Selective Laser Trabeculoplasty (SLT) Consent Form

PROCEDURE

Selective Laser Trabeculoplasty (SLT)​

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DESCRIPTION OF PROCEDURE

Selective Laser Trabeculoplasty (SLT) is a laser procedure used to treat glaucoma. It targets specific cells in the eye's drainage system (trabecular meshwork) to improve the outflow of fluid and lower intraocular pressure. This procedure is designed to help control glaucoma and reduce the risk of vision loss.​

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BENEFITS

The goal of this procedure is to:

• Lower intraocular pressure.

• Reduce the need for glaucoma medications.

• Help to preserve vision.

• Slow the progression of glaucoma.

 

ALTERNATIVES

Alternatives to SLT laser treatment may include:

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• Eye drop medications: Various eye drops are available to lower intraocular pressure.

• Other laser procedures: Other types of laser treatment for glaucoma exist, such as Argon Laser Trabeculoplasty (ALT).

• Incisional glaucoma surgery: Surgical procedures like trabeculectomy or the insertion of a glaucoma drainage device may be necessary in some cases.

 

The risks and benefits of these alternatives have been explained to me.

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RISKS AND COMPLICATIONS

I understand that, as with any medical procedure, there are risks and potential complications associated with SLT laser treatment. These include, but are not limited to:

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• Temporary discomfort: Some discomfort or a mild burning sensation may occur during or immediately after the procedure.

• Temporary blurred vision: Vision may be temporarily blurred following the procedure.

• Eye inflammation: Inflammation within the eye is possible and is usually treated with eye drops.

• Increased intraocular pressure: Eye pressure may temporarily increase (pressure spike) after the procedure.

• Corneal abrasion: A scratch on the surface of the eye.

• Bleeding: Bleeding within the eye is rare.

• Infection: Infection within the eye is rare but serious.

• Cataract progression: There is a potential risk of cataract development or progression.

• Failure to lower eye pressure: The procedure may not successfully lower eye pressure.

• Need for further treatment: Additional medications, laser treatment, or surgery may be needed in the future.

• Rarely, loss of vision.

 

I have been informed about the material risks that are specific to my circumstances.

 

ACKNOWLEDGEMENT OF UNKNOWN RISKS

I understand that it is not possible or reasonable to predict every possible risk or complication that may occur.​

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POST-PROCEDURE CARE

I understand that I will need to follow my physician's instructions carefully after the procedure. This may include:

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• Using prescribed eye drops (if applicable).

• Avoiding rubbing the eye.

• Attending follow-up appointments to monitor my eye pressure and response to treatment.

• Reporting any changes in vision, pain, or redness immediately.

 

AUTHORIZATION OF ADDITIONAL PROCEDURES IN UNFORESEEN CIRCUMSTANCES

I understand that during the procedure, unforeseen or unknown conditions may be discovered that require additional or different procedures than those initially planned. I authorize the above-named healthcare provider, or their designate, to perform such additional procedures that, in their professional judgment, are immediately necessary and desirable to address these conditions, and where delaying such procedures would not be in my best interest.​

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CONSENT TO ANESTHESIA AND MEDICATIONS

I consent to the administration of appropriate anesthesia and all other medications deemed necessary to facilitate the treatment.​

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CONFIRMATION OF UNDERSTANDING

I have had the opportunity to ask questions about the procedure, its alternatives, risks, and benefits. I believe I have received enough information to make an informed decision. I voluntarily consent to the Selective Laser Trabeculoplasty (SLT) procedure described above.​

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RIGHT TO WITHDRAW CONSENT

I understand that I have the right to withdraw my consent at any time before the procedure begins.​

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ACKNOWLEDGEMENT

I acknowledge that no guarantees have been made to me as to the result of the procedure(s).