Photo Consent Form OCT

• Glaucoma
• Macular eye diseases
• Retinal diseases
• Eye/Brain tumors
• Eye damage caused by diabetes, strokes, high blood pressure and other systemic conditions

If you have a personal or family history or any physical examination findings consistent with any of these conditions, or take high risk medications, such as plaquenil, it may be necessary to perform more in-depth testing or eye imaging studies. Please advise the technician if any of these apply to you.

-Visual Field Screening ($15): This is a computerized instrument that maps the range of peripheral (side) vision. This test measures how well the structures of the eye communicate with the brain.

-Digital Fundus Imaging ($20): This test provides the doctor with a full image of the central retinal structures (the optic nerve, macula, and main blood vessels). There is normal variation in these structures from person to person and it is good to have a record of each patient’s eyes. In some patients, these images may detect undiagnosed eye disease. Many eye diseases cause slow structural changes over time. Having a reference image allows your doctor to more accurately identify changes in your eye structures and treat diseases at an earlier stage. Early diagnosis can reduce the risk of visual complications.

-iWellness OCT ($39): This state-of–the-art technology lets the doctor see beneath the surface of the retina. Eye diseases often have no outward signs or symptoms. This unique technology helps the doctor detect vision threatening diseases in the very early stages, when they are most treatable and usually cannot be detected by any other evaluation.