This program outline is true until
Consent
You are being fit with rigid gas permeable (RGP) contact lenses, also known as Ortho-K, refers to the use of specially designed RGP 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 waking hours. The Ortho-K 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.
Corneal Reshaping Treatment 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 on the cornea may occur, which can lead to reduced sight in rare cases. Although uncommon, infection of the cornea can develop rapidly and lead to loss of vision. The risk of infection of the cornea has been shown to be greater among patients who wear their lenses overnight than among those who do not sleep in their lenses.
I have read and fully understand the above information. I agree to adhere to the wearing and follow-up schedules as prescribed. If I fail to return for my scheduled follow-up visits, I may forfeit my chance to continue overnight wear of Ortho-K contact lenses. All of my questions concerning my eyes and contact lenses have been answered to my satisfaction.
My Commitment to My Lenses
I am being fit with rigid gas permeable (RGP) contact lenses also known as Orthokeratology (Ortho-K). These contact lenses reshape the cornea (the clear layer on the front of the eye) for a short time, which allows me to see clearly without the use of glasses or contact lenses while I am awake.
The Ortho-K contact lenses must be worn on a regular basis during sleep so that I can see clearly during the day without glasses or contact lenses.
It is important that I agree to the following guidelines to keep my eyes healthy and allow me to wear contact lenses. Place a checkmark in each line to agree.