CONSENT FOR BILATERAL SIMULTANEOUS PRK
Introduction
The FDA recommends a minimum of three months between the treatment of the first eye and treatment of the second eye with PRK. 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 pre- sent 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 disadvantages of your deci- sion.
The advantages of having PRK 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, increasing the like- lihood of a better outcome in the second eye.
Visual Recovery: If the eyes are operated on 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 partic- ularly 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 PRK procedure has produced sat- isfactory visual results without loss of vision or other undesirable side effects such as glare, ghost images or increased light sensitivity.
The disadvantages of having PRK 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: 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 PRK 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 espe- cially important if you are unable to wear a contact lens in your unoperated eye.
Cost: Fees may be reduced, and, if both eyes heal satisfactorily, you may miss less work.
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The risks of having PRK 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 infec- tion 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 under-correction    in one eye, chances are it will happen in both eyes. If a retreatment is required in one eye, it is quite possi-  ble that your fellow eye also will require a retreatment.
Visual Recovery: Some patients experience delayed visual recovery and symptoms such as blurred vision, night glare or ghost images. There is no way to predict 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 abil- ity 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 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.
PATIENT CONSENT
I have read and understand the above risks and benefits of bilateral simultaneous PRK, and I understand 
that this summary does not include every possible risk, benefit and complication that can result from bilat-  eral simultaneous PRK. My doctor has answered all of my questions about the PRK 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:
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