CRT informed consent

CRT Informed Consent Document You are being fitted with gas permeable (GP) contact lenses, also known as Corneal Refractive Therapy (CRT). Corneal Refractive Therapy refers to the use of specially designed GP contact lenses to temporarily reshape the cornea (the clear layer on the front of the eye), allowing you to see clearly without the use of glasses or contact lenses during your waking hours. The Corneal Refractive Therapy contact lenses must be worn on a regular basis during sleep in order to reduce the need for glasses or contact lenses during the day. Complications and Side Effects Corneal Refractive Therapy carries the same risks as other types of contact lenses such as swelling of the cornea, scratching of the eye, irritation, infection, unusual eye discharge, excessive tearing, dry eyes, sensitivity to light, pain, redness, and distorted vision. These risks are usually temporary if the contact lenses are removed promptly and if appropriate professional care is received. In some instances permanent corneal scarring, infection, or blood vessel growth can develop rapidly and lead to loss of vision. The risk of infection of the cornea has been shown to be greater among patients that wear their lenses overnight than among those who do not sleep in their lenses. Corneal RefractiveTherapy also has risks that are not typically associated with other types of contact lenses such as blurry or variable vision, especially late in the day. The blurry vision and how long it lasts each day should decrease with time. You may also experience distortions or ghost images, particularly outside at night, which may affect night driving. For the first few weeks, the risk may be increased in patients with a high degree of correction or large pupils. All risks are minimized if you follow the correct contact lens wearing schedules and care procedures. However, remove your contact lenses if problems occur, and report to your primary eye care practitioner as soon as possible. With any procedure, there may be unforeseeable risks. If you experience any of the symptoms listed above, remove your lenses immediately. If the condition continues after lens removal, you should immediately call for an appointment or consultation with your eye care practitioner who will provide the necessary treatment. Lens Wear Schedule: Dr. Labiento Smith will recommend a wearing schedule for you to follow. The wearing time necessary for Corneal Refractive Therapy is minimally 7 to 8 hours per night. There will be a follow-up schedule to check your vision and contact lenses. It is important that you attend every visit (bringing your lenses) that is recommended in order to maintain the health of your eyes. Alternative to Corneal Refractive Therapy: Alternatives to Corneal Refractive Therapy include, among others, eyeglasses, traditional contact lenses, and refractive surgical procedures. Pregnancy: Pregnancy could adversely affect treatment results with Corneal Refractive Therapy. If problems exist during pregnancy, you may need to temporarily discontinue Corneal Refractive Therapy contact lens wear. Patient Name: ___________________ Legal Guardian: ___________________ Date: __________________