ADVANCED SURGICAL PLAN FOR THE

TREATMENT OF KERATOCONUS

PATIENT ID EYE TO OPERATE DATE

smg OS 2023/10/23

PRODUCT SEGMENT 1 FEMTOSECOND PARAMETERS

Ferrara5
Reference: AFR25320 Depth: 378 µm
DOCTOR
arn Segment: 320°/250µm Int. Diameter: 4.5 mm

Ext. Diameter: 5.7 mm

Incision: 90°

Ref. Segment 1: AFR25320

The data that you provide to AJL Ophthalmic related to third parties (patients for whom you request nomogram calculations from us) belong to the interested party and you declare (taking
responsibility for and guaranteeing AJL Ophthalmic that such declaration is true) that the data is exact, current and true; that you have duly informed the affected party and you have their express
consent to communicate this data to AJL Ophthalmic for the aforementioned purpose and that the data is included in the files thereof. In turn this may communicate to the health insurance companies
or healthcare centres the essential billing data, to justify the expenditure for the intervention of AJL when this expenditure shall be paid thereby.

You, as the grantor, shall be solely responsible for any complaints that may be formulated by the affected and/or third parties, regarding this communication, as well as for any damages that may be
occasioned due to the lack of information and consent of the affected party, holding AJL Ophthalmic fully harmless.

The surgical planes suggested by AJL Ophthalmic are based on the experience and the data provided by the ophthalmologist. The ophthalmologist is responsible for the veracity and accuracy of the
information provided to AJL OPHTHALMIC S.A.

Therefore, the ophthalmologist is solely responsible for the surgery and complications that may arise in the execution of the surgery procedure. The ophthalmologist also agrees to waive the right to
carry out any legal action or claim against the Managers, Partners or Employees of AJL Ophthalmic S.A. in relation to the surgical planes suggested by AJL Ophthalmic S.A.