Frequently Asked Questions


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


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.

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.


Which Contact Lens Solutions Should I Use?
Cleaning, disinfecting, saline, rewetting drops—oh my! Understand the differences between the various contact lens solutions and which is the best solution for your specific contacts. Always inform your doctor about the solution you’re using. You can find many of the solutions at your local Walgreens, CVS, drugstore, grocery store, or amazon. Some products require a prescription and are only available through your doctor or the product website.

Multipurpose Solution or MPS
Multipurpose solutions are an all-in-one contact lens solution that cleans, disinfects, and conditions and stores your contact lenses.
1. Tangible Clean – All In One Multi-Purpose Contact Lens Solution. Clean, rinse, disinfect, condition, and store your soft, hybrid, corneal and scleral RGP contact lenses. No need for multiple solutions complicating your care routine.
2. BioTrue – Soft Contact Lenses including Silicone Hydrogels. Disinfects and cleans lenses overnight while simultaneously adding hydration for lens comfort that lasts all day.
3. Unique pH™ is a multi-purpose solution that cleans and and conditions rigid gas permeable contact lenses.
4. Boston SIMPLUS® is a “daily rigid gas permeable contact lens care system that cleans, removes proteins, rinses, disinfects and conditions”. It is approved by Tangible Sciences to use on contact lenses coated with Hydra PEG.

Hydrogen Peroxide Disinfecting Solutions
Hydrogen peroxide care systems can be prescribed for patients with sensitivities to the preservatives in multipurpose solutions.
1. CLEAR CARE®: Cleans and disinfects contact lenses with 3% hydrogen peroxide overnight, or for a minimum of six hours. This preservative-free solution is a great option for patients sensitive to preservatives in multi-purpose solutions. Safe for all soft and RGP contact lenses.

Contact Lens Storage Hygiene
It is recommended that patients store their contact lenses in a clean lens case with fresh solution every night. It’s important to empty and wash the cases each morning, refilling them with fresh solution every night. Avoid keeping solution in the case and “topping off,” as this can foster germ growth, potentially leading to serious eye infections. Developing a routine of proper lens storage hygiene is essential for maintaining eye health and preventing complications.

Artificial Tears or Lubricant Eye Drops for Contacts
Artificial tears are formulated to lubricate the ocular surface and provide temporary relief from dry eye symptoms. If you are a contact lens wearer, always make sure the box says, “For Contacts” on the label. You can always ask which brand your doctor recommends.

Keep an Eye Out
Stay up to date on recalled Artificial Tears. Here’s the most recent updated on Feb 3rd, 2024. Always call your eye doctor if you experience any adverse reactions to your eye drops.

Rewetting Drops or Rehydrating Drops for Contacts
Rewetting drops hydrate contact lenses while they are in the eye. Triple check that you are using the appropriate solution intended for Contact Lenses. If you accidentally instill the wrong drop into your eye not intended for Contact lenses, your eyes can burn, turn red, your eyes can become irritated, and potentially experience visual loss.

Again, Make Sure the Box Says, “For Contacts”

According to Forbes Health (1) the top two contact lens rewetting drops are:
1. Biotrue Hydration Boost Contact Lens Drops Add moisture back into your eye for up to 8 hours. It’s is preservative free.
2. REFRESH® RELIEVA® FOR CONTACTS LUBRICANT EYE DROPS Instill drops while wearing your contact lenses. Relieves dry eye symptoms.

Scleral Fill Solution
This preservative free saline solution is specifically designed to fill the bowl of the scleral lens. They come in sterile single use vials. This non-preserved saline sits directly on the surface of the eye for hours a day. It’s important to choose the best solution for your eyes.

  1. Nutrifill is the only FDA cleared insertion solution containing the 5 essential electrolytes, sodium, calcium, magnesium, potassium, and phosphate which contribute to a healthier ocular environment. Nutrifill has a pH (7.4) and osmolality (300) which mimics the natural tear.
  2. Menicon Lacripure  is an FDA cleared non-preserved saline. Patients can open account on their webiste or order from amazon, or the Dry Eye Shop.
  3. Bausch + Lomb Scleral Fil – is an FDA preservative free saline solution “Indicated as an insertion and rinsing solution for scleral lenses.” Patients and ECPs can find scleralFil on amazon or the Dry Eye shop.

When you order the InSight Scleral Lens from us, be sure to ask customer service about our Scleral Lens Care Kit. Learn more here.

More Solutions on the Market
This is by no means an exhaustive list. This is merely a list of a few examples of different eye drops and contact lens solutions that you’ll find online and in stores. It’s worth repeating to take your time, ask questions and verify with your eye doctor and the pharmacist that you have the correct solution for you.

Always Talk to Your Doctor
Always call or email your doctor to let them know which solution you are using or considering using. If you need to switch solutions, call your doctor to verify that that works for you specifically.

Remember, your eyes are a precious gift—let’s keep them sparkling!



Health, Happiness & Multifocal Lenses

Metro Optics custom multifocal lenses fill a niche commodity lenses can’t touch.

By using Metro Optics proven presbyopic lens designs, you will realize how simple and rewarding it is to fit custom multifocal contact lenses. 

Metro Optics Multifocal Quick Reference:

Our design portfolio includes soft, corneal GP and scleral lens designs proven to enhance the vision of thousands of presbyopic patients:

MetroFocal  – Center distance soft multifocal, normal cornea profile, up to 2.50D add power, available in toric parameters for patients with 0.75 to 8.00D cornea astigmatism – best suited for the mild to moderate presbyope who desires a soft lens. Empirically order lenses using manifest and keratometry readings. Available in Definitive 74% SiHy, 60 Dk which provides three times the oxygen to the cornea in comparison to other hydrogels (1).

Metro Progressive  – Center distance corneal GP aspheric multifocal, normal cornea profile, up to 2.50D add power, rotation-free optics for patients with less than 2.75D astigmatism, available in back-toric and bi-toric for patients with over 3.00D corneal astigmatism – best suited for the mild-to-moderate presbyope who is a current GP wearer or desires the crispest vision possible in a multifocal design. Empirically order lenses using manifest and keratometry readings.

Metro SEG  – Translating crescent bifocal with an aspheric intermediate zone, normal cornea profile, unlimited add power, available in back toric and bi-toric for patients with over 3.00D cornea astigmatism – best suited for the moderate to advanced presbyope who is a current GP wearer or desires the crispest distance and near vision possible. Empirically order lenses using manifest and keratometry readings.

InSight Scleral – Center distance multifocal scleral, normal to highly irregular cornea profiles, up to 3.00D add power, thin design maximizes Dk/t of the chosen lens material – best suited for the mild to moderate presbyope who needs a medically necessary lens for keratoconus, post-surgical ectasia or severe ocular surface disease. Diagnostic fitting is required with live virtual training available with a Metro Optics consultant.

An Infinitely Better Material for Corneal GP and Scleral Lenses

When it comes to quality, Metro Optics ensures all lenses are manufactured with the best materials available in the market. To provide your patients with the healthiest contact lens environment, it is recommended to choose a high dK/t lens material such as Optimum Infinite, which has a hyper oxygen permeability value of 180Dk and a high flexural modulus of 1341MPa, defying the high Dk/low flexural modulus convention (2). This material also has excellent surface wettability, which can be further enhanced through the addition of Tangible hydra-PEG coating to make Infinite the healthiest choice for your corneal GP and Scleral lens wearers. 

Metro Cares About Your Practice

Other than manufacturing high quality custom lenses, Metro Optics also provides many benefits to ensure our customers have a profitable custom lens practice. We have always offered 90-day warranties on all lens designs, easy return policies, competitive pricing and expertise consultation to finalize fittings quickly. We will also continue to support our customers by extending warranties on fittings performed prior and during the rebuilding phase of the COVID-19 pandemic. Visit our website at to learn more about our entire line of custom contact lenses.




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