Intacs Humanitarian Device Exemption

September 2, 2010

Intacs For Keratoconus

Home

Patient Survey

Subject:
First Name: (optional)
Last Name: (optional)
1) Do you have Keratoconus? If No, and you are inquiring for a friend or loved one, please answer the remaining questions for the patient as best you are able.	Yes No
2) What is your age?	15-20 21-30 30-40 41 or above
3) When were you diagnosed with Keratoconus?	Last 12 months 1-3 years 3-5 years 5 years or more
4) Do you currently wear Contact Lenses?	Yes No
If so, what type?	Soft Custom Soft (Toric) Hard / RGP Both Soft & Hard
5) Are your Contact Lenses worn comfortably?	Very comfortable Somewhat Not very
6) Length of time Contact Lenses worn comfortably in a day?	1-2 Hrs. 3-5 Hrs. 5-8 Hrs. All Day
7) Rate your Vision Quality with Contact Lenses.	Very Good Above Average Average Less than Average Not Good
If Contact Lens are not comfortable, Intacs can be an option for you. Would you like more information on Intacs?
Email address:
Feel free to tell us anything else you feel we need to know:	Enter your message here.

Intacs For Keratoconus

Humanitarian Device: Authorized by U.S. Federal law for use in the treatment of nearsightedness and astigmatism associated with keratoconus. The effectiveness of this device for this use has not been demonstrated.

Website best viewed at 800x600 or higher
Flash Player required