Contact Lenses and your eyes

Key Benefits

Better peripheral vision.
No heavy glasses on your face
You never "forget" your glasses anywhere
A cost effective alternative
With all the advances in materials and designs, almost everyone can wear contacts.

Capabilities

When you come in for a Contact Lens Exam, we are able to offer you many, many possibilities. Besides having all the popular and most advanced lenses, we are able to special order also. No matter what you require, we will be able to get you into some contact lenses successfully.

Do You Want to Sleep in Your Lenses?: Did you know that if you sleep in the wrong types of lenses, you are putting yourself at risk for some serious complications including blindness? We have multiple types of lenses that have been approved for sleeping by the FDA. Ask your Optometrist about sleeping in your lenses when you first come in.

Is it Time for Bifocals?: Are your arms getting too short? It might be time to get yourself a bifocal! Why not try some bifocal contacts to see if you can get your reading vision back. Most bifocal contact wearers find that their day-to-day activities are much easier with their contacts in. Some even use their contacts exclusively and only use their glasses as back-ups now. It is suggested that you always have yourself a back-up set of glasses in case you have any contact lens complications.

Have you been told that you can't wear contact lenses?: We have found that almost EVERYONE is able to wear contact lenses if they are motivated to. There have been so many advances in the shape and materials of contact lenses in the last couple years, that we no longer have as many restrictions on who can and cannot wear lenses. Check with your Optometrist to see if you're a candidate now.

see below for our contact lens introduction sheet...

__________________________________________________________________________________________________

Dalton EyeCare Professionals, P.C.

NEW CONTACT LENS PATIENT INFORMATION

We appreciate your choice of our office for your contact lens needs. Contact lens wear can improve the quality of your life. However, you must take proper care of your lenses and know what to do in the event of a problem. This information sheet provides important instructions and information. Please read it completely, keep it handy and refer to it if you have any questions.

EMERGENCY INFORMATION

· Remove the lenses and call our office for assistance if you experience any of the following:

( EYE PAIN

( SENSITIVITY TO LIGHT

( REDNESS OF YOUR EYES

( EXCESSIVE TEARING OR DISCHARGE

( CLOUDY, FOGGY OR REDUCED VISION

· In an emergency, please remove your lenses and call this office. If after hours, please contact your nearest hospital emergency room

· Periodic examinations are a necessary part of maintaining an appropriate and safe contact lens fit. You should return for all scheduled periodic examinations as recommended by this office.

· Different types of lenses have varied risk. Although the risks associated with contact lens wear are small, they are still real.

· I understand that methods available to correct my vision include:

q Soft Lenses q Rigid lenses q Spectacles q Refractive Surgery q No correction

LENS WEAR SCHEDULES AND REPLACEMENT INFORMATION

· Contact lenses are medical devices that are regulated by the U.S. Food and Drug Administration and may additionally be subject to state law requirements. Maintaining healthy eyes and proper vision includes regular periodic examinations by an eyecare professional. As with prescription medications, contact lenses can only be dispensed with a prescription of an eye care practitioner.

· Your lenses are designed to be worn on the following schedule:

q Daily wear, up to ___ hours with removal before sleeping

q Continuous wear up to ____ nights

q Other__________________________________________

· Your lenses are designed to be replaced on the following basis:

q daily q weekly q biweekly q quarterly q every 6-months q yearly q ______

IMPORTANT: Wearing your lenses beyond this schedule may expose you to additional risk. If you chose to purchase replacement contact lenses elsewhere, please be advised that your contact lens wear schedule, care regimen, lens replacement cycle, and periodic examinations will remain unchanged.

LENS CARE

· To a large extent, lens wear success will depend on carefully following the care instructions we reviewed, and following common-sense instructions concerning hand-washing prior to lens handling and lens case cleaning or frequent replacement.

· To best meet your needs we have recommended the following lens care products:

q Care System: _____________________ q Contact Lens Cleaner: ______________

q Rewetting Drop ___________________ q Other ___________________________

IMPORTANT: Always care for your contact lenses as instructed. Do not change care products unless you are specifically instructed to do so by our office. Different products are not equivalent – please do not substitute. Please call if you have any questions about lens care.

ACKNOWLEDGEMENT

I have read this document carefully, and fully understand the importance of the doctor’s recommendations. I have been trained in the care and handling of my contact lenses. I understand the policies of this office and understand that I am free to purchase lenses from a dispenser of my choosing. I understand the importance of following all directions, caring for my lenses as instructed and returning for all recommended, periodic examinations.

I have been given the opportunity to have all of my questions answered and concerns addressed.

_________________________ ________ _________________________

Patient Signature Date Doctor/Assistant Signature