ABN: Redacted Business trading name: Redacted Redacted Primary contact name: Primary contact numbers Business: Redacted Mobile: Redacted Email: Redacted Alternative contact name: Redacted Alternative contact numbers Business: Redacted Phone: Redacted Redacted (a) Are you a consultant acting on behalf of an Applicant? Yes No (b) If yes, what is the Applicant(s) name that you are acting on behalf of? Redacted (a) Are you a lobbyist acting on behalf of an Applicant? Yes No If yes, are you listed on the Register of Lobbyists? Yes No PART 2 INFORMATION ABOUT THE PROPOSED – MEDICAL SERVICE Application Micro-bypass stenting for open-angle glaucoma (external to Schlemm’s canal) Provide a succinct description of the medical condition relevant to the proposed service (no more than 150 words further information will be requested at Part F of the Application Form) – Glaucoma is a chronic degenerative optic neuropathy in which the neuro-retinal rim of the optic nerve becomes progressively thinner, caused by an acquired loss of retinal ganglion cell axons and atrophy of the optic nerve. The lens and cornea of the eye both lack direct blood supply. Therefore, these anterior structures are nourished by a separate circulatory system. The aqueous humour, produced by the ciliary
ABN: Redacted Business trading name: Redacted Primary contact name: Redacted Primary contact numbers Business: Redacted Mobile: Redacted Email: Redacted Alternative contact name: Redacted Alternative contact numbers Business: Redacted Phone: Redacted Redacted (a) Are you a consultant acting on behalf of an Applicant? Yes No (b) If yes, what is the Applicant(s) name that you are acting on behalf of? Redacted (a) Are you a lobbyist acting on behalf of an Applicant? Yes No If yes, are you listed on the Register of Lobbyists? Yes No PART 2 – INFORMATION ABOUT THE PROPOSED MEDICAL SERVICE Application Micro-bypass stenting for open-angle glaucoma (external to Schlemm’s canal) Provide a succinct description of the medical condition relevant to the proposed service (no more than 150 words – further information will be requested at Part F of the Application Form) Glaucoma is a chronic degenerative optic neuropathy in which the neuro-retinal rim of the optic nerve becomes progressively thinner, caused by an acquired loss of retinal ganglion cell axons and atrophy of the optic nerve. The lens and cornea of the eye both lack direct blood supply. Therefore, these anterior structures are nourished by a separate circulatory system. The aqueous humour, produced by the ciliary