Condition and Proposed Treatment
My Ophthalmologist has diagnosed me with severe diabetic retinopathy. My eye is bleeding and there is a chance that I will go blind without treatment.

Alternatives

1. Observation: not recommended in most of the cases, can lead loss of vision.
2. Good blood sugar control – can reverse the damages in the retina but it may take too long to take effect and cause loss of vision. It is highly recommended that the blood sugar should be well controlled in order to avoid further damage in the eye.
3. Surgery with vitrectomy – maybe required if there is vitreous hemorrhage

Risks

1. Pain – mostly during the procedure, subsides after a few minutes to hours.
2. More bleeding due to poor blood sugar control.
3. Irritation and blurry vision – usually a temporary effect due to placement of a contact lens on the eye in order to visualize the hole in the retina.
4. Macular puckering – not a very common complication but any type of surgery in the eye can induce wrinkling of the retina in the back of the eye. Surgery to remove the wrinkle maybe required if vision is compromised.

Anesthesia: Topical drops of Proparacaine

Consent for treatment
By signing bellow, I acknowledge that I have read and understand the above and have had the opportunity to discuss this information with my doctor to my satisfaction. I consent to the Argon laser Retinopexy of the:

If patient is a minor, unable to sign or without decision making capacity, relationship of person authorized to consent must be stated.