40 Walnut Street, Suite 101, Wellesley Hills , Ma 02481
[email protected]
617-796-EYES (3937)
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LASIK Quiz
LASIK Quiz with Dr. Marc Leibole
1. Do you have difficulty seeing in the distance without glasses?
Yes
No
2. Are you over the age of 21?
Yes
No
3. Do you have any rheumatologic or autoimmune conditions (such as rheumatoid arthritis, HIV or lupus)?
Yes
No
4. Has your distance vision remained fairly stable for the past few years?
Yes
No
5. Have you ever had herpes simplex infection in your eyes?
Yes
No
6. Like all surgical procedures, LASIK has the risk of complications. Even complication-free procedures can result in less than 20/20 vision, or infrequently may produce side effects such as glare or halos. These risks are very low for appropriate candidates, and most problems can be treated and resolved. If you are an appropriate LASIK candidate, are you willing to accept a reasonable risk?
Yes
No
7. In order to qualify for LASIK surgery, would you be willing and able to attend a few evaluation/pre-operative visits as well as several follow-up visits?
Yes
No
8. Are you currently taking steroids or immunosuppressant medications?
Yes
No
9. Do you have keratoconus or glaucoma?
Yes
No
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Home
About
Testimonials
Physicians
Services
Comprehensive Eye Exams
Refractive Surgery
LASIK
LASIK Quiz
Advanced Surface Ablation
Glaucoma
Retinal and Diabetic Care
Oculoplastics
Dry Eye and MGD
Patient Forms
LipiFlow
News
Videos
Contact
Directions
Cataract Surgery Paperwork
Premier Vision Consultants “ Cataract” New Patient Mailer
Premier Vision Consultants “ Cataract” New Patient Medical History
Cataract Laser Center Surgical Assessment Questionnaire