Consent Forms
Welcome to OMIC’s Consent Form library, a collection of procedure-specific consent forms that you can modify to suit your practice and patient population. Contact riskmanagement@omic.com with questions.
Found
61
resources.
Sep 11, 2026
| Consent Form
...laser suture lysis You have already had glaucoma surgery. During that surgery, the ophthalmologist (eye surgeon) placed sutures (stiches). Your ophthalmologist now recommends using a laser to open one or more of the sutures to allow fluid to drain out of your eye. This is called laser suture lysis. The...
Apr 8, 2026
| Consent Form
...Laser Assisted Cataract surgery. What is Laser Assisted Cataract Surgery? The femtosecond laser (FS laser) is a medical tool the eye surgeon may use to perform some of the steps of cataract surgery. About Laser Assisted Cataract Surgery The eye surgeon uses the laser instead of a surgical blade and...
Sep 11, 2026
| Consent Form
...a someterse a una cirugía de Trabeculoplastia con Rayos Láser. Beneficios ¿Cómo tratará la cirugía de Trabeculoplastia con Rayos Láser mi visión y/o afección [Cómo puede ayudar este medicamento]? El objetivo de la trabeculoplastia con rayos láser es ayudarle a conservar la visión que tiene actualmente. Des pues del Láser,...
Sep 11, 2026
| Consent Form
...About Laser Iridotomy Surgery Your ophthalmologist (eye surgeon) recommends laser iridotomy surgery. The ophthalmologist uses a laser to create a small hole in your iris. This hole will release fluid from behind your iris. Your iris can then move away from the cornea, and your angle will open. · [Include...
Sep 10, 2026
| Consent Form
...provided at all times during the laser energy applications. 2. Flash Fires – Utilization of laser energy always raises the possibility of fire-related incidents. These are rare and are preventable by careful maintenance of the surgical equipment and stringent laser safety precautions. Possible Short-term Effects of CO2 Laser Skin Resurfacing...
Sep 15, 2026
| Consent Form
...minor problems that could occur following the procedure.] Risks What are the main risks of Retina Laser Surgery (Retinopexy)? There is no guarantee that retina laser surgery will improve your condition. Sometimes it doesn’t work. In addition, retina laser surgery is risky. Sometimes it can make the problem worse, cause...
Sep 11, 2026
| Consent Form
...[State any minor problems that could occur following the procedure.] Risks What are the main risks of Laser Iridoplasty surgery? There is no guarantee that Laser Iridoplasty surgery will improve your condition. Sometimes it doesn’t work. In addition, Laser Iridoplasty surgery is risky. Sometimes it can make the problem worse,...
Mar 9, 2023
| Consent Form
...both laser and anti-VEGF injection to treat ROP. Your Ophthalmologist Is Recommending Laser Surgery. Ophthalmologists have been treating ROP with laser surgery for many years. This type of laser surgery is called PRP (pan-retinal photocoagulation). The laser stops the eye from making more of the VEGF chemical. When successful, the...
Sep 14, 2026
| Consent Form
...of sufficient blood causes the retina to release chemicals in the eye that actually makes the ROP worse. About Pan-Retinal Photocoagulation Laser Surgery · Pan-retinal photocoagulation or PRP uses a laser to treat the peripheral retina so that it will stop releasing the chemicals in the eye that make the...
Apr 9, 2026
| Consent Form
...record. Version 4/2026 [Your Letterhead] Laser Capsulotomy Surgery Consent You have [Condition], and your doctor, [Name, MD/DO], is recommending Laser Capsulotomy after Cataract surgery. What is YAG Laser Capsulotomy? YAG Capsulotomy is a laser treatment used to improve vision after cataract surgery, and is usually performed as an outpatient. A...
Sep 11, 2026
| Consent Form
...First, instead of a microkeratome blade, it uses the FDA-approved IntraLase laser to create a flap with laser energy. The IntraLase laser is capable of creating extremely precise flaps by producing tiny bubbles inside the cornea that are 1/10,000 of an inch in diameter. The laser beam cannot penetrate into...
Sep 14, 2026
| Consent Form
...-1 D to -12 D). 2. LASIK is a two-phae operation. First, a thin layer of cornea is either surgically cut with the microkeratome or a flap is created using a laser. The exposed surface of the cornea is then reshaped with an excimer laser, and the flap is returned...
Sep 10, 2026
| Consent Form
...The laser energy can be delivered in different ways: · Trans-scleral approach. The ophthalmologist places the laser on the sclera (white wall of the eye), and the laser energy goes through the eye. The laser may damage the sclera. · Endoscopic approach. The ophthalmologist makes a small incision (cut) in...
Sep 14, 2026
| Consent Form
...this tissue back on the eye after the laser treatment, using sutures, according to the ALK procedure method. It is also possible that the flap incision could result in an incomplete flap, or a flap that is too thin. If this happens, it is likely that the laser part of...
Sep 16, 2026
| Consent Form
...by using an instrument (a surgical iridotomy) or within two weeks before the placement of the phakic implant by using a laser (YAG-laser iridotomy). Before phakic implant surgery begins, your pupils will be dilated and you will be given an anesthetic to minimize your pain during surgery. You may undergo...
Sep 15, 2026
| Consent Form
...D or diopters) and low to higher amounts of myopia (generally -1 D to –12D) through either PRK (photorefractive keratectomy) or LASIK (laser in situ keratomileusis). LASIK is an operation which combines the creation of a flap with the microkeratome or a laser and the removal of tissue with the...
Sep 14, 2026
| Consent Form
...flap is lifted, the flap is flipped over out of the way, and the laser application is performed within the corneal bed instead of on the corneal surface as with PRK. The flap is replaced immediately following the laser application. The flap is held in position through an almost immediate...
Apr 23, 2026
| Consent Form
...is recommending Retina Laser Surgery (Retinopexy). What is [Condition]? · [State the condition and how it impacts the patient.] About Retina Laser Surgery (Retinopexy) · Retina Lasers are an intense beam of light that can be precisely focused to treat certain diseases of the retina. The retina is a delicate...
Mar 9, 2023
| Consent Form
...for laser surgery. In other babies, the abnormal blood vessels are too far back in the eye to perform laser surgery safely. Other parts of the eye or blood in the eye may block the view to the abnormal blood vessels, making it impossible to perform the laser surgery. As...
Sep 11, 2026
| Consent Form
...fewest risks to the patient’s eyesight and overall health. • Usually eye drop medications or laser therapy are used first. Often, multiple medications are needed to get the desired pressure level. • If medications and laser treatment do not work well enough, or if patients have trouble using eye drops...
Sep 11, 2026
| Consent Form
...those that lower the eye pressure with the fewest risks to the patient’s eyesight and overall health. · Usually eye drop medications or laser therapy are used first. Often, multiple medications are needed to get the desired pressure level. · If medications and laser treatment do not work well enough,...
Apr 8, 2026
| Consent Form
...implanted. · Endoscopic cyclophotocoagulation: Your ophthalmologist makes an incision (cut) and passes a light into the eye to guide the laser. The laser treat the cells in the eye that make fluid. The cells create less fluid, and your eye pressure goes down. No device is implanted. Benefits (how the...
Sep 10, 2026
| Consent Form
...the patient’s eyesight and overall health. Usually eye drop medications or laser therapy are used first. Often, multiple medications are needed to get the desired pressure level. If medications and laser treatment do not work well enough, or if patients have trouble using eye drops because of cost, side effects,...
Sep 11, 2026
| Consent Form
...laser therapy are used first. Often, multiple medications are needed to get the desired pressure level. · [bookmark: _GoBack]If medications and laser treatment do not work well enough, or if patients have trouble using eye drops because of cost, side effects, and other difficulties, then glaucoma surgery is required. There...
Sep 11, 2026
| Consent Form
...and overall health. · Usually eye drop medications or laser therapy are used first. Often, multiple medications are needed to get the desired pressure level. · If medications and laser treatment do not work well enough, or if patients have trouble using eye drops because of cost, side effects, and...
Sep 16, 2026
| Consent Form
...eye drop medications or laser therapy are used first. Often, multiple medications are needed to get the desired pressure level. · If medications and laser treatment do not work well enough, or if patients have trouble using eye drops because of cost, side effects, and other difficulties, then glaucoma surgery...
Sep 16, 2026
| Consent Form
...choices may include: · Usually eye drop medications or laser therapy are used first. Often, multiple medications are needed to get the desired pressure level. · If medications and laser treatment do not work well enough, or if patients have trouble using eye drops because of cost, side effects, and...
Sep 10, 2026
| Consent Form
...treatment choices may include: · Usually eye drop medications or laser surgery are used first. Often, multiple medications are needed to get the desired pressure level. · If medications and laser treatment do not work well enough, or if patients have trouble using eye drops because of cost, side effects,...
Sep 14, 2026
| Consent Form
...verification that you have obtained informed consent. · Keep the original in the patient’s medical record. Version 10/09/2014 CONSENT FOR PHOTOTHERAPEUTIC KERATECTOMY Dr. has described to me a procedure called Phototherapeutic Keratectomy (PTK). PTK is done by using the Excimer Laser. The Excimer Laser is used to remove scars, smooth...
Sep 14, 2026
| Consent Form
...lead to permanent scarring and loss of vision that may require corrective laser surgery or, if very severe, corneal transplantation. o Keratoconus: Some patients develop keratoconus, a degenerative corneal disease affecting vision that occurs in approximately 1/2000 in the general population. While there are several tests that suggest which patients...
Sep 14, 2026
| Consent Form
...require laser treatments or additional surgery, or may be too severe to repair, leading to permanent loss of vision · Retinal swelling (cystoid macular edema), which may require eye drops or injections · Glaucoma (elevated pressure inside the eye, which may lead to loss of vision by damaging the optic...
Sep 11, 2026
| Consent Form
...Restylane, Hylaform, Cosmoderm and Perlane. Aside from these treatments, additional options for the correction of lines and wrinkles do exist, including facial creams, BOTOX® Cosmetic (Botulinum Toxin Type A), chemical peels, and laser skin surface treatments, and surgery. Other options not mentioned here may exist. All options should be discussed...
Sep 16, 2026
| Consent Form
...those that lower the eye pressure with the fewest risks to the patient’s eyesight and overall health. · Usually eye drop medications or laser therapy are used first. Often, multiple medications are needed to get the desired pressure level. · If medications and laser treatment do not work well enough,...
Sep 11, 2026
| Consent Form
...at separate visits because it would necessitate two periods of recovery from the laser surgery and might require additional time away from work. If the complication happens during surgery, your surgeon may need to perform another surgery right away to treat it. Your surgeon may discover a new condition or...
Sep 14, 2026
| Consent Form
...necessitate two periods of recovery from the laser surgery and might require additional time away from work. 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. ____________ Initial Consent Statement: “I have read and...
Apr 8, 2026
| Consent Form
...correction: use for toric IOL and relaxing incisions www.omic.com/astigmatism-correction/ · Presbyopia correction: use for presbyopia-correcting IOLs and monovision www.omic.com/presbyopia-correction/ · Laser-assisted cataract surgery: use for laser-assisted cataract surgery or laser relaxing incisions www.omic.com/laser-assisted-cataract-surgery/ You may want to create forms for astigmatism, presbyopia, or laser-assisted surgery that contain both the main...
Apr 8, 2026
| Consent Form
...IOL and relaxing incisions www.omic.com/astigmatism-correction/ · Presbyopia correction: use for presbyopia-correcting IOLs and monovision www.omic.com/presbyopia-correction/ · Laser-assisted cataract surgery: use for laser-assisted cataract surgery or laser relaxing incisions www.omic.com/laser-assisted-cataract-surgery/ · You may want to create forms for astigmatism, presbyopia, or laser-assisted surgery that contain both the main consent form and...
Apr 9, 2026
| Consent Form
...incisions www.omic.com/astigmatism-correction/ · Presbyopia correction: use for presbyopia-correcting IOLs and monovision www.omic.com/presbyopia-correction/ · Femtosecond laser: use for laser-assisted cataract surgery or laser relaxing incisions www.omic.com/laser-assisted-cataract-surgery/ These are sample consent forms. OMIC policyholders are not required to use it. Be sure to review it and modify it to suit your actual...
Sep 10, 2026
| Consent Form
...need for eye drops, laser treatment, or another operation · Abnormal collection of fluid in the eye, with the need for another surgery · Worse or lost vision · Pressure that is too low · Damage to the eyeball or structures inside the eye such as the iris or the...
Sep 10, 2026
| Consent Form
...Page 2 of 3 · Failure to control eye pressure, with the need for eye drops, laser treatment, or another surgery · Abnormal collection of fluid in the eye, with the need for another surgery · Worse or lost vision · Pressure that is too low · Damage to the...
Apr 22, 2026
| Consent Form
...the patient’s eyesight and overall health. · [bookmark: _GoBack]Usually eye drop medications or laser therapy are used first. Often, multiple medications are needed to get the desired pressure level. · If medications and laser treatment do not work well enough, or if patients have trouble using eye drops because of...
Aug 25, 2024
| Consent Form
...an irregularly shaped cornea; instead of being round like a basketball, the cornea is shaped like an American style football. This can make your vision blurry. In addition to toric IOLs, astigmatism can be reduced by glasses, contact lenses, and refractive surgery (Laser assisted in situ keratomileusis [LASIK] or Photorefractive...
Sep 14, 2026
| Consent Form
...(or myopia) using the excimer laser is associated with a higher chance of developing corneal scarring or “haze.” This corneal haze may develop years after the original procedure and can result in decreased vision. Refractive surgeries such as Photorefractive Keratectomy (PRK), Laser-Assisted Subepithelial Keratomileusis (LASEK), and Advanced Surface Ablation (ASA)...
Sep 10, 2026
| Consent Form
...the need for eye drops, laser treatment, or another operation · Worse or lost vision · Pressure that is too low · Damage to the eyeball or structures inside the eye such as the iris or the lens · Infection · The need for more surgery · Bleeding in the...
Sep 10, 2026
| Consent Form
...The ophthalmologist cannot tell you about every risk. Here are some of the most common and serious risks: · Failure to control eye pressure, with the need for eye drops, laser treatment, or another surgery · Abnormal collection of fluid in the eye, with the need for another surgery ·...
Sep 10, 2026
| Consent Form
...properly performed. Your ophthalmologist cannot tell you about every risk. Here are some of the most common and serious risks: · Failure to control eye pressure, with the need for eye drops, laser treatment, or another surgery · Abnormal collection of fluid in the eye, with the need for another...
Sep 11, 2026
| Consent Form
...· Page 1 of 2 2 Page 3 of 3 · Failure to control eye pressure, with the need for eye drops, laser treatment, or another surgery · Abnormal collection of fluid in the eye, with the need for another surgery · Worse or lost vision · [bookmark: _GoBack]Pressure that...
Sep 16, 2026
| Consent Form
...condition, with the need for eye drops, laser treatment, another injection, or eye surgery · Worse or lost vision · Damage to the eyeball · Infection, soon after the injection, or months or years later · Inflammation · Cataract or clouding of the lens (except if you have already had...
Apr 23, 2026
| Consent Form
...list all risks and complications that may occur. The main risks and complications of [procedure/treatment]PRK are: PRK in eyes with more than 4 D of astigmatism: I understand that the FDA approval of the excimer laser for PRK was based on attempting to correct eyes with no more than 4...
Apr 8, 2026
| Consent Form
...and sometimes even the excimer laser in a procedure called PTK (phototherapeutic keratectomy). The cornea can be scraped if the lesions are superficial, or a deeper excision called a superficial keratectomy may be indicated · Mitomycin-C (MMC) maybe used during excision (removal) to minimize the recurrence of anterior basement corneal...
These are sample forms—download, review and revise as needed.