LASIK Refractive Surgery Informed Consent

# LASIK Refractive Surgery Informed Consent > **Important — not medical advice.** For use by a licensed provider; tailor to the patient, your protocols, and state law. **Date:** ___________ **Surgeon / Ophthalmologist:** ___________ **Practice / Surgery Center:** ___________ **Patient Name:** ___________ ("Patient") **Date of Birth:** ___________ **Eye(s) to Be Treated:** ___________ **Refractive Error to Be Corrected:** ___________ --- ## 1. Description of the Procedure (a) **LASIK (Laser-Assisted In Situ Keratomileusis)** is a two-step refractive surgical procedure that permanently reshapes the cornea to correct nearsightedness (myopia), farsightedness (hyperopia), and/or astigmatism, reducing or eliminating dependence on glasses or contact lenses. (b) **Step 1 — Flap creation:** A thin, hinged flap of corneal tissue is created using either a mechanical microkeratome (metal oscillating blade) or a femtosecond laser (bladeless LASIK / IntraLASIK). The flap is lifted and folded back to expose the underlying corneal stroma. **Flap Creation Method:** ___________ (c) **Step 2 — Excimer laser ablation:** A computer-controlled excimer laser (193 nm ultraviolet) removes precise amounts of stromal tissue to reshape the corneal curvature. The ablation pattern is determined by the Patient's manifest and cycloplegic refraction, wavefront aberrometry, and topography. For myopia, the central cornea is flattened; for hyperopia, the periphery is flattened to steepen the center; for astigmatism, the ablation is asymmetric to create a more spherical curvature. (d) **Step 3 — Flap repositioning:** The corneal flap is repositioned and adheres without sutures due to the natural properties of corneal tissue. (e) The procedure takes approximately 10–15 minutes per eye. Patients are typically awake and given topical anesthetic drops; a mild oral sedative is sometimes offered for anxiety. **Excimer Laser Platform:** ___________ **Wavefront-Guided / Topography-Guided:** ___________ ---