TELE-MED CONSULTATION REGISTRATION
& INFORMED CONSENT

PURPOSE: It is required to complete this questionnaire and read and acknowledge the attached Informed Consent document prior to the Tele-Medicine Consultation with Dr. Johnson. This is part of establishing a formal 'doctor-patient' relationship. 

Patient Registration and Informed Consent
Please complete the following and read through and digitally sign the Informed Consent form.
Gender
You are aware of Floaters in:
Eye surgery / History
Current/Previous Eye Conditions:

PURPOSE AND GOALS:

ATROPINE SULFATE is an anticholinergic-class of medication that has been used in ophthalmology for many decades. It can be used as a long term pupil dilating agent as well as part of the treatment for severe inflammation (uveitis). More recently there has been interest in its long-term daily use to prevent progression of myopia in children. At its usual commercial strength (1%), it widely dilates the pupil and its effect can last for days. At much lower concentrations, a  custom-compounded solution of atropine can very slightly dilate the pupil (perhaps 1 to 1.5mm) offering the potential for symptomatic relief from the shadows caused by vitreous densities. Importantly, at this much lower strength, it does not diminish the focusing ability of the eye needed for near vision.

 

THE GOAL OF TREATMENT is purely symptomatic. It does does affect the physical amount, location, density, etc., of your floaters. There is a well-described and well-understood relation between pupil size, and the quality of the shadow that the floaters cast onto the retina. The larger the pupil, the less dense and less noticeable the floaters. It is the same  effect that occurs when you wear sunglasses indoors, but it is more socially appropriate to get that mild pupil dilation with once-a-day eyedrops than wearing eyeglasses indoors.

FEES:

TELEMEDICINE VIDEO CONSULTATION . . . . . $125.00

This consultation is focused on the special problem of floaters that may not be candidates for YAG laser treatment and not severe enough to justify the more invasive and risky surgical vitrectomy.

* This consultation fee INCLUDES mailing a 4ml bottle (about 120 drops) of custom-compounded atropine 0.01% preservative-free eyedrops.

Optional: you can upload a drawing of how you see your eye floaters

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