Corneal Refractive Therapy (CRT) Consent Form Logo
  • Corneal Refractive Therapy (CRT) Consent Form

    1. Thank you for your interest in the Corneal Refractive Therapy (CRT) Program.

      This program is NOT to rid you or your child of the use of glasses or contact lenses forever, but to reduce the dependency on them. New studies have shown evidence of controlling the progression or nearsightedness with this custom technique.

      In order for this process to be successful, all instructions and follow up appointments must be followed. There are two wearing schedules:

      A. Nightwear schedule – This will be the schedule of choice. CRT lens wear during night hours only to achieve 20/40 or better vision during the day. We will try to fit all patients with a nightwear schedule if possible. However, if the results are not to an optimal level, some patients may be switched to a daywear schedule.

      B. Daywear schedule – The patient wears lenses during daytime hours, still enjoying much improved vision upon removal of lenses.

       

      **Please note, if CRT wear is stopped for any reason, vision will return to original status**

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  • Nearsighted rage from -0.50 to -2.00 : $1,256.54*

    Nearsighted range from -2.25 to -6.00 : $1,570.68*

    Astigmatism range greater than 1.00D : $1,656.55*

    *taxes included

    ONE MONTH NO-FAULT GUARANTEE

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  • I have read and understand the above conditions and I will comply with the accordance and contents.

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

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