Patient Selection for

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1 Patient Selection for Laser Vision Correction Suitable Candidates: n Must be 18 years old n Healthy eyes n Stable prescription for at least one year (i.e. change no greater than 1.00 D a year) n Acceptable corneal thickness and corneal curvature n Realistic expectations* n Clear understanding and acceptance of risks *Realistic expectations means the following: Attaining specific goal(s) to enhance lifestyle, comfort, safety, career opportunity Searching for perfection or guarantee is NOT suitable Desire for immediate recovery is NOT suitable Bad Candidates: n Unstable prescription (i.e. change greater than 1.00 D a year) n Unstable, uncontrolled diabetes n Immunosuppressed patients n Auto-immune disorders n Pregnant or nursing mothers n Patients on Amiodorone n Systemic illness wound healing problems n Use of any medication inhibiting tissue growth 1565 Carling Ave., Suite 110, Ottawa, ON K1Z 8R1 n IN-FOCUS ( ) n n fax n Hotel Dieu Hospital, 166 Brock St., Suite 325, Kingston, ON K7L 5G2 n n n fax n

2 Parameters: n Wavefront: Myopia: sphere, and up to cyl Hyperopia: sphere, and up to cyl (limited by corneal curvature and thickness) n Standard PRK: Myopia: sphere to sphere and up to cyl (limited by corneal curvature and thickness) Hyperopia: sphere, and up to cyl n INTRALASE SBK: Myopia: sphere to sphere and up to cyl (limited by corneal curvature and thickness) Hyperopia: sphere to cyl n CLE: All prescriptions Age dependant (usually for ages 40 and older) *Please note that the laser has capabilities to treat up to myopia, hyperopia and astigmatism. With very high prescriptions the outcomes with laser are not favourable as the quality of vision is compromised. Limitations exist due to corneal thickness and curvatures. A CLE procedure will give the patient a better outcome in extreme cases. Monovision: n Candidates for monovision are ages 40 and older. n Very low myopes may only need one eye treated. n For other patients, monovision means that one eye, usually the non-dominant eye, will be left slightly undercorrected (if myopic), or overcorrected (if hyperopic). n Target for monovision ranges from D to 1.75 D, depending on age. n Reminder that if the patient cannot adjust, an enhancement procedure may be done when prescription is stable at no additional cost to the patient if within one year of original procedure. They will however require reading glasses.

3 FOCUS EYE CENTRE Ottawa 1565 Carling Ave. Suite 110 Ottawa, ON K1Z 8R1 (613) IN-FOCUS ( ) Kingston Hotel Dieu Hospital 166 Brock Street Suite 325 Kingston, ON K7L 5G2 (613) Preparing for your laser vision correction consultation 1. Carefully Review the Enclosed Materials 2. Make a List of Any Questions or Concerns You May Have Both the Canadian Ophthalmological Society (COS) and the Canadian Society of Cataract and Refractive Surgery (CSCRS) state that careful patient selection [and pre-operative testing] is the key to good outcomes following refractive surgery. (COS News Release, Nov. 24, 2000). Unlike discount centres, Focus insists that your initial consultation be performed by one of our experienced eye doctors. Take advantage of your meeting with the doctor by preparing a list of any questions or concerns you may have regarding laser vision correction prior to your consultation. 3. Remove Contact Lenses at Least One Day Before Your Consultation It is important that your eyes be allowed to return to their natural shape before having laser vision correction. The following is the average length of time contact lenses must be removed prior to surgery: Type of Contacts Length of Time Disposable 4-7 days Soft 1-2 weeks Hard/Toric up to 8 weeks If you are interested in having surgery as early as possible after your consultation, please ensure that you keep your contact lenses out for the period of time set out in the schedule above. 4. Bring Along Someone Who Can Help You in the Decision-Making Process During the pre-operative examination and consultation, the doctor will describe in detail the benefits, risks and different types of laser vision correction procedures. We strongly recommend that you bring your spouse, partner, family member or friend to assist you in understanding the information and making an informed decision. Your consultation will take approximately one hour. 5. Bring Along a Pair of Sunglasses As part of the pre-operative testing, your pupils will be dilated. You will be very sensitive to light and your near vision may be blurry for about three hours or so afterwards. Although you will be able to drive after your consultation, you will find it very helpful to wear sunglasses until your pupils return to their normal size. A-3 rev 11/09 We look forward to meeting you and helping you discover a world without glasses or contact lenses! Bring your into focus world

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5 FOCUS EYE CENTRE Ottawa 1565 Carling Ave. Suite 110 Ottawa, ON K1Z 8R1 (613) IN-FOCUS ( ) Kingston Hotel Dieu Hospital 166 Brock Street Suite 325 Kingston, ON K7L 5G2 (613) Wavefront-Guided Procedures Every person s vision is as unique as their fingerprint. Focus Eye is committed to providing outstanding medical care and the best possible results. This means using the gold standard in Laser Vision Correction technology: the WavePrint System from VISX, Inc. Unlike traditional eye examination methods which provided information about only the corneal surface of your eye, the WavePrint Map reveals the way your entire optical system processes light. The WavePrint System thus provides a precise and more detailed analysis of your vision. Using this information, Focus doctors can more accurately assess whether you are a good candidate for laser vision correction and the type of laser procedure which is best for you. The WavePrint System allows Focus to give our patients the potential to see better than 20/20, to see better than they do with their contacts or glasses. Depending on the results of your WavePrint Map, your doctor may recommend a Wavefront-guided procedure as the optimal procedure for you. Wavefront is recommended for all qualified patients. In a Wavefront-guided procedure, information from the WavePrint Map is inputted into the laser. The result is a highly personalized treatment that takes into account the unique, individual characteristics of your entire optical system. Wavefront-guided procedures are fully approved by Health Canada. Recovery Time Intralase SBK with Wavefront...as little as 24 hours. PRK with Wavefront...in most cases, patients are able to return to work after 4 to 7 days. However, some patients may need longer as healing is individual. A-5 rev 11/09 The Benefits of Wavefront In numerous clinical studies of Wavefront-guided procedures both PRK and Intralase SBK the results have been excellent. This is consistent with the results obtained from the Wavefront-guided procedures performed at Focus. With Wavefront, suitable candidates have an increased likelihood of: achieving 20/20 vision or better; obtaining better vision than they had with their glasses or contacts; achieving improved quality of vision. In studies where patients have had one eye treated with Wavefront and the other treated using traditional procedures, the majority of patients reported sharper vision with the Wavefront-treated eye; avoiding possible night vision difficulties. For those candidates at risk of night vision problems with traditional procedures, the risk is significantly reduced with Wavefront-guided procedures. Please do not hesitate to speak to any of our doctors or education coordinators, if you have questions about wavefront guided procedures at Focus Eye Centre. Bring your into focus world

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7 FOCUS EYE CENTRE Ottawa 1565 Carling Ave. Suite 110 Ottawa, ON K1Z 8R1 (613) IN-FOCUS ( ) Kingston Hotel Dieu Hospital 166 Brock Street Suite 325 Kingston, ON K7L 5G2 (613) Questions & answers about Laser Vision Correction Q. What is LVC and Why Wavefront? At the best clinics, Laser Vision Correction (LVC) in 2010 and beyond is an extremely refined and precise procedure when done by an experienced surgeon in a quality clinic using the finest techniques and technology. Focus possesses all of the above, including Wavefront-guided Intralase SBK and PRK procedures. Wavefront-guided Laser Vision Correction is our Standard of Care. Considered the gold standard for Laser Vision Correction, Wavefront is a pre-operative, no-touch diagnostic procedure that produces a computer generated map of any and all anomalies in the patient s eye. Wavefront guided Laser Vision Correction affords greater precision for the surgeon and better results for our patients. Q. What is Intralase SBK? Intralase SBK is an advanced form of surface ablation that allows patients a visual recovery time measured in hours rather than days. SBK is a procedure comprising the removal and retention of the epithelial layer by the femtosecond Intralase laser and the traditional excimer laser to correct the refractive error. The term SBK refers to the part of the cornea where the cleavage plane is created (i.e. just below the Bowman s layer in the anterior part of the cornea). This prevents almost all the potential complications of the traditional LASIK flap (e.g. decreasing the structural integrity of the cornea, a 30-plus percentage incidence of dry eyes and susceptibility to trauma) while providing post-operative comfort and rapid visual recovery. Intralase SBK and PRK are both considered extremely safe procedures. The judgment of our surgeons is that these are the safest means of providing Laser Vision Correction. Q. What is PRK? PRK (Photorefractive Keratectomy) uses a cool beam from the Excimer laser to reshape the surface of the cornea with a very short wavelength of light energy. Only a minute amount of tissue is removed, normally less than 10% of the cornea. The structure of the eye is not weakened and remains intact. PRK was first performed in 1987 and several million procedures have been performed in countries around the world. Due to the results Focus Eye and its patients are experiencing with Intralase SBK and PRK, our surgeons have made the decision to no longer offer LASIK. A-4 rev 09/09 Bring your into focus world

8 Bring your into focus world Q. Will I become nearsighted again? PRK and Intralase SBK procedures are essentially permanent corrections. Studies have shown results to be stable once healing is completed, three to six months after the procedure. However, small amounts of regression can occur. Instances of this are exceptional rare. Be aware that following LVC the human eye continues to undergo the normal aging process. So while refractive corrections are permanent, the eye remains subject to age-related issues such as cataracts and presbyopia, which occur independent of LVC. Q. Who is a good candidate? Most people who are nearsighted (myopic) or farsighted (hyperopic), with or without astigmatism, are eligible for the procedure. To be considered a good candidate, your prescription must be stable (i.e. less than one diopter of change over the course of a year). Normally, once you have reached your twenties, your prescription will have stabilized. If you undergo the procedure when your prescription is unstable, you may regress from the desired result. Also, women who are pregnant or who are nursing, are not good candidates for the procedure. Q. What are the risks? Laser Vision Correction is considered to be very safe. As with any surgical procedure, there can be complications and these will be described by your eye doctor. Visual outcomes for both PRK and Intralase SBK procedures are comparable. It is important to note that individual results may vary due to each person s healing rate. For this reason, less than 5% of patients (depending on their initial prescription) will need to undergo a touch-up procedure following their initial, primary treatment. The data on patients who have had Laser Vision Correction supports stable results with little, if any, regression. The risks and complications of both PRK and Intralase SBK will be discussed in detail on the day of your consultation. Q. Is there any pain? There is no pain during the procedure. Freezing drops are administered before the procedure to alleviate any discomfort. You may experience a scratchy sensation and may be sensitive to light for the first couple of days. Should you have any discomfort, pain relief medication is available. Q. Do I need to take time off work? Every person s healing rate is unique. Patients who have PRK generally return to work 4 to 7 days after the procedure. Normal activities including sports may be resumed at this time. With Intralase SBK, some patients see well enough to return to work within 24 to 48 hours. Q. What can I expect after Laser Vision Correction? After a laser procedure you can expect to see as well as you did with your glasses or contact lenses. For many patients the procedure means freedom to participate in sport and leisure activities without the hassles of corrective lenses or glasses. Others are motivated by the ability to see the alarm clock first thing in the morning. Whatever your motivation, the procedure offers a new freedom. Q. What is the Goal of Focus Eye Centre? Our goal is to provide a viable alternative to those nearsighted, farsighted and or astigmatic patients who are motivated to reduce or eliminate their need for glasses or contact lenses. Making an informed decision with reasonable expectations is an integral part of achieving this goal. A-4 rev 09/09

9 FOCUS EYE CENTRE Ottawa 1565 Carling Ave. Suite 110 Ottawa, ON K1Z 8R1 (613) IN-FOCUS ( ) Kingston Hotel Dieu Hospital 166 Brock Street Suite 325 Kingston, ON K7L 5G2 (613) Monovision The human eye can focus on objects at different distances, similar to a camera, by automatically adjusting its depth of focus through a process called accommodation. All humans naturally lose their ability to accommodate over time, beginning gradually at age 42 and completely by age 60. For individuals who are nearsighted, this is not a big problem as they can take off their distance glasses and still see well up close. For individuals who are farsighted, the loss of the ability to accommodate will result in the need for reading glasses or bifocals. So far the technology for refractive surgery has not yet come up with a reliable bifocal correction on the cornea. Therefore, if you are over 42 and want to see both distance and near without glasses then you will need monovision correction. This means that one eye is focused for distance and one eye is focused for near vision. Normally the dominant eye is focused for distance. Although you may think monovision will leave you feeling unbalanced, almost all of our patients adjust completely within one week to a month. After this initial adjustment period, patients are not even aware which eye is being used just that they can now see both distance and near for most of their everyday vision needs. As patients get closer to age 60 they will need magnifiers for very close work such as threading a needle or reading in bed. (At Focus Eye Centre, the majority of our patients over 42 years of age choose to have monovision and the overwhelming feedback is that it works.) To summarize monovision: Advantages Ability to do most activities without glasses. Functional near vision without glasses (e.g. reading, writing and working on a computer). Retain peripheral vision and depth perception. Disadvantages May lose some stereopsis (near). After age 60 will need magnifiers for very close work (e.g. threading a needle). A-6 rev 09/09 Bring your into focus world

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11 LIFETIME COMMITMENT We stand behind our results Eligibility/Requirements In order to be eligible for the Focus Lifetime Commitment program the patient must: have had their initial Laser Vision Correction procedure at Focus Eye Centre; have attended all of the required post-operative eye exams, be compliant with drop regime, and follow all the necessary post-operative instructions set out by the physician managing the patient s care; have had an annual eye examination with a Focus affiliated eye doctor upon completion of the one year post-operative period which must be documented and signed off by Focus physicians; and The patient is responsible for the cost of the annual eye examination. Upon completion of their one year postoperative review period, patients must consult their own eye doctor if they encounter any problems with their eyes including a reduction in their vision. Your eye doctor will advise you whether an enhancement would be appropriate and, if so, will refer you back to Focus Eye Centre. CRITERIA FOR ENHANCEMENT Patients are eligible for an enhancement if their residual refractive error is +/ with an Uncorrected Visual Acuity (UCVA) of 20/40 or worse and the enhancement is recommended by the Surgeon at Focus Eye Centre. If an enhancement is recommended by Focus Eye Centre it will not occur until a minimum of 9 months from the original procedure or at the surgeon s discretion. Patients who fall in the High Myopia, High Hyperopia, and High Astigmatism category are guaranteed a maximum of 2 enhancement procedures per eye due to the severity of the initial preoperative refraction. See the Additional Consent form for further clarification. If the patient requests a retreatment that falls outside the Criteria for Enhancement as detailed in the Lifetime Commitment, this retreatment will be subject to a fee. BENEFITS Focus Eye Centre will provide any necessary additional treatments directly related to the patient s initial Laser Vision Correction procedure at no charge provided it falls within the Criteria for Enhancement as detailed in the Lifetime Commitment. However, if the recommended enhancement involves a procedure which was more expensive than the original treatment method, the patient will be responsible for an additional fee of up to $1000 per eye. Eye drops will be dispensed by Focus Eye Centre within the first year only, or following an enhancement within the first year, or at the discretion of the physician. If the enhancement occurs within one year of the date of the initial treatment, patients have the choice of having their post- enhancement examination at Focus Eye Centre or with a Focus affiliated doctor. If the enhancement occurs more than one year from the date of the initial treatment, patients are responsible for the cost of the post-operative examinations if the examinations are not conducted at Focus Eye Centre. Focus Eye Centre s co-management program for post-operative care is only valid in Canada. Patients residing outside of Canada are responsible for the cost of all post-operative care. RESTRICTIONS Patients will be excluded from Lifetime Commitment Policy if one (or more) of the following conditions are preexisting, and/or present at the time of surgery or are conditions that occur after date of surgery: Amblyopia, Strabismus, Ptergium Have had an initial and/or Retreatment surgery elsewhere Diabetes Type I or II, Auto-Immune disorders (ie. Lupus, Crohns/Colitis, RA...) Glaucoma, Cataracts, Keratoconus, Corneal Dystrophy s or Keratitis Have had a trauma or injury to the eye The Standard Enhancement Policy will apply for those patients who are not eligible for the Lifetime Commitment Policy, whether through restriction (s) as outlined above, or non-compliance of the terms and conditions of the program. The Standard Enhancement Policy is outlined below: Entitled to Retreatment(s) within 2yrs of their initial surgery. After this 2yr period a $500 Retreatment Fee (plus technology fee if applicable) per eye will apply, conditional on Surgeon Recommendation and Patient Compliance relating to Post- Operative Care. I have read and understand the conditions of the Lifetime Commitment outlined above. I understand that should I not qualify at the time of surgery, or do not meet the conditions, I will be covered by the Standard Enhancement Policy as outlined above. Patient Name: Patient Signature: Date: Witness Name: Witness Signature: Date: 1565 Carling Ave., Suite 110, Ottawa, ON K1Z 8R1 n IN-FOCUS ( ) n n fax n Hotel Dieu Hospital, 166 Brock St., Suite 325, Kingston, ON K7L 5G2 n n n fax n C7 Rev. 01/11

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13 Surgeon Profiles Dr. David R. Edmison, MD, FRCS(C) Medical Director, Ottawa Dr. Edmison is the founder and Medical Director of Focus Eye Centre and has been involved in laser vision correction since He is a leader and pioneer in the field of refractive surgery. Having performed over 30,000 Laser Vision Correction procedures, Dr. Edmison is one of the most experienced and respected laser eye surgeons in Canada. Between 1996 and 1998, Dr. Edmison was the President of the Canadian Society of Cataract and Refractive Surgery. He is also the former Chair of the Department of Ophthalmology at the Grace General Hospital in Ottawa. Dr. Edmison is currently on staff at the Ottawa Hospital, Riverside Campus, and the Hotel Dieu Hospital in Kingston. Dr. Edmison has been part of a volunteer cataract-teaching program run by ORBIS in Fuzhou, China, and conducted research for VISX (now AMO), the leading manufacturer of excimer lasers. In addition, he has published numerous articles in the area of ophthalmic surgery and is frequently asked to lecture at international conferences. Dr. Claude Ménard, MD, FRCS(C), CPSQ Refractive & Corneal specialist Dr. Claude Ménard is a long-serving and valued refractive surgeon at Focus Eye Centre. He is also a corneal specialist who has performed more than 200 corneal transplants and over 3,500 cataract surgeries. Dr. Ménard is a member of many professional associations including the Association des Ophtalmologistes du Québec where he sat on the board of directors from 1996 to At the Université de Sherbrooke, Dr. Ménard was professor of corneal diseases for the residency program from 1988 to 1994 and associate professor of Ophthalmology at the Faculty of Medicine from 1995 to Dr. Ménard was the Head of the Ophthalmology department at the Centre Universitaire de Santé de l Estrie in Since 1999, Dr. Ménard has been the Head of the Department of Ophthalmology at the Centre Hospitalier des Vallées de l Outaouais in Gatineau, Québec and is an associated member at the Centre Communautaire du Pontiac in Shawville. Dr. Ménard is actively involved in ophthalmic research and regularly gives presentations across Canada. Since founding Focus, there s not been a more exciting time to be involved in laser vision correction. With the advancements of Intralase SBK and Wavefront, the majority of our patients now have even better vision than they had with glasses or contacts. Focus Eye Centre is truly a leader in laser vision correction. The results we are able to achieve for patients at Focus these days are nothing short of impressive. Dr. Kevin Smith, MDCM, FRCS(C) Oculoplastic specialist Dr. Kevin Smith is an ophthalmologist, cataract and oculoplastic surgeon, providing Blepharoplasty (Eyelid Rejuvenation Surgery) to Focus Eye patients. Dr. Smith is a Fellow of the Royal College of Surgeons (Canada) in Ophthalmology and is American Board Certified in Ophthalmology. A Montreal native, he has been in private practice in Ottawa since 1992, averaging 500 cataracts and 500 oculoplastics procedures each year. He is currently the Team Ophthalmologist for the Ottawa Senators Hockey Club. Dr. Smith earned a B.Sc. in Mathematics, a Diploma in Management and an M.D.C.M. from McGill University. His post-graduate training included: Rotating Internship, St. Mary s Hospital, McGill University, ; Residency in Ophthalmology, Chief Resident, University of Western Ontario, ; Fellowship in Ophthalmic Plastics and Orbital Reconstructive Surgery, McGill University, Dr. Smith worked for the Department of National Defense, first as a base flight surgeon in Portage, Manitoba ( ) and then as an ophthalmologist with the rank of Major at the National Defense Medical Centre ( ). It is a true pleasure to be able to extend Blepharoplasty treatments to Focus Eye patients. My association with Focus and Everesr SurgiCentre is a professional union that makes sense, as evidenced by the outstanding outcomes patients are seeing. Dr. John Cheung, MD, FRCS(C) Medical Director, Kingston Dr. John Cheung is Medical Director of Focus Eye Centre in Kingston. He is also an Assistant Professor of Ophthalmology at Queen s University in Kingston, Ontario. Dr. Cheung graduated with honours from the Faculty of Medicine at University of Toronto in He studied Ophthalmology at Queen s University and then did further post-graduate study in Ophthalmology at McGill University in Montreal. Dr. Cheung is a member of the American Board of Ophthalmology and is a Fellow of the Royal College of Physicians and Surgeons of Ontario. Dr. Cheung has written several articles in the field of ophthalmology and is the recipient of numerous academic prizes and graduate scholarships including the R. Samuel McLaughlin Foundation Fellowship Award at McGill University and the Wilkinson Scholarship at the University of Toronto for excellence in the field of Ophthalmology. Dr. Cheung has been affiliated with Focus Eye Centre since He has a stellar reputation for offering excellent care to his patients and delivering superior results with both clear lens exchange and refractive procedures. I m very proud of Focus s commitment to bringing the best technology to patient care. In particular, I m excited about the great results we ve been having with Wavefront technology, and the positive effect it has had on the people we treat. A7 rev 11/ Carling Ave., Suite 110, Ottawa, ON K1Z 8R1 n IN-FOCUS ( ) n local (613) n Hotel Dieu Hospital, Suite 325, 166 Brock St., Kingston, ON K7L 5G2 n n local (613) n

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15 FAST factsa NEWS Intralase SBK Workshop Updates SERVICE FOR DOCTORS AFFILIATED WITH FOCUS EYE CENTRE The response to Intralase SBK has been quite positive from both patients and Co-Managing doctors. Intralase SBK with Wavefront now encompasses 80% of all procedures performed at Focus Eye Centre. Please see below for a summary of discussion points highlighted at the Spring 2009 Co-Management meetings, Monday, April 27 and Wednesday, May 6. This document is accessible via InSight the secure dedicated website for Co-Managing doctors. Complications: Haze: Difuse sub epithelial haze can develop at the 1 3 month check-up. This is quite common and does not affect quality of vision and will fade overtime. Drops are not required and the patient is not symptomatic. Edema: Presents at the 24hr and may be detected at the 1 week post-op visit. Rarely persists after first week unless patient is elderly or has a pre-existing corneal condition. Striae: Most patients undergoing Intralase SBK have a bandage contact lens (BCL) inserted after surgery. The use of the contact lens has resulted in far less micro-striae and interface debris. The contact is typically removed at the 24hr post-operative visit at Focus. If significant striae are noted at the one week Intralase SBK follow-up and this is interfering with the quality of vision the patient should be sent back to Focus immediately. Please also notify Nancy Bast (Co-Management Coordinator) of the patient s name so she can expedite the process. Protective eye shields are to be worn at night for the first week after surgery, and are strongly recommended to prevent striae. Patients are also advised to avoid rubbing or squeezing eyes to prevent striae. Flap dislocation: Although rare, vigorous rubbing or a blow to the eye may result in flap dislocation during the first month post-op. Refer immediately back to Focus for repositioning. Interface Debris: Normal post-op finding. Patients with pre-existing blepharitis may have a higher incidence of interface debris. This will gradually disappear over 2 3 months. DLK: Usually detected at the 24hr post-op. Due to the thickness of the flap, Pred Forte (PF) Q2H has excellent penetration and DLK typically resolves within the first week. Transient Light Syndrome (TLS): Extreme photophobia may develop approximately one month post SBK. This has been noted in less than 5% of our patients. The course of treatment is to initiate PF QID and to follow-up within 1 2 weeks, to make sure photophobia symptoms have resolved at which point drops can be discontinued. Epithelial In-growth: Very rare, can be confused with interface debris. If presents, please send patient back to Focus for evaluation. Regression: Percentages for myopes same as PRK. Hyperopes show a significant reduction in regression verses PRK. Retreatments: Stability dependent. On average 6 months post-op. SBK retreatments post PRK treatments epithelial tissue is not as strong and recovery may take longer (i.e. BCL X 48hours). PRK retreatment patients are eligible for Intralase SBK enhancement at an additional fee of $ per eye. Intralase SBK may benefit Hyperopes post PRK due to reccurence of regression. Dry eyes: Incidence of dry eyes reported following SBK is considerably less than with LASIK and the same, or slightly less than with PRK. Most patients will discontinue artificial tears 1 3 months post-op.when determining patient candidacy, Intralase SBK may prove advantageous for patients with pre-existing dry eyes, or who are contact lens intolerant. FAQs: Q: Why does the Intralase SBK flap appear rough in comparison to a LASIK flap? A: The Multiple (>1 micron) small explosions beneath the epithelium coalesce together but still leave a slightly irregular surface. Bonding is enhanced because of this. Advantages of the SBK flap include: Less risk during surgery (minimal risk of Ischemic Optic Neuropathy) More tissue remains on the bed lessens occurrence of ectasia Re-growth of nerves faster Scarring / haze at edge of flap is more common with SBK than LASIK patients are not symptomatic Less incidence of dry eyes Flap is plano increased safety factor in the event flap is removed, vision will not change, similar to PRK vs. LASIK not perfectly plano thinner in the middle Less epithelial in-growth which is problematic with LASIK Important to remember all flaps will not look the same due to individual healing differences Q: Is striae a concern? A: If vision is not impacted, striae is not a concern Q: Is flap debris normal? A: If there is no inflammatory response, debris is not centrally located and VA is not affected, no course of concern. Q: Is corneal edema a common finding post SBK? A: 1 2 weeks post- SBK patients may report a foggy VA or halos related to the edema. Ottawa: 1565 Carling Ave., Suite 110 n IN-FOCUS ( ) n n fax n Kingston: Hotel Dieu Hospital, 166 Brock St., Suite 325 n n n fax n

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17 FAST factsa NEWS SERVICE FOR DOCTORS AFFILIATED WITH FOCUS EYE CENTRE New Patient Selection Parameters for Hyperopes Having tracked statistical outcomes at Focus for years, we have concluded that hyperopic patients over achieve best outcomes with CLE (Clear Lens Exchange), says Dr. David Edmison, Medical Director. Please contact us at: by at or by calling Based on this data, we will be recommending this procedure for those patients who otherwise qualify. This change is reflected in the updated Patient Selection Parameters attached, in full, here. We ask that you read this information closely, especially as it pertains to hyperopes, and contact us by phone or should you have any questions. Ottawa: 1565 Carling Ave., Suite 110 n IN-FOCUS ( ) n n fax n Kingston: Hotel Dieu Hospital, 166 Brock St., Suite 325 n n n fax n

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19 FAST factsa NEWS SERVICE FOR DOCTORS AFFILIATED WITH FOCUS EYE CENTRE InSight Comes Online OD Intranet designed to bring best info to eyecare professionals Focus Eye Centre prides itself on the close working relationships it has developed with ODs in the local community. These relationships date back to Focus Eye s inception 15 years ago and will be maintained well into the future. These days Focus affiliated ODs number upwards of 200 and offer our laser vision correction (LVC) centre a valued and valuable link to the men and women who are primary healthcare practitioners of the eye. As a means of further our connection, as well as fostering knowledge exchange between Focus surgeons and ODs and those ODs working in the community, we have built an OD Intranet InSight accessible via Focus Eye s main website ( The mission of InSight is to keep Focus-affiliated ODs abreast of the latest developments in laser vision correction, particularly surgical techniques and treatments being used by Focus Eye. InSight is a natural extension of what we do each and every day in terms of connecting and conferring with ODs, says Nancy Bast, Co-Management Coordinator at Focus. We are also cognizant of the fact that ODs are often the first face a patient meets when they are struggling with vision correction. Often the best vision-care solution is a pair of glasses or contact lenses. However, many people find the benefits of LVC too numerous and positive to resist, adds Bast. surely become the industry standard based on the outcomes it is delivering. There have been more than 1 million SBK procedures performed in the U.S., and the U.S. Navy, a long-time proponent of PRK for its fighter pilots, has already moved to adopt SBK as their standard of care. InSight is a natural extension of what we do each and every day in terms of connecting and conferring with ODs, InSight asks the question Why Refer? and looks into the particulars of OD Co-Management. It also delves into industry-leading treatment issues such as the data on Intralase SBK (Sub-Bowman s Keratomileusis), which involves creating an ultra-thin corneal flap of approximately 100 microns just below Bowman s layer with a femtosecond laser. Simply stated, Intralase SBK combines the advantages of PRK and LASIK, with recovery times measured in hours rather than days. The case for Intralase SBK is extremely compelling, and one you ll be hearing a lot about in the coming days as doctors and patients alike adopt what will Two-way communication and 24/7 access are of paramount importance, according to Nancy Bast, who points out that InSight allows ODs to download pre- and post-operative forms. We are also encouraging our ODs to send us their comments and questions about the work we do and the ways in which we can better assist ODs in the work they do. Whether it is an eye exam or troubleshooting an infection, performing LVC or CLE, Focus and its affiliate ODs share a common goal: getting people their best possible vision in the safest and most effective manner. (613) IN-FOCUS

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21 FAST factsa NEWS SERVICE FOR DOCTORS AFFILIATED WITH FOCUS EYE CENTRE Why Wavefront Wavefront is a diagnostic technique that produces detailed information which is then programmed into the laser prior to your patient s procedure. Wavefront goes beyond treating nearsightedness, farsightedness and astigmatism by detecting all the irregularities that impact on the path of light from the front of the eye (cornea) to the retina at the back, and then eliminating them. While our Standard laser vision correction results are excellent, Wavefront affords greater precision for the surgeon and better results for our patients. Our surgeons are recommending Wavefront to candidates that fall within the parameters. It is a Standard of Care here at Focus, and simply put, a better treatment option. Focus Eye Internal Results: Highlights of Wavefront results are as follows: 91% 20/20 Uncorrected Visual Acuity or Better at 3 months 50% 20/15 Uncorrected Visual Acuity or Better at 3 months 100% 75% 59% 25% 0% 100% 75% 59% 25% 0% PRK and PRK-WGA Low Myopia 3 MonthUncorrected Visual Acuity % % PRK-WGA Low Myopia 3 Month Uncorrected Visual Acuity 50% >20/15 73% PRK 94% 91% PRK-WGA % % 95% 100% 91% PRK-WGA /15 or better 20/20 or better 20/25 or better 20/40 or better 100% >20/20 >20/25 >20/40 The surgeons at Focus started using Wavefront in late 2002, and since that time have had extraordinary results. Many patients are seeing better than they ever could with glasses or contacts. The majority of our Wavefront patients have recorded better vision than they were able to achieve before their procedure in many cases 20/15 or even 20/10. In addition, patients also talk of an improved quality of vision. David Edmison, MD, FRCSC, Medical Director. Each patient outcome is as unique as the individual s fingerprint. But Wavefront is not for everyone; it depends on the results of the examination with the surgeon and consultation with the patient. The goal, as always, is to identify and deliver the best outcome for your patients. Who Qualifies for Wavefront? The patient parameters for WGA are as follows: Myopia: sphere, and up to cylinder. Hyperopia: sphere, and up to cylinder. Minimum requirement for pupil size: 5 mm. (613) IN-FOCUS

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