[ADDENDUM TO GENERAL CONSENT FORM]

LASER SURGERY

Complications which could occur weeks, months, or even years later:

1. Failure to achieve intent of surgery
2. Loss of central or side vision
3. Bleeding in eye
4. Early or late increase in pressure in eye (glaucoma)
5. Corneal burns
6. Damage to lens (cataract)
7. Retinal hole
8. Collection of fluid in back of eye
9. Damage to optic nerve
10. Damage to the iris
11. Damage to an intraocular lens implant, if present
12. Loss of vision or loss of eye

Local complications of anesthesia injections around the eye:

1. Perforation of eyeball
2. Destruction of optic nerve
3. Interference with circulation of retina
4. Possible drooping of eyelid
5. Respiratory depression
6. Hypotension

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Six reasons OMIC is the best choice for ophthalmologists in America.

Consistent return of premium.

Publicly-traded insurance companies exist to make profits for shareholders while physician-owned carriers often return profits to their policyholders. Don’t underestimate this benefit; it can add up to tens of thousands of dollars over the course of your career. OMIC has one of the most generous dividend programs for ophthalmologists and has returned more than $90 Million to our members through dividends.