INFORMED CONSENT FOR A LASER TREATMENT OF RETINAL DISORDERS

You suffer of disorders of your retina. As treatment for this condition, your ophthalmologist proposes laser photocoagulation.

This document contains the information about the reasons, conditions, results, risks and limitations of the proposed medical act.

WHY LASER THERAPY?

Because you have one of the following conditions which may lead to visual, sometimes permanent, loss of vision.
 

Laser treatment is one of the most appropriate treatments of the following conditions:

* Rip or hole in the retina: The presenting symptoms are usually perceived as the perception of recurrent lightning, of a “black rain” or of floaters. Sometimes the lesions are discovered during a routine check up in the absence of symptoms. The goal of treatment is to create a solid scar reaction around the lesion and try to prevent a retinal detachment. In some conditions, a more extended, such a 360º circular dam, may be proposed.

* Diabetic retinopathy: After several years of evolution, diabetes causes significant disorders of the retinal circulation, potentially responsible for severe visual loss and, in extremis, to the anatomical disorganisation of the eyeball. Laser treatment can be proposed to treat individual lesions. If there is a risk of bleeding in the vitreous, extended treatment aiming, at once, large areas of the retina (pan photocoagulation) may be proposed.

* Macular oedema: Occurs in age related macular degeneration, lens implanted eyes, myopic degeneration of the central area of the retina etc. Laser treatment aims to dry the lesion and to stabilize the vision.

* Other retinal diseases: Retinal vein occlusion, eye tumour, angiomatosis, macro aneurysm, central serous chorio-retinopathy, etc.

THE LASER TREATMENT

The laser beam uses a light capable of carrying a large amount of energy that will be delivered in a specific location of the eye. It can coagulate abnormal vessel, destroy tissues and create a scar.

The session is performed on an outpatient basis after the pupils have been dilated by the instillation of eye drops.

Anaesthesia of the eye is obtained by the instillation of anaesthetic drops. The patient sits in front of the laser machine. Laser impacts are applied with or without interposition of a lens placed on the eye. The whole procedure time does not exceed 20 minutes per session.

When the lesions are numerous or extensive, the treatment is carried out in several sessions separated by several days to several weeks.

USUAL COURSE

In the vast majority of the cases the treatment is well tolerated and you will leave immediately after treatment and resume, in the next hour or two, your normal activities.

The eye care is reduced to nothingness or the instillation of drops in the manner that will be indicated by your ophthalmologist.

Control will be necessary at a date stated by your ophthalmologist.

COMPLICATIONS OF THE TREATMENT

The non serious complications are:

* Glare, due to the laser session itself and to pupil dilation, will be felt throughout the examination and will last 2 hours. It is advisable to have sunglasses when leaving the Cabinet and not to drive as long as you feel this glare.

* Arterial hypotension may occur in susceptible individuals. It will quickly disappear when lying down.

* Extended pupil dilation, lasting several days. It is annoying by the glare it induces. This risk is unpredictable and very rare.

* Pain: Retinal laser photo-coagulation causes very little or no pain. Laser impacts may be painful if the retina is inflamed. In such a case, the parameters of the impacts are lowered to the minimal effective and maximal tolerable.

* Irritation of the cornea (superficial keratitis): It is a rare hazard, occurring in less than 1% of the cases. Promptly treated, it cures generally in 24 to 72 hours.

* Alterations to the peripheral visual field. NB: This area of the visual field is not used in ordinary daily life. They are inevitable, inherent to the effect of the treatment.

* Conjunctival bleeding due to the contact lens: rare, benign, disappears in few days.

These incidents are of no concern. If you have ever experienced any of them at a previous angiography, report it below in this document.

The severe complications of retinal laser photocoagulation are rare:

* Alterations to the medial and central visual field. NB These areas of the visual field are used in ordinary daily life. Alterations occur when the impacts are to be placed on the centre or on the mid periphery of the retina. They can impede, immediately or a few days to years after the laser treatment, good peripheral vision such as driving a car, especially in night conditions.

* Macular oedema: This hazard is due to the accumulation of water in the centre of the retina. It is a distance reaction to laser impacts and is responsible of a loss of the detail vision, lasting a few weeks to several months, sometimes permanently. It can occur especially in chronically poorly treated diabetics where the treatment has to be extensive, covering the entire mid and peripheral retina. Its risk is less than 1%.

* Crisis of acute glaucoma. This risk is inherent to all dilation of the pupils. It is exceptional and not quantifiable.

* Misplaced impact, reaching the middle of the centre of the retina. This incident can permanently reduce details vision. It is extremely rare and occurs in restless, undisciplined patients who do not control their eye movements and their bodies. To avoid this, you are asked to keep the most calm and compliance during this examination.

LIMITATIONS OF THIS TREATMENT

In most cases, lasting healing of the lesion is achieved.


It is often necessary to repeat the treatment in order to consolidate it.

This treatment does not prevent the appearance of other lesions, especially in chronically poorly controlled diabetes.

This treatment does not allow recovery of visual acuity. At most, it can prevent a possible additional fall of the visual acuity. It is impossible to quantify the rate of the stabilization of the vision because the success depends on the location, extent, depth and aggressiveness of the lesions. These factors are too variable from one individual to another and to one moment to another in the same individual to allow statistical studies.

PRECAUTIONS TO BE TAKEN

Shocks of the head and rubbing the eyes should be avoided until healing is complete.

A change in the Aspirin or blood thinners treatments may be requested from your GP.

If in doubt, please ask your ophthalmologist for additional information.

YOU SHOULD CONTACT YOUR OPHTHALMOLOGIST IMMEDIATELY IN CASE OF

• Pain, severe sensitivity to light, redness, tearing, secretions, swelling of the eyes or eyelids
• Sharp decrease of the vision.
• Perception of floaters with flashes of lightning, a black rain or a motionless large dark spot.