OPTOS SHEET

Here at First Eye Care we are excited to now offer a state-of-the-art digital scanning technology that allows us to view the inside of your eye without the use of dilation drops. The OPTOMAP allows us to evaluate your retina for problems such as macular degeneration, retinal holes, retinal detachments, hypertension, and diabetic retinopathy. The OPTOMAP is safe, for kids and adults, and allows you the opportunity to see the inside of your eye just as the doctor sees it.

DILATED EXAM

VS.

OPTOMAP EXAM

1. Blurred near vision for 4-6 hours 1. NO blurred vision
2. Light Sensitivity for 4-6 hours 2. NO light sensitivity
3. Longer office visit waiting for drops to take effect 3. Map takes less than 2 minutes
4. No permanent record of retina 4. Permanent digital image to review
5. Only the doctor can see the retina 5. You can see the retina

EARLY DETECTION IS CRUCIAL!!!

Our doctors strongly recommend that ALL patients have a thorough examination of their retina every year. ***Without the OPTOMAP or a dilated examination, we cannot fully assess the health of your eye*** There is an additional fee of $39.00 for the OPTOMAP. This procedure is NOT covered by insurance. Dilation may still be required.

Please note: for DIABETIC exams, you will be dilated AND have the optomap photos taken. The optomap photos will be billed to your medical insurance.

This test is fast, easy, and comfortable

Please check one:

I elect to have a digital image of my retinas today ($39).I prefer a dilated exam of my retinas today (no additional fee) and I have been informed of the side effects listed above.

(parent or guardian if minor)