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  • Informed Consent For Intravitreal Injection - Retinaassociates

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PATIENT DATE OD OS TM INFORMED CONSENT FOR () INTRAVITREAL INJECTION INDICATIONS Agerelated macular degeneration (AMD) is the leading cause of blindness in people over 50 years.

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*After your injection do not wear any make up for 24 hours. *Avoid getting water into your eye or swimming for a couple of days. *Please do not wear any contact lenses for 2 days after your injection. *Please continue taking any existing eye drops/medication prescribed.

Intravitreal injection is a procedure where medicines are injected directly into the jelly-like material inside your eye known as the vitreous. Intravitreal injections are a common method to treat retinal diseases such as diabetic retinopathy, macular degeneration, macular oedema and vein occlusions.

We recommend the following steps: 1) Apply a topical anesthetic; 2) apply 5 percent or 10 percent povidone-iodine drops and/or periocular povidone-iodine eyelid preparation; 3) insert a sterile speculum to separate the lids; and 4) reapply povidone-iodine immediately over the injection site prior to injection.

You should not rub your injected eye. You should not wash your face and hair or shower for 48 hours. You should not swim for a week after the injection. You will be given a follow-up appointment four to eight weeks after the injection or course of injections.

Do not drive for 6 hours after the injection as your vision will be blurred by the dilating drops. It is normal for your eye to feel slightly gritty, uncomfortable or watery and the white of the eye may be red for a day or so after the injection. This should settle within 2 days.

There are no special precautions following intravitreal injections. You can travel, and if you have any of the above problems, please see an ophthalmologist. Avoid getting water into your eye or swimming for the first few days. What should I do if I am worried after receiving my treatment?

What is an intravitreal injection? An intravitreal injection is the injection of a drug into the vitreous humour (the jelly at the back of the eye). It is given through the sclera (the white of the eye). It may be given as a single dose or as a course of treatment where further injections will be required.

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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232