TLC Michigan, LLC
TLC Laser Eye Centers
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LASIK (LASER IN SITU KERATOMILEUSIS)/ PRK (PHOTOREFRACTIVE KERATECTOMY)
Informed Consent. This Informed Consent is intended to supplement the Vision Correction Surgery Patient
Information Form to provide you with additional information concerning surgery so that you can make an
informed decision whether to undergo LASIK or PRK surgery. You should carefully read both the Vision
Correction Surgery Patient Information Form and this Informed Consent and discuss all your questions and
concerns with your surgeon or personal eye care provider.
Alternatives to LASIK. The safest alternative to LASIK and PRK is to continue to wear your eyeglasses or
contact lenses and not have surgery. Other surgical alternatives include INTACS, CK, LASEK or intraocular
lenses. Be sure to ask your surgeon or personal eye care provider to learn more about these procedures.
You May Not Be a Candidate for Surgery if You:
• Have eye inflammation or infection, severely dry eyes, excessive corneal scarring, certain
degenerations or dystrophies of the cornea, amblyopia (lazy eye), strabismus (muscle imbalance) or
previous strabismus surgery, keratoconus or any recurrent, residual or active eye condition which may
• Have a history of Herpes Simplex eye infections, uncontrolled vascular disease, uncontrolled diabetes,
an autoimmune disease or rheumatologic conditions, such as lupus or rheumatoid arthritis.
• Are immunocompromised or take medications that may suppress your immune system.
• Have an implanted electronic device such as a pacemaker or defibrillator.
• Have progressive nearsightedness or farsightedness.
• Had previous corneal surgery.
• Have corneal blood vessel growth within 1 mm of the ablation zone.
• Have a history of keloid formation.
Take certain medications, such as Accutane, Cordarone or Imitrex.
Risks and Complications of LASIK and PRK. This Informed Consent summarizes possi