Board-Certified Ophthalmologist

Phone 503.581.5287  
Fax  503.386.1377  
PRK Surgery Waiver

I, , do acknowledge that due to small orbital bones,
Patient Name
thin corneas, the inability to lift the original LASIK flap, or requirements of my employer I am not able to have the laser assisted in-situ keratomileusis (LASIK) surgery. However, because of these limitations I realize that Photorefractive Keratectomy (PRK) is a much better option for my vision needs.

I also understand that I will experience a prolonged healing time, which will require more follow-up visits and extra attention from Dr. Dodd. I have been informed of the added discomfort that will be experienced during healing due to the laser treatment being performed directly on the surface of the cornea. With all things considered, I do realize that results in PRK clinical studies were equivalent to LASIK results, but with a longer healing period. I understand the above statement and willingly proceed the PRK surgery.
Patient Signature
Medical Center Eye Clinic
655 Medical Center Drive NE
Salem, OR. 97301