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Laser Refractive Surgery
LASIK Eligibility Evaluation

Do you suffer from nearsightedness, farsightedness, or astigmatism?  Do you find glasses or contacts cumbersome or uncomfortable, and wish you could reduce their prescription or discard them?

Am I a Candidate for LASIK?

LASIK can be very successful when performed on the right patients, but it is not for everyone. This test can help you determine if you're a good candidate.  Answer these dozen of so questions about your eyes and health.

User Agreement

This screening test is based on general guidelines and practices used by some eye care professionals and organizations. Many factors influence your suitability for LASIK, and all factors cannot be covered by this test. You should consult an eye care professional for advice related to your specific condition and particular needs. We attempt to present only accurate information on this website, but cannot guarantee the accuracy, currency, or completeness of the information presented, and assume no liability for any actions stemming from or related to this test. This screening test does not constitute medical advice.

How old are you?

                Under 18 ___ 18 to 39 ___ 40 to 64 ___ 65 or older___

Are you Male ____  Female ____

Which of the following statements best reflects your primary reason for seeking LASIK surgery? (Please select only one.)

                ___I would like to get LASIK for career reasons.

                ___I would like to get LASIK for lifestyle reasons (sports, leisure, etc)

                ___I think I look better without glasses and do not like contact lenses.

                ___I would like to reduce my dependence on glasses and/or contact lenses.

                ___I would like to completely eliminate my need for glasses and/or contact lens

Are you willing to educate yourself on LASIK and its associated risks and benefits?     Yes___ No ___

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___

After receiving LASIK, would you be willing and able to comply with a schedule of medications and visits to your eye care professional for follow-up exams? Yes___ No___

Do you have any of the following conditions? (Please select all that apply.)

           Diabetes ___

Autoimmune disease (for example, AIDS, lupus, rheumatoid arthritis,     multiple     sclerosis, or myasthenia gravis) ___

           Immunocompromised for any reason ___

           Collagen vascular disease ___

           To the best of my knowledge, I have none of these conditions ___

Are you currently taking medications, such as steroids or immunosuppressants, which can slow or prevent healing? Yes___ No___

Do you have any of the following conditions? (Please select all that apply.)

                Keratoconus or other corneal thinning disorder___

                Corneal scarring ___

                Glaucoma ___

                Cataracts ___

                Ocular herpes diagnosed in past year ___

                Retinal disease ___

                Dry eye ___

                To the best of my knowledge, I have none of these conditions ___

What type of refractive error do you have?

                Nearsightedness (myopia) -- you have trouble seeing distance ___

                Farsightedness (hyperopia) -- you have trouble seeing up close ___

                Don't know ___

Do you have astigmatism?

                Yes ___ No ___ Don't know ___

Has your vision correction -- that is, your glasses or contact lens prescription -- changed over the past year or two? Yes ___ No___

 

You have successfully completed our screening test. Print this test to generate your customized report to show Dr. Shnayder.

 

Thank you!

You may be a good candidate for LASIK or other laser vision corrective surgery.  Before the decision can be made however, you must have an eligibility exam and consultation with Dr. Shnayder.  He will ask questions about your medical history and give a thorough eye exam designed to determine if the procedure is appropriate for your individual case.  The doctor will also talk about the benefits, risks, available options, and preparation and recovery associated with the surgery to ensure that your goals and expectations are realistic.

Contact us today to schedule a consultation with Dr. Shnayder.