Consent for Bilateral Simultaneous LTK
For Treatment of Hyperopia

If you elect to have surgery performed on both eyes at the same time, you should understand both the possible advantages and disadvantages of your decision.

The advantages of having LTK performed on each eye at a separate time are:

Safety:  You will not experience the risk of developing an infection in both eyes at the same time, which although rare, could lead to significant loss of vision in both eyes. 

Accuracy:  The doctor can monitor the healing process and visual recovery in the first eye and may be able to make appropriate modifications to the treatment plan for the second eye if necessary.  By delaying surgery, it may be possible in some patients to improve the accuracy of the result in the second eye.

Visual Recovery: If the eyes are operated separately, you will be able to function with your fellow eye while the first eye is healing.  Therefore, you may be able to return to work and drive earlier.  This is particularly important if your healing is delayed and vision remains blurred for a prolonged period.

Satisfaction:  You will be given the opportunity to determine whether the LTK procedure has produced satisfactory visual results without loss of vision or other undesirable side effects such as pain, glare, ghost images, or increased light sensitivity. 

The disadvantages of having LTK performed on each eye at a separate time are:

Convenience:  It may be more inconvenient for you to have each eye treated at separate visits.  This will necessitate two periods of recovery from the laser surgery and may require additional time away from work.

Visual Recovery: There will be a potential period of imbalance in vision between your two eyes.  This is especially important if you are unable to wear a contact lens in your unoperated eye. 

Cost:  Professional and facility fees may be greater if the eyes are operated on different days and the additional time off work can be costly.

The advantages of having LTK performed on both eyes at the same time are:

Convenience:  It may be more convenient to have both eyes treated during the same visit.

Visual Recovery: The balance in vision between your two eyes may be restored more rapidly.  This is especially important if you are unable to wear a contact lens in your unoperated eye.

Cost:  Professional and facility fees may be reduced, and, if both eyes heal satisfactorily, you may miss less work.

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The risks of having LTK performed on both eyes at the same time are:

Safety:  The risk of infection and other healing complications is applicable to both eyes simultaneously.  Therefore, if an infection occurs in one eye, it may also occur in the other eye.  Although rare, a serious infection in both eyes can cause significant loss of vision and even legal blindness.

Accuracy:  By correcting both eyes simultaneously, there is no opportunity to learn from the healing patterns of the first eye before treating the second eye.  Therefore, if there is an over-correction or undercorrection in one eye, chances are it may happen in both eyes.  If a retreatment is required in one eye, it is quite possible that your fellow eye may also require a retreatment.

Visual Recovery:  Some patients can experience delayed visual recovery and experience symptoms such as blurred vision, night glare or ghost images.  There is no way of predicting how long your eyes will take to heal, and some of these complications can result in prolonged recovery of normal vision.  Blurred vision may continue in both eyes for several weeks, which could make driving difficult or dangerous and could interfere with your ability to work.  Therefore, it may be necessary to take one or more weeks off work.

Satisfaction:  Both eyes tend to experience similar side effects.  If you experience undesirable side effects such as pain, glare, ghost images, increased light sensitivity, or corneal haze in one eye, you will likely experience them in both eyes.  These side effects may cause a decrease in vision or other negative effects, and some patients have elected to not have their second eye treated.

“I have read and understand the above risks and benefits of bilateral simultaneous LTK for treatment of hyperopia, and I understand that this summary does not include every possible risk, benefit and complication that can result from bilateral simultaneous LTK.  My doctor has answered all of my questions about the LTK procedure.  I wish to have both of my eyes treated during the same treatment session if my doctor determines that the treatment in the first eye appeared to be technically satisfactory.”

The reason(s) I wish to have both eyes treated at the same time are: 

 Greater convenience		 Possible faster recovery
 Contact lens intolerance and/or difficulty wearing contacts	 Less time away from work	
 Elimination of possible vision imbalance between treated and untreated eyes

Patient signature								Date

Witness										Date