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Double Carding

Controversial use of excimer laser for Lasik allows surgery with greater parameters than approved by the FDA.

Topographical map of a central island after Lasik  
Double carding extends treatment beyond FDA approval.  


Double carding is a controversial and possibly illegal technique to perform refractive surgery beyond the FDA approved parameters of the excimer lasers. All excimer lasers have limitations of treatment imposed by the FDA. These limitations may be significantly less than what a doctor may consider to be appropriate care.

Laser Key Card

The manner by which some excimer lasers are controlled is with a card similar to a credit card that the doctor purchases from the laser manufacturer. The card allows the doctor to provide a single treatment and only within the FDA approved parameters. If a doctor believes that treatment beyond the FDA approved parameters is appropriate, during surgery the doctor will exchange the first card for a second card and continue the treatment.

Let's say that you have 18.00 diopters of myopia and the laser the doctor uses is only allowed to treat up to 12.00 diopters of myopia. The doctor will start the surgery with card number one and do 12.00 diopters of correction. Then, without you moving, the doctor replaces card one with card two and performs the additional 6.00 diopters of treatment.

Legality Unclear

The legality of this technique is unclear. The doctors who double card state that they are essentially doing two surgeries and at worst this is an off-label use of the device. They further argue that it is better for the patient to have both surgeries done consecutively than to have the patient come back in a month for the second 6.00 diopters of correction.

Patient Informed Consent

Any patient which will have a double carded treatment should be fully informed of the off-label nature of the use of the medical laser. The attempted correction has not been scrutinized by the FDA and probable outcomes are unknown. The patient should clearly understand that double carding is not in the spirit of the FDA limitations, may be illegal, and certainly is questionable.

Looking For Best Lasik Surgeon?

If you are ready to choose a doctor to be evaluated for conventional or custom wavefront Lasik, Bladeless Lasik, PRK, or any refractive surgery procedure, we recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization. Locate a USAEyes Evaluated & Certified Lasik Doctor.

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