[ADDENDUM TO GENERAL CONSENT FORM]

ORBITAL AND PLASTIC SURGERY

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

1. Loss of vision
2. Loss of eye
3. Double vision
4. Disfigurement
5. Hemorrhage or infection
6. Failure to solve problem, and possible aggravation of problem
7. Possible necessity for multiple additional procedures, including surgery,  chemotherapy and radiation
8. Eyelid malposition, possibly requiring secondary procedure
9. Tearing
10. Possible penetration of sinuses or intracranial space with attendant complications such as meningitis or spinal fluid leak
11. Sensory loss on face

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.