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Informed Consent For Lasik Surgery

LASIK is an elective surgery that permanently changes the shape of the cornea to correct vision without glasses or contacts. It involves creating a corneal flap and removing tissue with a laser. Risks include dry eyes, over or under correction requiring additional surgery, and rare but vision-threatening infections, malfunctions, or ectasia. While LASIK aims to improve vision, the results are not guaranteed and additional procedures may still be needed.

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100 views2 pages

Informed Consent For Lasik Surgery

LASIK is an elective surgery that permanently changes the shape of the cornea to correct vision without glasses or contacts. It involves creating a corneal flap and removing tissue with a laser. Risks include dry eyes, over or under correction requiring additional surgery, and rare but vision-threatening infections, malfunctions, or ectasia. While LASIK aims to improve vision, the results are not guaranteed and additional procedures may still be needed.

Uploaded by

Moerieda Rinquest
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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INFORMED CONSENT FOR LASIK SURGERY

The following information is intended to help you make an informed decision about having
Laser Assisted In-Situ Keratomileusis (LASIK) surgery to correct your vision.

Since it is impossible within the context of this form to state all possible risks of any
surgery or procedure, this form cannot provide a comprehensive listing of every
conceivable problem. All sight threatening complications will be listed.

OVERVIEW OF LASIK

LASIK permanently changes the shape of the cornea. The surgery is performed under
topical anaesthesia. The LASIK procedure involves folding back a thin layer of corneal
tissue (corneal flap). A layer of corneal tissue is then removed with an excimer laser. The
flap is then replaced. This causes the shape of the cornea to change so that the focusing
power of the cornea is corrected.

Although the goal of LASIK/PRK is to improve the vision to the point of not being
dependent on glasses or contact lenses, this result is not guaranteed. Additional
procedures, spectacles or contact lenses may still be required to achieve adequate vision.

LASIK does not correct the condition known as presbyopia, which occurs in most people
between the ages of 40 and 50 years and requires them to wear reading glasses. If you
presently wear reading glasses, it is likely you will still need reading glasses after
treatment. If you do not need reading glasses now, you may need them when you reach
this age.

RISKS AND COMPLICATIONS

NON VISION THREATENING COMPLICATIONS:


a) Dry eyes. This is very common after LASIK and is present to some degree in all
cases. This is usually a temporary phenomenon and resolves after a few weeks.
Occasionally this can be severe enough to cause discomfort and blurred vision.
b) Over-correction or under-correction may occur and LASIK surgery may not give
you the result you expected. It may be possible or necessary to have additional surgery to
fine-tune or enhance the initial result. It is also possible that your initial result could regress
over time.
c) Increased sensitivity to light. This may require the use of sunglasses but usually
settles after a few weeks.
d) Decreased vision in dim light and starburst or halo around lights at night can
occur in some patients. These effects diminish after the first few months, but some
elements can be permanent. Very occasionally patients have severe enough problems to
make them feel insecure driving at night.
e) Loose epithelium or abrasions of the corneal surface. This may cause some
discomfort during the first 48 hours. This may also result in delayed healing and delayed
improvement of vision.
f) Inflammation. Rarely inflammation can occur at the flap interface (LASIK). This is
known as Diffuse Lamellar Keratitis (DLK). It usually resolves in about a week with
treatment but if severe could cause haze of the cornea.

Dr Dale Harrison, Specialist Ophthalmologist, MBChB (UCT) DCH (SA) FCOphth (SA)
Pr No. 0127280 • T: 27 21 674 1741 / 1846 • C: +27 82 461 1851
E: [email protected] • www.drdaleharrison.co.za
Room 207, Library Square, Wilderness Road, Claremont, 7708
VISION THREATENING COMPLICATIONS.
It is possible that there could be partial loss of vision as a result of the following:
a) Infection that cannot be controlled by antibiotics.
b) Malfunction of the microkeratome or the laser
c) Flap complications, such as an incomplete flap or a buttonhole in the flap. These
are generally not vision threatening complications but may necessitate postponing the
procedure for several months.
d) Epithelial ingrowth. Surface cells of the cornea can grow underneath the flap
causing scarring of the flap and this could require further surgery.
e) Ectasia. Progressive thinning of the cornea resulting in distortion of the shape of
the cornea. This rare complication is more likely to occur in patients with thin corneas but
can occur in any patient. It may require further treatment such as crosslinking to
strengthen the cornea or wearing a hard contact lens.
f) Other risks. Irregular corneal shape could result in distorted vision or ghosting
which may not be correctable by re-treatment, glasses or contact lenses. Severe
complications could require a corneal transplant using donor cornea. It is even possible
that a severe complication could result in complete loss of vision.

PATIENT

I understand that my diagnosis is short-sightedness or far-sightedness with or without


astigmatism. LASIK is an elective procedure which is an alternative to wearing glasses or
contact lenses.
While it is hoped that LASIK will eliminate or reduce my dependency on glasses I
understand that there is no guarantee of a particular outcome and having the treatment
does not necessarily mean total freedom from spectacles. If I am over 45years of age I
understand that I will probably need reading glasses.
I have been informed of and understand the realistic benefits and possible complications
associated with LASIK. In signing below I confirm that I have read this Informed Consent
Form.

I consent to have LASIK surgery performed on my RIGHT / LEFT / BOTH eyes.

……………………………… ……….…………………………… …………….


PATIENT SIGNATURE PATIENT NAME (Capitals) DATE

NB: Please initial both pages

I certify that I have explained the operation; the nature, purpose, potential benefits and
possible risks associated with it.

………………………………………. ……….
DR DC HARRISON DATE

Dr Dale Harrison, Specialist Ophthalmologist, MBChB (UCT) DCH (SA) FCOphth (SA)
Pr No. 0127280 • T: 27 21 674 1741 / 1846 • C: +27 82 461 1851
E: [email protected] • www.drdaleharrison.co.za
Room 207, Library Square, Wilderness Road, Claremont, 7708

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