CONSENT FOR BILATERAL SIMULTANEOUS LASIK
Introduction
Both within and outside the United States, LASIK has become a common procedure for many refractive surgery patients.  In both PRK and LASIK, the second eye may be treated sooner than three months after the first eye, or even at the same time; however, there may be risks associated with simultaneous treatment that are not present when the eyes are treated on different days.  If you elect to have surgery performed on both eyes at the same time, you should understand both the possible advantages and disadvan- tages of your decision.
The advantages of having LASIK 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 very rare, could lead to significant loss of vision in both eyes.  Since the pressure in the eye is increased significantly for a short time during the LASIK procedure, there is a very remote possibility of internal bleeding or damage to the retina which could lead to significant loss of vision or even blindness. Should this happen to both eyes, the consequences could of course be devastating.
It is also possible to develop a delayed cloudiness in the cornea or even corneal scarring which is not visi- ble immediately after the procedure.  Although this is uncommon and generally clears with time, it can  result in significant loss of vision for a prolonged period of time.  Should this occur in both eyes at the same time, carrying out normal activities could be difficult.
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.  By delaying surgery, it may be possible in some patients to improve the accuracy of the result in the second eye.
Visual Recovery: Although most LASIK patients experience a rapid recovery in their vision, the recovery can at times be delayed.  If the eyes are operated separately, you can function with the fellow eye while the first eye fully recovers.  This is especially true if you are able to wear a contact lens in the unoperated eye.
Satisfaction: You will be given the opportunity to determine whether the LASIK procedure has produced satisfactory visual results without loss of vision or other uncommon undesirable side effects such as glare, ghost images, or increased light sensitivity.  If you are over age 40, you will have an opportunity to experi- ence the change in your close vision which results from the correction of your nearsightedness.  This could influence your decision on whether or not to fully correct your other eye to maintain some degree of close vision without the need for glasses (monovision).
The disadvantages of having LASIK performed on each eye at a separate time are:
Convenience: It may be inconvenient for you to have each eye treated at separate visits.  This will necessi- tate two periods of recovery from the laser surgery and may require additional time away from work.
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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.  It is not usually pos- sible to use the operated eye without a corrective lens along with a strong corrective lens in the unoperated eye because it produces a strong sense of imbalance, dizziness, and a form of double vision.
Cost: 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 LASIK 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 will usually be restored more rapidly.  This is especially true if you are unable to wear a contact lens in your unoperated eye.
Cost: In addition to possibly missing less work by allowing both eyes to recover at the same time, fees may be discounted if you have surgery on both eyes at the same time.
The risks of having LASIK performed on both eyes at the same time are:
Safety: The risks of infection, delayed clouding of the cornea, corneal scarring and internal bleeding or reti- nal damage are very rare but potentially devastating.  If these serious but rare complications occur in one eye, they may also occur in the other.  Should any of these complications happen, you could experience sig- nificant loss of vision or even temporary or permanent 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 under-correction   in one eye, chances are it may happen in both eyes. If a retreatment is required in one eye, it is quite pos-  sible that your fellow eye may also require a retreatment.
Visual Recovery: LASIK patients generally experience rapid visual recovery.  Some patients, however, 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 complica- tions can result in prolonged recovery of normal vision.  Blurred vision may rarely continue for several weeks in both eyes, which could make driving difficult or dangerous and could interfere with your ability    to work. The healing corneal flap is most susceptible to trauma during the first several weeks after surgery. Should both flaps become accidentally displaced, significant visual loss in both eyes may result.
Satisfaction: Both eyes tend to experience similar side effects.  If you experience undesirable side effects such as 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.
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CONSENT STATEMENT
"I have read and understand the above risks and benefits of bilateral simultaneous LASIK, and I understand that this summary does not include every possible risk, benefit and complication that can result from bilat- eral simultaneous LASIK.  My doctor has answered all of my questions about the LASIK procedure.  I wish to have both of my eyes treated during the same treatment session if my doctor determines that the treat- ment in the first eye appeared to be technically satisfactory.  I do or do not (please circle your choice) want the opportunity to briefly look around the room after the treatment in my first eye to assess the approximate quality of my vision before deciding to proceed with treatment of the second eye.  If I choose to evaluate   my vision after the first eye is treated, I understand that this brief assessment is not a guarantee of a satis- factory visual outcome in either eye but is an attempt to determine that a serious complication to the back    of my eye has probably not occurred.
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 signature_______________________________ Date____________________________