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Frequently Asked Questions

Metro
15/Jan/2025
Uncategorized

InSight Scleral Lens Checklist

What Information Do You need to order an InSight Scleral Lens?

Our methodology focuses on simplicity and optimizing your chair time. Provide us with your observations, and we’ll handle the lens parameters.

If you can place a diagnostic lens on the eye with sodium fluorescein (NaFl), note your observations, we can deliver an initial lens within a few days.

Corneal and scleral GP lenses typically take 2–3 days to manufacture; Hydra-PEG adds one day to the process. Standard shipping is 2-3 business days.

Checklist for Simplified Ordering:

1. Initial Lens Selection
Based Selection on Sagittal Height
This reflects the overall curvature of the cornea.

  • Steep/Ectatic Corneas: Start with the Prolate 5.000 SAG
  • Flatter/Oblate Corneas: Select the Oblate 4.750 SAG

2. Evaluation (Three Steps)

  1. Central Clearance:
    Aim for ~250 microns of clearance, represented by a 1:1 ratio—250 microns of post-lens tear film and 250 microns of lens center thickness.
  2. Peripheral Clearance:
    Ensure NaFl clears the limbus 360° with 50–80 microns of peripheral clearance. Look for any areas of bearing or blanching; the limbus should always be vaulted.
  3. Edge Alignment:
    The lens should sit comfortably on the conjunctiva. Check for signs of impingement or blood vessel constriction.

    Please send images or short 2-3 second videos of the lens on the eye.

    Quick Tip:
    After lens removal, check for staining and report it to consultation if present.

3. Patient Feedback

Ask the patient how the lens feels:

  • Lens Awareness: If the patient feels the lens, it’s likely a landing issue.
  • Discomfort: If the lens is uncomfortable, remove it immediately. Scleral lenses should be very comfortable.

4. Topography:

Provide topographical data for consultation—it gives a clearer picture for customized lens fitting.

5. Anterior Segment OCT (Optional):

If available, AS-OCT images offer additional data to help understand what is happening with the lens on the eye, though it is not required.

6. HVID (Horizontal Visible Iris Diameter):

This measurement is essential for incorporating multi-focal optics, optimizing visual acuity and customizing the lens to the patient’s lifestyle.

7. Sphere-Cylinder Over-Refraction:

The SCOR provides the most accurate visual acuity and avoids inducing astigmatism. The InSight Scleral Lens can incorporate up to +3.00 D of ADD power.

8. Pertinent Patient Information:

Provide details such as:

  • Previous contact lens wear
  • Surgical procedures
  • Visual demands
  • Any factors that could significantly impacting the lens design

9. Hydra-PEG (Optional):

Ask during consultation if Hydra-PEG is suitable for the patient. Hydra-PEG benefits include:

  • Improves wettability by lowering the wetting angle
  • Reduces deposits and fogging

Please call consultation with the above information to discuss further, and we will have the lenses to you in a few short days.

If you don’t have all the information listed above, don’t worry! Our experienced consultants can design a lens based on the details you provide. The more accurate information we receive, the faster we can get the final lens to you.

We are here to support you every step of the way!

Sincerely,
Your Metro-Optics Team

CONSULTATION: 800-223-1858
EMAIL: info@metro-optics.com

 

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Metro
12/Dec/2024
Keratoconus

Patient Outcome: Successful InSight Scleral Lens Fitting of Corneal Transplant

Dr. Lechlitner

Optometrist: Stephanie Lechlitner, O.D.
Practice: Oak Hill Eye Care, Austin, Texas
Patient: 72 YO Female
Condition: Repeat Corneal transplant and repaired retinal detachment OD

Presentation:
Patient presented with high myopia OU. Irregular corneal surface OD due to corneal graft.

Ocular History:
The patient has been functioning with monocular vision for about 10 years. She experienced a failed corneal transplant and recently experienced a full retinal detachment OD.

Prescribed lenses:
InSight scleral in Optimum Extra 100Dk material with Hydra-PEG surface treatment.

                  Base Curve       Power       Diameter       SAG PC
OD             6.96                    -14.50       15.6                4.342 Toric
OS             6.78                    -8.50         15.6                4.393 Toric

Outcome:
OU VA 20/25
The patient is over the moon with how well these scleral lenses are working and is very grateful for this technology.

Learn more here

Help More Patients in Your Area:
Find Oak Hill Eye Care on our Physician Locator page as a specialty contact lens practice. Is your practice on the map? Check here.

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Metro
07/Nov/2024
Keratoconus

Successful Treatment of Keratoconus with ComfortKone Aspheric Lens

Optometrist: Dr. Stephen Hakimi
Practice: Pasadena Eye Associates
Patient: 50 YO female
Condition: Unilateral Keratoconus

Ocular History:
The patient wore RGPs successfully for many years but began experiencing reduced vision and clarity in her left eye. She was highly sensitive to even minor prescription changes of 0.25 Diopters, which triggered associated symptoms such as headaches and stomach aches.

Treatment:
Dr. Hakimi fit her left eye in the ComfortKone Lens, FDA Cleared for the indication of Keratoconus.

Outcome:
The ComfortKone lens provided stable vision with improved clarity and comfort, helping her eyes work together alleviating her discomfort.
Learn more here

Help More Patients in Your Area:
Find Pasadena Eye Associates on our Physician Locator page as a specialty contact lens practice. Is your practice on the map? Check here.

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Metro
03/Nov/2024
Keratoconus

Successful Treatment of Keratoconus with ComfortKone Lens

ECP: Esmeralda De La Torres
Practice: Kelsey-Seybold Main Campus
Patient: 25 YO Female
Condition: Undiagnosed Keratoconus

Ocular History::
A 25-year-old female patient presented with 20/400 OD and 20/200 OS. She was able to see although everything was blurry. Her vision was better as as a young child and progressively deteriorated as she grew up to where she was counting fingers by age 25.

Treatment:
Once the patient was properly diagnosed with Keratoconus, Esme was able to successfully fit her in the FDA Cleared ComfortKone RGP Lens.
Learn more here

Outcome:
BCVA:
20/50 OD
20/40 OS

The patient cried in the chair when she was able to see clearly for the first time in her life. Her aunt said, “Next is your driver’s license!” The patient was overwhelmed with joy.

Help More Patients in Your Area:
Find Kelsey-Seybold on our Physician Locator page as a specialty contact lens practice. Is your practice on the map? Check here.

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Metro
01/Nov/2024
KeratoconusUncategorized

Successful Treatment of Keratoconus with InSight Scleral Lens

Dr. Arun Kaistha

Doctor: Dr. Arun Kaistha
Practice: Cooper River Eye Eye Associates, New Jersey
Patient: 15-year-old male
Condition: Undiagnosed Keratoconus

Background:
A 15-year-old male patient had been struggling with deteriorating vision for several years, visiting multiple doctors. Despite numerous consultations, the root cause of his vision issues remained unidentified, leaving the patient barely able to count fingers.

Treatment:
Upon visiting Dr. Kaistha, the patient was properly diagnosed with Keratoconus. The patient was fit in the InSight Scleral Lens.

Learn more here

Outcome:
VA of 20/20 with comfortable all day lens wear. The successful diagnosis and treatment significantly improved his vision and quality of life.

Help More Patients in Your Area:
Find Dr. Kaistha on our Physician Locator page as a specialty contact lens doctor. Is your practice on the map? Check here.

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Metro
26/Sep/2024
Contact Lens Care

Properly Care for Scleral lenses with the Metro Optics Care Kit

Proper contact lens hygiene plays a significant role for successful scleral lens outcomes. One study found that 66% of complications in contact lens wearers were due to poor hygiene.1 

We offer a scleral lens care kit to improve compliance and overall lens performance. The care kit includes a ten day supply of the highest quality products and how to order more.

Care Kit Contents

  • Tangible Clean MPS 3.4 oz
  • Nutrifill Sterile Saline Insertion Solution with electrolytes
  • DMV Vented Scleral Cup for insertion
  • DMV Ultra Remover
  • Mirror
  • Clear travel bag
  • Tangible Clean 15% Discount Code
  • Care instructions

InSight Scleral Len Care Kit

Scleral Care Kit inside of clear travel bag

Autoship Option
Many of our accounts elect to automatically ship a scleral care kit with their scleral lens order. They incorporate the cost into their scleral lens fitting and materials fees. If you’re interested in the care kit auto ship option, please complete the form in the link below.

SCLERAL LENS AUTO SHIP REQUEST

Request Samples
If you’re interested in using these products in your practice, Tangible Science and Nutrifill offer samples to practitioners who open wholesale accounts.

Visit our Scleral Lens Success Guide to see the step by step instructions on how to request samples.

References
1. Dumbleton, K., Caffery, B., & Jones, L. (2020). Contact lens-related complications and the importance of compliance with lens care. PLOS ONE, 15(9), e0239116.

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Metro
16/Aug/2024
Contact Lens Care

6 Steps to Successfully Incorporate Specialty Contact Lenses Into Your Practice

Are you looking to offer specialty contact lenses for patients who can’t achieve their best vision with glasses or daily contacts?

Metro Optics’ innovative portfolio enables eye care professionals to source high-quality custom contact lenses, ranging from  mild prescriptions to high-cylinder patients, and even the most hard-to-fit eye conditions.

6 Steps to Success

  1. Network: Spread the word about your services. Reach out to fellow physicians, other specialists, hospitals, and professionals locally and online. Get to know your business neighbors, ask if you can bring literature to their practice, and ask questions about their demographics. Talk to realtors, hair stylists, church members, pickleball league buddies, your child’s friends’ parents—everyone!
  2. Staff Education: Educate your staff with the abundance of free resources on YouTube, the GPLI webinars, and Scleral Lens education Society. Empower staff by getting familiar with ocular conditions, lens modalities, and billing. Schedule lunch and learns with your local reps to learn more about each company and their lens designs. Register your account in the Physician Portal to access Insertion and Removal video tutorials.
  3. Questionnaire: Ask your patients questions about their vision, comfort, dryness, and satisfaction with their current contacts. Often, patients won’t bring up issues unless prompted, assuming their vision is as good as it can be. The doctor can address their answers during the visit.
  4. Patient Education: Offer educational resources for your patients, such as concise one-page handouts that outline the benefits of custom contact lenses. Including information on their options, the proper care systems,  solutions and where to purchase them can enhance patient compliance and over all ocular health.
  5. Leverage Your Labs: Don’t hesitate to ask your labs questions. They are a valuable resource with insights and expertise. Each lab may offer different perspectives on lens modalities, designs and strategy. Let technology do the heavy lifting! Send images to your consultants at info@metro-optics.com to optimize the fitting session.
  6. Current content: Actively updating content on your website and social media profiles helps your ideal patient find your practice when they search online. If your website includes content that addresses their ocular condition, they will be more likely to schedule an appointment with you. Offer resources for them to connect with other people with their condition. For example https://nkcf.org for your Keratoconus patients.

When patients see that you genuinely care about providing the best possible vision rather than just settling for the status quo, they will trust and invest in you because you’ve invested in them. While some patients may be content with their current vision, others will be thrilled that you’ve given them a better option.

Education is powerful. By offering all available options to your patients, you enable them to make informed decisions, enhancing their overall experience and satisfaction.

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Metro
06/Aug/2024
Keratoconus

Successful Treatment of Keratoconus with KeraSoft Thin

Bilateral Keratoconus KeraSoft Thin

Patient:24 YO Male College Football Player
Condition: Bilateral Keratoconus

Ocular History:
Undetermined manifest refraction due to high corneal irregularity.

Treatment:
Due to high physical activity and poor GP lens tolerance, lens fit was converted to piggy-back system resulting in BCVA 20/50 OU.

Refit in Kerasoft OU with first fit parameters:
• OD BC 8.40, -4.75 -3.75 X 10, Diameter 15.0, Standard peripheral
• OS BC 8.20, -18.25, Diameter 15.0, Standard peripheral

LEARN MORE about KeraSoft
KeraSoft Diagnostic Fit Set

Outcome:
Dispense visit over-refraction:
• OD +1.25 -1.00 X 45 for 20/20 minus
• OS Plano for 20/20 minus

Remade OD with new lens power
-3.75 -4.50 X 65

Shortly following lens dispense, patient was recruited to a professional practice squad, relocated, and neglected follow-up.

Eight months post-dispense

  • Patient reaches out to report a drop in visual acuity.
  • The patient was instructed to report to the practitioner’s office at their earliest convenience for evaluation.
  • Upon evaluation, Kerasoft lenses exhibit excessive movement along with small over-refraction.
  • This decline in lens performance is due to lenses being used beyond their effective duty cycle.
  • The patient is informed that Kerasoft lenses must be replaced at a recommended 3-month interval.
  • The lenses can perform adequately for up to 6 months, but material degradation will result in poor performance beyond that time.
  • New Kerasoft lenses were ordered in the original parameters and in multi-packs.
  • Original dispense lens performance was restored by the new lenses and the patient was scheduled for routine follow-up.

Help More Patients in Your Area:
We want to make it easy for patients to find your practice. Is your practice listed on the map? Check the Physician Locator Page.

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Metro
01/Jul/2024
Uncategorized

Focus: Graham Eye Associates

Today our focus is on Dr. Tammi Graham, OD of Graham Eye Associates in the Woodlands, Texas. We asked Dr. Graham ten questions to learn more about her, and her practice. Her answers offer clarity and insight into the life-changing world of custom contact lenses.

Graham Eye Associates front desk

1. What inspired you to specialize in custom contact lenses, and what unique approach do you bring to your practice?

My inspiration to specialize in custom contact lenses stemmed from the clinical care of my patients suffering from ocular surface and corneal diseases. My clinical training included management of these conditions through the use of traditional medical therapeutics, as well as the use of custom contact lenses to recover functional vision. This unique multi-dimensional clinical approach has consistently been shown to be one of the most effective and efficient treatment protocols for my patients. 

2. Can you walk me through your process for fitting custom contact lenses for patients with specific eye conditions or needs?

The most important process in the fitting of custom contact lenses is the initial comprehensive examination of the visual system and the factors that affect its function. This includes a thorough reporting of the patient’s medical history, the physical and visual examination of the eyes, as well as establishing an understanding of the patient’s daily visual needs. Analyzing all the information gathered will allow a more accurate and successful selection of custom contact lenses for our patient.

Graham eye associates scleral lens insertion

3. How do you stay updated with advancements and technologies in the field of custom contact lenses to ensure your patients receive the best care possible?

Attending continuing education courses and participating in specialty contact lens workshops keep me updated on the advancements and technologies in the field.

4. Could you share a particularly challenging case you’ve encountered in your practice and how you approached it?

One of the most challenging clinical cases I’ve had involved a patient that had complications associated with a corneal graft. The patient’s cornea had many scars from these complications which resulted in many irregularities on the entire ocular surface. These irregularities are challenging in the custom lens fitting process because their anatomic and physiologic behaviors can be difficult to manage. I approached this case by using a combination of topical medications and persistent customization of the contact lenses until we arrived at the maximum fit and comfort level for the patient.

5. What measures do you take to ensure patient satisfaction and comfort with their custom contact lenses?

I utilize direct and indirect surveys to get updates on the patient’s experiences with the fitting process, visual improvement, and overall comfort with their custom contact lenses. Direct surveys are conducted as part of the patient’s in-person follow up exams, and indirect surveys are conducted via HIPAA compliant messaging.

Dr. Tammi Graham slit lamp

6. How do you collaborate with other eye care professionals or specialists to provide comprehensive care for your patients?

Doctor to doctor communication is very important to me because this is when our patients receive the most comprehensive care. I make it a priority to send reports to doctors with whom we share in the care of our patients.

7. In what ways do you customize your approach for patients with unique lifestyle or occupational demands?

Individualizing the clinical approach for each patient starts with spending time to get to know how the patient spends their day. This may include understanding the nature of their work, their hobbies, and how they like to spend their free time. This individualized approach makes it fun and motivating for patients throughout the fitting process.

8. Can you discuss any innovative techniques or technologies you utilize in your practice for fitting custom contact lenses?

I utilize specialized slit lamp techniques to view the custom lenses’ fitting behavior when worn on the patient’s eyes. In addition, I rely on corneal topographies to create maps of the cornea to assess the cornea’s response to the custom lens. I also utilize the optical coherence tomography to assess the eye anatomy and physiology as it adapts to the custom lenses.

Graham eye associates

9. What advice do you often give to patients to help them maintain optimal eye health while wearing custom contact lenses?

We emphasize proper care and hygiene to maintain good eye health and safety during lens use. In general, we recommend patients wear their lenses during the day except in special cases when overnight wear might be indicated. There are additional recommendations and wear tips that we provide during the training and dispense visit.

10. How do you handle patient education and support regarding the use and care of their custom contact lenses, especially for first-time users?

We offer multiple training sessions as part of the initial dispense for new wearers. We keep close follow up on our patients’ progress to make sure that they are adjusting well to their new custom lenses. We also pre-schedule follow up exams to assess the patient’s vision and eye health as they get more accustomed to using their new lenses.

Schedule an appointment with Dr. Graham.

Find Dr. Graham on our Physician Locator

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Metro
16/Feb/2024
Keratoconus

What is the ComfortKone Lens?

What is the ComfortKone Lens?
ComfortKone is an FDA Cleared RGP contact lens design for Keratoconus applications. The ComfortKone Aspheric is the most advanced lens for patients in any stage of Keratoconus. This unique lens design provides consistent results with maximum comfort and visual acuity for keratoconus patients.

What does FDA Clearance mean?
The ComfortKone lens design holds an FDA 510k clearance specifically for Keratoconus application. This means that Metro Optics submitted lens design and patient case information to the FDA demonstrating safety and efficacy of the lens on keratoconic corneas.

What is special about the ComfortKone?
This design uses a corneal alignment fitting approach to maximize comfort and visual acuity. The design features a comprehensive fitting system with controlled parameters that provide quick and consistent results, and the computer driven manufacturing systems used to create the ComfortKone ensures that every lens and fit is completely reproducible.

What are the design specifics?
The back surface of the ComfortKone lens is begins with a central spherical base curve zone which vaults over the corneal apex. It
transitions to an aspheric zone creating an alignment to the keratoconic slope. This base curve configuration causes the lens to center itself over the cone which is usually a bit off corneal center, and does not adversely affect vision or comfort. The back surface peripheral curves are similar to standard lens designs to provide maximum edge comfort and tear exchange under the lens. The front surface of ComfortKone can feature both spherical and toric optics.

Base Curve Evaluation
Slit-lamp evaluation of the lens will quickly reveal any necessary changes. After allowing the lens to settle for several minutes, instill fluorescein and use blue cobalt light with a wratten filter. The wratten filter will overcome the UV inhibitors present in the lens material so you can clearly see the tear film behind the lens. Note any areas of touch or excessive clearance from the lens center to edge. Send
photos and videos of the fluorescein patterns to your Metro Optics consultant. Be sure to use a wratten filter over the camera lens when capturing images.

Over-Refraction
The most accurate method for determining lens power for any keratoconus patient is to over refract over the best fitting diagnostic lens. This should be done following lens settling and base curve evaluation. A spherocylindrical over-refraction should be taken as the ComfortKone lens is available in toric optics.

What about empirical fitting of ComfortKone?
Although this not the ideal approach, a ComfortKone lens can be designed empirically with the aid of keratometry readings or corneal topography and manifest refractions with the help of a Metro Optics fitting consultant.

Learn More here about the ComfortKone design and our other Keratonus lens options.

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