What Happens After You Refer a Patient

Written for colleagues. If you have not referred to a specialty lens practice before, the reasonable hesitation is not about whether sclerals work — it is about what happens to your patient, and to your relationship with them, once they walk out of your office.

Here is the pathway, plainly.

Before the first visit

Send the referral by phone, fax or the form on our referring physicians page. Your working diagnosis and any topography you already have is useful for establishing a timeline, but nothing is mandatory — we repeat the imaging ourselves.

If a case is urgent, say so on the referral. A patient whose graft lens has stopped working, or who cannot drive or do their job, is a different scheduling problem from a stable keratoconic who has been managing for years.

If you would rather talk it through first, ask for Dr. Kresch. A five-minute conversation often settles whether a referral is the right move.

Visit one: the specialty evaluation

This is a longer appointment than a routine exam, and the patient is told that in advance.

• Corneal topography — the shape of the front surface, and the comparison point for any future progression question.
• Eaglet Eye scleral profilometry — a three-dimensional map of the sclera and the limbal transition, not just the cornea. This is the part that separates a designed lens from a selected one: the sclera is asymmetric on almost everyone, and a lens taken from a trial set lands on that asymmetry rather than accommodating it.
• Ocular surface assessment — tear film, lid margins, meibomian function. This changes lens decisions more often than people expect, and an unaddressed surface will undermine an otherwise good fit.
• A diagnostic lens on the eye, so the patient sees what corrected vision actually looks like before committing to anything.

That last point does a lot of work. Many of these patients have been told for years that their vision is as good as it gets. Seeing a chart clearly through a diagnostic lens is usually the moment the conversation changes.

The first consultation is complimentary, so there is no financial barrier to sending someone for an opinion — including a patient you are not sure about.

What your patient is told

Straight answers, and specifically:

• Whether a lens can help, and what the realistic ceiling is. Where central scarring caps acuity, we say so before anyone spends money.
• That the fitting takes several visits, and roughly how many.
• That handling takes one to two weeks to feel natural, and that we will train them until it does.
• That the lens corrects vision and does not stop keratoconus progressing — a distinction a surprising number of patients have never had made clear.
• That they remain your patient for their primary eye care.

We do not sell a lens to someone it will not help, and we do not quote an outcome we cannot stand behind.

Visit two onward: fitting and dispensing

The lens is designed from the patient’s own scleral map and ordered. At dispensing they get one-on-one insertion and removal training, a care routine, and a written schedule for building up wearing time.

Follow-ups refine the design after real-world wear, because a lens that is comfortable at hour two and not at hour ten needs a change, and that only shows up in daily life. Most patients settle in one or two refinements. Complex corneas take more.

What comes back to you

A written report after the evaluation, and again once the lens is dispensed and settled:

• Topography and profilometry maps, with the clinically relevant findings called out
• Whether the disease appears stable or progressing, and on what evidence
• The lens design fitted, its parameters, and why that design over the alternatives
• Corrected acuity achieved, and what limits it if anything does
• Ocular surface findings, since these frequently change the lens decision
• Our recommended follow-up interval, and what we will be watching

On documentation: keratoconus sits in the H18.6 family, and the code turns on whether the disease is stable or unstable as well as laterality — the same distinction that governs cross-linking candidacy. Our progression assessment supports the coding as well as the clinical decision. Post-transplant and post-surgical status codes apply separately, and your billing team should confirm specifics for your own claims.

If the answer is no

Sometimes it is. Dense central scarring caps what any lens can deliver. Some surfaces are too compromised for scleral wear to be safe. Occasionally a patient simply does not want the handling commitment, which is a legitimate answer.

You still get a report explaining what was found and why the answer was no. That closes a question that would otherwise stay open, and it gives you something concrete to tell your patient. A referral that ends in a clear no is a useful referral.

On cross-linking

Dr. Kresch is an optometrist and does not perform cross-linking. What we do is both ends of it, and that is where these patients most often fall through the gaps.

Before: candidacy turns on documented progression, not on the diagnosis. We establish that with serial topography and send you the comparison. A meaningful number of patients referred as urgent turn out to be stable, and some presenting as routine are not.

After: cross-linking stabilises the cornea without smoothing it, so the irregularity that was blurring the patient’s vision is still there. Most of these patients need a lens to see, and a good number are never fitted for one. See vision after cross-linking.

If you already work with a corneal surgeon we fit alongside them. If you would like a referral pathway, we can point you to surgeons we work with regularly.

The short version

Your patient gets seen, evaluated properly, told the truth, and returned to you. You get a report you can file and act on. Nobody is poached.

Call (248) 545-2800, fax (248) 581-4074, or use the form on the referring physicians page.