Download Required Testing Pre Op Exam

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LASIK Pre-Operative Exam
Required Testing By Co-Managing Doctors
• Contact lens history-type of lens, time out before exam
See Section – for specific information
• Medical history- allergies, previous eye surgeries
See Section – for specific information
• Dominant Eye
• Current glasses/date to check refractive stability
• Entrance Testing: pupil evaluation, cover test, EOM, confrontation visual fields
• Uncorrected distance and near VA
• Manifest Refraction including best correctable VA and near add
• Cycloplegic Exam with best correctable VA- 1% Cyclopentolate is required
• IOP-applanation or non-contact
Pressures between 20-30mmhg must have a visual field prior to surgery
• Slit lamp evaluation of the anterior chamber including lids, conjunctiva, cornea
Dry eye patients/CL wearers must have SPK resolved before surgery
• Dilated Fundus Examination including lens, macula, peripheral retina
• Intended Target- Monovision, patients under age 21 may be targeted +0.25 due
to myopic progression with age
• Assessment-patient’s refractive diagnosis and LASIK candidacy, any other
medical/ocular conditions and relativity to LASIK
• Plan-patient’s intent to have LASIK surgery, documentation of any specific
counseling done with patient-halos, starbursts, dry eyes, rx change, etc.
• Please initial that you have thoroughly discussed instructions for day of surgery
and after surgery, expectations and no guarantee of 20/20,
risks/alternatives, presbyopia, enhancements, night vision
Testing Done at Dishler Laser Institute
• Orbscan- maps anterior and posterior surfaces, pachymetry
• Zywave- predicts amount of aberrations, predicted phoropter refraction
• Pupil Size- this is tested using the Pupillometer with infrared light
• Keratometry/ ∆K- predicts the amount and location of corneal astigmatism
• Corneal white to white
• Pachymetry- will be confirmed by Visante OCT pachymetry if needed
• Humphrey visual field if needed
• Day of surgery slit lamp evaluation to check for SPK or other corneal conditions
• Final refraction check
• Confirm intended target with patient
• Answer any final questions
• Please fax/send all pre-operative LASIK exams to our office at least one week
before the scheduled surgery day so we have time to prepare the charts for surgery
• Information must be on a current DLI form (included in this packet) and must be legible
• A complete pre-operative exam form must be filled out before all enhancements as well