. Post-operative side effects, adverse effects and complications 2. Refractive Complications 3. Healing Complications 4. Other Miscellaneous Complications 1. Post-operative Side Effects, Adverse Effects and Complications There are several effects which may be encountered early in the post-operative period, which include foreign body sensation, pain or discomfort, sensitivity to bright lights, blurred vision, dryness of the eye, red or swollen eye, tearing and fluctuation in vision. Pain may be experienced during the first hours after surgery. It is very common to experience a foreign body sensation during this time similar to an eyelash in your eye. Patients experiencing pain will be provided with medication to take if necessary. Fortunately, pain is not always a sign of complication, but daily or more frequent examinations may be required if pain is persistent. Infection following RESTOR surgery is rare but very serious and can potentially even result in blindness. The most important long-term side effect is night glare, star bursting, haloes or simply reduced visual quality under low light conditions. It is very common to have night glare early during the recovery course and night glare is more common when only one eye has been treated. In a small percentage of patients night glare may be permanent and affect your night driving abilities. 2. Refractive Complications Refractive problems that may be encountered include too much correction, too little correction, a prescription imbalance between eyes, or aggravation of muscle imbalance problems. The RESTOR surgical procedure may result in over corrections and under corrections due to the variability in patient healing patterns and other surgical variables, leaving a patient nearsighted, farsighted or with astigmatism. This may or may not require patients to wear spectacles, contact lenses or undergo further surgery. Further surgery entails additional risk and is not guaranteed to provide an ideal visual outcome, although improvement is typically achieved. Patients may also heal differently between eyes, based upon differences between eyes in pre-operative prescriptions, corneal curvature, variation in healing or other surgical variables. Differences in refraction between eyes is termed anisometropia; this is most severe when only one eye is treated, and may result in a loss of depth perception, eye strain, headache, and double vision. 3. Blurriness/Loss-of-Best Corrected Visual Acuity Blurriness is very common during the healing process. After the RESTOR procedure, there is considerable improvement in vision within the first few days. It generally requires 3 to 5 days until vision is clear enough to drive; however it may even take longer. Approximately 1-2% of patients independent of the-procedure performed will develop corneal irregularities reducing the sharpness, crispness and clarity of their vision preventing them from reading the bottom 2 or more lines on an eye chart that glasses, contacts or another surgery cannot restore. That is, initial blurriness resolves in approximately 98%-99% of patients over 6 to 12 months, however it may be permanent in approximately 1-2% of treated patients. There is no way of predicting or predetermining that will be in this 1-2%. A patient, who loses sharpness, will have vision that is worse than the vision before surgery. All forms of eye surgeries possess the same or higher risk/loss of best-corrected visual acuity, 5

6 4. Corneal Healing Complications Corneal healing problems with RESTOR are more likely to be experienced by patients corrected for higher degrees of astigmatism. Corneal healing may not only affect the speed of visual recovery but the smoothness, and may produce visual blurring. Corneal scarring may be produced with RESTOR. The most important aspect of corneal healing following RESTOR or any other form of vision enhancement surgery following vision correction surgery is the development of corneal irregularities which may permanently affect the quality, crispness and sharpness of the final visual result. Corneal irregularities or irregular astigmatism is produced when the cornea heals in an irregular pattern. Irregular astigmatism from both healing and surgical complications may result in a loss of best-corrected vision. Specifically, the best vision a patient measures after surgery even with lens correction may not be as good as the patient enjoyed before vision enhancement surgery. In some cases, patients will actually gain best-corrected vision. In certain cases, the vision may be severely impaired and affect the ability of a patient to drive legally, this is most important in patients who already have reduced visual acuity from other causes. The RESTOR procedure is not intended to increase the visual potential of a patient and many candidates with high prescriptions often are unable to read 20/20 before surgery and should not expect to read 20/20 after surgery. Furthermore, a patient who is best corrected before surgery to 20/40 is already borderline for legally driving and any loss of best-corrected vision from healing or surgical complications may prevent legal driving. 5. Other Complications Other possible complications that may be associated with the RESTOR procedure include inflammation of the retina (macular edema), dislocated lens material, elevation of intra-ocular pressure (glaucoma), hemorrhage (choroidal hemorrhage) or corneal epithelial defect, secondary cataract (cloudiness of the lens), corneal scarring, corneal swelling, corneal ulceration or inflammation, irregularities of the cornea, endothelial cell loss (a loss of endothelial cell density, increase in irregularity of cell size or shape which may result in corneal swelling), inflammation of the iris, itching, double vision, drooping of the eyelid, contact lens intolerance and reading difficulty. The most common long-term side effect is dryness of the eyes. This may continue for several months to a year after the procedure, and in a few cases, may be permanent. Patients may need to use moisturizing eye drops during this period. There are cases where patients have significant dry eye symptoms following surgery that require additional treatments or procedures beyond lubricant drops. In rare cases, this may include the insertion of punctual plugs or similar therapies. These techniques have been used for years for patients who have not had any surgical procedures but who have chronic dry eyes or dryness from contact lenses. It is important to note that it is impossible to list every conceivable complication that is not listed above. Risks and complications that are considered to be unforeseeable, remote or not commonly known are not discussed. In addition, there may be long-term effects not yet known or anticipated at the present time. The most severe possible complications would necessitate more invasive or repeated surgery and could potentially produce partial or complete loss of vision. SECTION 8: EXPECTATIONS OF THE PROCEDURE The goal of the RESTOR procedure is to achieve the best visual result the safest way. It is also important to recognize with the RESTOR procedure, the goal is to allow patients to enjoy a full range of vision, with independence from glasses for most activities. RESTOR will not eliminate your need for reading glasses for fine print, but is useful for reading your watch, opening your mail or reading price tags without reading glasses. Complications are an inherent part of surgery and despite our best efforts, training and skill some patients will experience problems. It is simply our hope to educate you as to what those problems may be so that you can make an informed decision whether or not to proceed. No one ever believes that they will be in the small percentage of people that develops a significant complication, so it is important for all candidates to appreciate that there are truly no guarantees. 6

7 SECTION 9: WRITTEN CONFIRMATION Please write in your handwriting the following two statements to confirm that you have understood and accept that RESTOR PRESBYOPIA procedure is an elective surgical procedure and as with all surgical procedures, the result cannot be guaranteed. That you acknowledge that although vision-threatening complications are quite rare, it is possible that partial or complete loss of vision may be produced as a result of a surgical or healing complication. That the procedure may not eliminate all of your PRES- BYOPIA, myopia, hyperopia or astigmatism and that additional correction with glasses, contact lenses or further surgery may be required. I understand that there are risks and no guarantees I understand that I still need to wear glasses for distance vision or near vision or both. SECTION 10: VOLUNTARY CONSENT Please sign below that you have carefully reviewed this informed consent document and that you have had an opportunity to any questions that you may have answered. By signing below you also indicate that you are aware that RESTOR PRESBYOPIA procedure is an elective procedure, that you do not need to have this procedure and that you understand your other surgical and non-surgical alternatives for vision correction. Patient Full Name: (print): Patient Signature: Witness Full Name (print): Witness Signature: Surgeon Name (print): Surgeon Signature: Co-managing Doctor: Date of Procedure: - - Month Day Year 7

8 Witness to Patient Consent I,, hereby certify that I have discussed and explained the RESTOR surgical procedure, the possible risks and benefits and alternative treatments, as outlined in the consent form, with. The patient has confirmed to me that(s) he has received the explanation of those surgical procedures, possible risks and benefits and alternative treatments. Furthermore, the patient has confirmed to me his/her understanding of the information contained in the consent form. I believe that the patient understands the explanations and answers, and freely and knowingly consents to the performance of the RESTOR PRESBYOPIA procedure. Witness Signature - - Month Day Year 8

CLINIQUE LASERVUE. Informed Consent Form for Photo-Refractive Keratectomy (PRK)

CLINIQUE 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 information

~ 1 ~ CLINIQUE LASERVUE. Informed Consent Form for LASIK

~ 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 information

LASER REFRACTIVE CENTER INFORMED CONSENT DOCUMENT PERIPHERAL CORNEAL RELAXING INCISION (PCRI)

LASER 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 information

CLINIQUE LASERVUE Informed Consent Form for Photo-Therapeutic Keratectomy (PTK)

CLINIQUE 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 information

FROM CATARACTS TO CLARITY

FROM 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 information

ALTERNATIVES TO PHAKIC IMPLANT SURGERY

ALTERNATIVES 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 information

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

More information

Informed 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) 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 information

CONSENT FOR PHOTOTHERAPEUTIC KERATECTOMY (PTK)

CONSENT FOR PHOTOTHERAPEUTIC KERATECTOMY (PTK) 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,

More information

LASIK. Lens. Cornea. Iris. Vitreous. Macula. Retina

LASIK. 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 information

Advanced Eyecare of Orange County/ Kim T. Doan, M.D.

Advanced 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 information

LASIK INFORMED CONSENT INITIAL TREATMENT

LASIK 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 information

LASER REFRACTIVE CENTER INFORMED CONSENT DOCUMENT SMALL INCISION LENTICULE EXTRACTION (SMILE)

LASER 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 information

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

LASIK. What is LASIK? Eye Words to Know. Who is a good candidate for LASIK? 2014 2015 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 information

Clear Advantage Vision Correction Center INFORMED CONSENT FOR LASIK AND FEMTOSECOND LASER

Clear 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 information

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

SAMPLE 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 information

IntraLASIK Correction Of Nearsightedness, Farsightedness and Astigmatism Using IntraLase TM Technology

IntraLASIK 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 information

INFORMED CONSENT FOR PHOTOREFRACTIVE KERATECTOMY (PRK) AND ADVANCE SURFACE ABLATION (ASA)

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 information

Scrub 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? 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 information

INFORMED 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 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 information

Cataract Surgery: What You Must Know Before Having It Done

Cataract 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 information

Ophthalmology. Ophthalmology Services

Ophthalmology. 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 information

Informed IntraLASIK Consent

Informed 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

More possibilities after.

More 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 information

VISIONCARE S IMPLANTABLE MINIATURE TELESCOPE (by Dr. Isaac Lipshitz)

VISIONCARE 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 information

FineVision 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. 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 information

CONSENT FOR CATARACT SURGERY REQUEST FOR SURGICAL OPERATION / PROCEDURE AND ANAESTHETIC

CONSENT 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 information

Cataract Surgery: Patient Information

Cataract 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 information

INFORMED CONSENT FOR CATARACT SURGERY

INFORMED 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 information

Pre-Operative Health Questionnaire. 3. Are you currently taking any of the following medications for. glaucoma: TRAVATAN LUMIGAN XALATAN

Pre-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 information

Pre-Operative Health Questionnaire. 3. Are you currently taking any of the following medications for. glaucoma: TRAVATAN LUMIGAN XALATAN

Pre-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 information

Cataract. What is a Cataract?

Cataract. 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 information

Your First Appointment:

Your 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 information

Cataract. What is a Cataract?

Cataract. 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 information

KNOW THE OPTIONS. Discover how the latest advances in vision correction can improve your sight.

KNOW 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 information

Cataract Surgery. Patient Information. How your care will be organised. Introduction

Cataract 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 information

The cataract laser technology of tomorrow is here for you today. See inside to learn about all your exciting new options

The cataract laser technology of tomorrow is here for you today. See inside to learn about all your exciting new options The cataract laser technology of tomorrow is here for you today. See inside to learn about all your exciting new options What is a cataract? A cataract is a clouding of the lens of the eye. This blocks

More information

INFORMED CONSENT FOR LASER IN SITU KERATOMILEUSIS ( LASIK )

INFORMED 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 information

Ophthalmology. Cataract

Ophthalmology. 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 information

Guide to modern day cataract surgery

Guide 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 information

Patient Information Brochure. Cataract

Patient Information Brochure. Cataract Patient Information Brochure Cataract Q: What is cataract? A: A cataract is an opacity (or cloudiness) in the lens of the eye. This cloudiness develops inside the lens and restricts light passing through

More information

Phone [850] Fax [850] Web Send s to: Search Millseye to download App Page 1 of 5

Phone [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 information

Patient Information Cataract Surgery

Patient 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 information

Vision Correction Surgery Patient Information Form

Vision 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 information

Information 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 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 information

Patient Information: laser vision correction

Patient 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 information

Cataract Surgery: Information for patients. Back of eye. Vitreous. Retina. Lens

Cataract 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 information

CORNEAL TRANSPLANT CONSENT FORM

CORNEAL 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 information

TREAT CATARACTS AND ASTIGMATISM WITH ONE PROCEDURE

TREAT CATARACTS AND ASTIGMATISM WITH ONE PROCEDURE TREAT CATARACTS AND ASTIGMATISM WITH ONE PROCEDURE Simulated images with an AcrySo fiq Simulated images with Toric IOL. Although this result is typical, cataracts and astigmatism. individual results may

More information

SAMPLE WHAT LASIK CAN DO

SAMPLE 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 information

The Eye: Homeostatic Imbalance. Ms. Nobis s 3rd hour Anatomy & Physiology

The Eye: Homeostatic Imbalance. Ms. Nobis s 3rd hour Anatomy & Physiology The Eye: Homeostatic Imbalance Ms. Nobis s 3rd hour Anatomy & Physiology Your assignment... 1. 2. 3. Find the slide with your name in the notes section at the bottom (they are alphabetical by last name).

More information

ALABAMA VISION CENTER

ALABAMA 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 information

The Visian ICL Advantages

The 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 information

Patient Information: Modern Cataract Microsurgery

Patient Information: Modern Cataract Microsurgery Mr Vaughan Tanner BSc MBBS FRCOphth Consultant Ophthalmic Surgeon Telephone: 01189 553457 01753 743418 http://www.tanner-eyes.co.uk Patient Information: Modern Cataract Microsurgery What is a Cataract?

More information

Cataract Surgery. This reference summary will help you understand what cataracts are and how they can be treated surgically.

Cataract Surgery. This reference summary will help you understand what cataracts are and how they can be treated surgically. Cataract Surgery Introduction A cataract is a clouding of the eye s lens. Cataracts are a common eye condition that affect many people aged 65 or older. Your doctor may recommend cataract surgery to enhance

More information

Informed 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) 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 information

Cataracts are a normal feature of aging. About half of adults aged 65 to 74 have cataracts.

Cataracts are a normal feature of aging. About half of adults aged 65 to 74 have cataracts. Cataract Mr Constable specialises in modern small incision phacoemulsification surgery for the treatment of cataracts using the latest microincision systems and implants. Most patients with cataracts can

More information

WANG 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 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 information

THE COMPLETE GUIDE TO. Cataract Solutions HERZIG-EYE.COM 1

THE COMPLETE GUIDE TO. Cataract Solutions HERZIG-EYE.COM 1 THE COMPLETE GUIDE TO Cataract Solutions HERZIG-EYE.COM 1 At the Herzig Eye Institute our commitment is to provide each patient with their best possible vision correction, superior surgical treatments,

More information

CORNEAL CONDITIONS CORNEAL TRANSPLANTATION

CORNEAL 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 information

Test Bank for Medical Surgical Nursing An Integrated Approach 3rd Edition by White

Test Bank for Medical Surgical Nursing An Integrated Approach 3rd Edition by White Test Bank for Medical Surgical Nursing An Integrated Approach 3rd Edition by White Link full download : http://testbankair.com/download/test-bank-for-medical-surgical-nursing-anintegrated-approach-3rd-edition-by-white/

More information

NEPTUNE RED BANK BRICK

NEPTUNE RED BANK BRICK NEPTUNE RED BANK BRICK Diabetes & The Eye Diabetics are more likely to develop Cataracts at a younger age. Diabetics are twice as likely to develop Glaucoma when compared to non-diabetics. The primary

More information

THE PATIENT S GUIDE TO CATARACTS: The Symptoms, Risks, and Surgical Treatment

THE PATIENT S GUIDE TO CATARACTS: The Symptoms, Risks, and Surgical Treatment THE PATIENT S GUIDE TO CATARACTS: The Symptoms, Risks, and Surgical Treatment 1 Table of Contents Causes of Cataracts... 3 Symptoms of Cataracts... 4 Diagnosis of Cataracts... 5 Cataract Treatment Options...

More information

Patient Information Alexander Ionides BSc FRCOphth MD Moorfields Eye Hospital. ICL Implantation

Patient Information Alexander Ionides BSc FRCOphth MD Moorfields Eye Hospital. ICL Implantation ICL Implantation ICL implantation involves inserting a lens into the eye to treat higher levels of short-sightedness typically, greater than -8.00DS. In high myopia (>-8.00D) the eye has too much focussing

More information

AgePage. Aging And Your Eyes. Steps To Protect Your Eyesight

AgePage. Aging And Your Eyes. Steps To Protect Your Eyesight National Institute on Aging AgePage Aging And Your Eyes Are you holding the newspaper farther away from your eyes than you used to? Join the crowd age can bring changes that affect your eyesight. Some

More information

DISTANCE LEARNING COURSE. Scope of the Eye Care Practice , BSM Consulting All rights reserved.

DISTANCE LEARNING COURSE. Scope of the Eye Care Practice , BSM Consulting All rights reserved. DISTANCE LEARNING COURSE Scope of the Eye Care Practice 2008 2012, BSM Consulting All rights reserved. Table of Contents OVERVIEW... 1 THREE O'S IN EYE CARE... 1 ROUTINE VS. MEDICAL EXAMS... 2 CONTACT

More information

INFORMED CONSENT FOR AVASTIN TM (BEVACIZUMAB) INTRAVITREAL INJECTION

INFORMED CONSENT FOR AVASTIN TM (BEVACIZUMAB) INTRAVITREAL INJECTION INFORMED CONSENT FOR AVASTIN TM (BEVACIZUMAB) INTRAVITREAL INJECTION INDICATIONS: Age-related macular degeneration (AMD) is the leading cause of blindness in people over 50 years of age. It is caused by

More information

Cataract Surgery Consent Form 1) WHAT IS A CATARACT AND HOW IS IT TREATED?

Cataract 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 information

PHOTOREFRACTIVE KERATECTOMY (PRK) PATIENT INFORMATION BOOKLET

PHOTOREFRACTIVE 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 information

ALLEGRETTO WAVE Scanning Spot LASIK Laser System

ALLEGRETTO 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 information

Retina of Auburn & Metro-Columbus

Retina of Auburn & Metro-Columbus INFORMED CONSENT FOR VITRECTOMY SURGERY What is a vitrectomy? Vitrectomy is the surgical removal of the vitreous gel from the middle of the eye. This procedure may be done for several reasons. To remove

More information

The pinnacle of refractive performance.

The 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 information

Evolution in Visual Freedom.

Evolution 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 information

Medical and/or Vision Insurance plans do not cover the Specialty Dry Eye Testing or LipiFlow services.

Medical and/or Vision Insurance plans do not cover the Specialty Dry Eye Testing or LipiFlow services. ADVANCED BENEFICIARY NOTICE (ABN) Patient s Name: Date of Birth: The purpose of this form is to help you make an informed choice about your visit today. Before you make a decision about your options, you

More information

CATARACT MICROSURGERY. BY Dr. Mark Deist

CATARACT 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 information

Consent for Cataract Surgery

Consent for Cataract Surgery Consent for Cataract Surgery Introduction This information is given to you so that you can make an informed decision about having an eye operation, before you sign the INFORMED CONSENT DOCUMENT. You have

More information

Visian 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 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 information

CRESP. Cadet Refractive Eye Surgery Program. Phone COL Ava Huchun, M.D.

CRESP. 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 information

The cataract laser technology of tomorrow is here for you today.

The cataract laser technology of tomorrow is here for you today. The cataract laser technology of tomorrow is here for you today. See inside to learn about all your exciting options Thanks to recent advancements, this is a great time to have cataract surgery Laser precision

More information

IS LASIK FOR ME? A Patient s Guide to Refractive Surgery

IS LASIK FOR ME? A Patient s Guide to Refractive Surgery IS LASIK FOR ME? A Patient s Guide to Refractive Surgery October 2008 IS LASIK FOR ME? A Patient s Guide to Refractive Surgery TABLE OF CONTENTS LASIK: A COMPREHENSIVE GUIDE... 2 Introduction... 2 What

More information

You can see vivid colours again after cataract management at Sankar Foundation Eye Hospital

You can see vivid colours again after cataract management at Sankar Foundation Eye Hospital The Department of Cataract in our Sankar Foundation is equipped with state-of-the-art operation theatres, surgical microscope phacoemulsification machine and microsurgical instruments. And also the department

More information

Cataract. A cataract is a clouding of the lens in your eye. It

Cataract. A cataract is a clouding of the lens in your eye. It Cataract A cataract is a clouding of the lens in your eye. It affects your vision. Cataracts are very common in older people. By age 80, more than half of all Americans either have a cataract or have had

More information

Facts 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. 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 information

The LenSx Laser System. Discover the assurance of bladeless cataract surgery

The LenSx Laser System. Discover the assurance of bladeless cataract surgery The LenSx Laser System Discover the assurance of bladeless cataract surgery Don t let cataracts limit your lifestyle If you or someone you care for has been diagnosed with cataracts, you re certainly not

More information

CATARACT & LENS SURGERY CATARACT SURGERY

CATARACT & 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 information

Everything Cataract. By Stephen J. Gordon, M.D.

Everything Cataract. By Stephen J. Gordon, M.D. Everything Cataract By Stephen J. Gordon, M.D. The word cataract is derived from the Latin word cataract. While it has other meanings, in ophthalmology it refers to an opacification or clouding of the

More information

Vision & Age - 40 s and 50 s Eyes

Vision & Age - 40 s and 50 s Eyes Vision & Age - 40 s and 50 s Eyes You rely on your sight to enjoy life to the fullest, but as you reach your 40 s and 50 s, you may notice your vision starting to change. As you age, the lens within your

More information

You will start medications 4 hours after your procedure.

You 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 information

Diabetes & Your Eyes

Diabetes & Your Eyes Diabetes & Your Eyes Diabetes is a disease that occurs when the pancreas does not secrete enough insulin or the body is unable to process it properly. Insulin is the hormone that regulates the level of

More information

Cataract Surgery Patient Information

Cataract Surgery Patient Information Cataract Surgery Patient Information www.ihg.org.uk Independent Health Group Patient Referral Centre T: 0330 3801362 E: ihg.referralsandenquiries@nhs.net Independent Health Group Limited is registered

More information

Cataract and Refractive Surgery Co-Management Policy and Procedure Manual

Cataract and Refractive Surgery Co-Management Policy and Procedure Manual Cataract and Refractive Surgery Co-Management Policy and Procedure Manual Michael R. George, M.D. Chief Surgeon and Medical Director Tylock-George Eye Care Index of Cataract and Refractive Surgery Manual

More information

The human eye is composed of many parts that work together. They receive visual images, focus them. So how does all this work?

The human eye is composed of many parts that work together. They receive visual images, focus them. So how does all this work? The human eye is composed of many parts that work together. They receive visual images, focus them properly, and send messages to the brain. H A N D O U T The Visual System To have vision, you must have

More information

The LenSx Laser System

The LenSx Laser System Important Product Information for the LenSx Laser CAUTION: The LenSx Laser is restricted by law to the sale and use by, or on the order of, a physician. DESCRIPTION: The LenSx Laser is for use in patients

More information

Important: Please read before your appointment

Important: Please read before your appointment Cataract Surgery Important: Please read before your appointment Consent for cataract surgery Prior to you having cataract surgery, you will be asked to sign a consent form. It is important that you understand

More information

Visian Toric ICL (Implantable Collamer Lens) For Nearsightedness with Astigmatism

Visian 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 information

Intravitreal Injection

Intravitreal Injection for patients Eye Clinic Ipswich Hospital Tel: 01473 703230 Intravitreal Injection What is an intravitreal injection? An intravitreal injection is the injection of a drug into the vitreous body (the jelly

More information

When Eyes Show Their Age

When Eyes Show Their Age When Eyes Show Their Age A guide to preserving the gift of sight for as long as possible with the compliments of Division of Health Services Diocese of Camden Expect Vision Changes Some loss of visual

More information

PATIENT REGISTRATION FORM

PATIENT REGISTRATION FORM PATIENT REGISTRATION FORM B S M R W A G KS MAC Z GR SO ZA L Please tell us about yourself so we can help you make the best decisions about your care. Date: Social Security #: E-mail: Name: MR / MRS / MS

More information

Glaucoma. What is glaucoma? Eye Words to Know. What causes glaucoma?

Glaucoma. What is glaucoma? Eye Words to Know. What causes glaucoma? 2014 2015 Glaucoma What is glaucoma? Glaucoma is a disease that damages your eye s optic nerve. It usually happens when fluid builds up in the front part of your eye. That extra fluid increases the pressure

More information