OPTOMAP Agreement Form

Advanced VisionCare offers a state-of-the-art digital scanning technology that allows us to see the inside of your eye without the use of dilation drops. The OPTOMAP allows us to evaluate your retina for problems such as macular degeneration, retinal holes, retinal detachments, hypertension and diabetic retinopathy. The scanning system is completely safe for kids and adults and allows you the opportunity to see the inside of your eye just as the doctor sees it.

DILATED EXAM

Blurred vision for 4-6 hours
Light sensitivity for 4-6 hours
Longer office visit to wait for drops to take effect
No permanent record of your retina
Only the doctor can see the retina

OPTOMAP EXAM

No blurred vision
No light sensitivity
Map takes less that 2 minutes to process
Permanent digital image that can be reviewed/compared each year
You can see your retina

EARLY DETECTION IS CRUCIAL

Our doctors recommend that all patients have a thorough examination of their retina every year. Without the OPTOMAP or dilated examination, the doctor cannot fully assess the health of your eye. There is an additional fee of $32.00 for the OPTOMAP. In most cases, the procedure is not covered by insurance. Dilation may still be required in rare instances.

Your Name & Surname

First Last

Please Select

I elect to have a digital photo of my retina ($32.00)

I prefer a dilated exam of my retina (no additional fee)

OPTOMAP Agreement Form

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Advanced Vision Care of North Arlington