FAQ

Frequently Asked Questions

 

 

 

 

  • How does the Morgan Lens work?
  • How do I insert the Morgan Lens?
  • Why is it easier to use the Morgan Lens?
  • Why is the Morgan Lens better for the patient?
  • Is it difficult for the patient to tolerate the Morgan Lens during use?
  • How do I get trained to use the Morgan Lens?
  • Why does MorTan recommend starting the flow of solution before inserting the Morgan Lens?
  • Can the Morgan Lens can cause a corneal abrasion?
  • Should I irrigate both eyes simultaneously, and how can this be done?
  • How long should irrigation be continued?
  • Does the Morgan Lens contain any Latex?
  • Is there a version of the Morgan Lens for children?
  • Why does MorTan, Inc. recommend that Lactated Ringer’s solution be used during irrigation with the Morgan Lens?
  • Should contact lenses be removed before irrigating an injured eye?
  • What are the contraindications to the use of the Morgan Lens?
  • Can the Morgan Lens be used to treat contamination from blood or
  • bodily fluids?
  • What insurance codes should be used with the Morgan Lens?
  • What is the cost of the Morgan Lens?
  • What other methods of ocular irrigation are available?
  • What is the shelf life of the Morgan Lens?
  • How can we decipher the lot number on a Morgan Lens package?
  • Can the Morgan Lens be used for applications other than emergency
  • eye irrigation?

 

 

How does the Morgan Lens work?
The Morgan Lens provides ocular irrigation and/or medication to the cornea and conjuctiva. It consists of a molded lens with directional fins, attached tubing and adaptor. Once inserted, the Morgan Lens floats on the very layer of solution it is delivering, separating itself from the tender ocular tissues and vaulting the cornea, never touching it.
As the lens floats above the eye, the flushing process soothes the injury and provides instant relief to irritated eyes.

 

How do I insert the Morgan Lens?
After a topical anesthetic is applied (when available) simply attach the Morgan Lens to the Morgan Lens Delivery Set or other administration set. Attach to solution and begin flow. While minimal flow is released, have the patient look down and insert the lens under the upper lid. Then, have the patient look up, retract the lower lid, and drop the lens in place. Adjust the flow to the desired rate and absorb the outflow with the MorTan Medi-Duct®, our ocular fluid management system, or with towels. You can also attach it to a syringe for a smaller, more controlled application.
Please view the Morgan Lens Instrucitonal Video (click here) for more information on the use of the Morgan Lens.

 

Why is it easier to use the Morgan Lens?
After insertion, which takes approximately 20 seconds, the Morgan Lens works on its own. Unlike hand-held irrigation procedures, your hands are free to go to work on other injuries or transport the patient while his or her eyes receive thorough irrigation.

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Why is the Morgan Lens better for the patient?
The natural reaction for a patient with an ocular injury is to squeeze the eye shut (blepharospasm). Not only does this make it difficult to effectively irrigate the eye using "manual methods", it is very painful for the patient to keep the eyelids open (note that experts recommend irrigating until the pH of the eye returns to normal, however long this may take). Injured eyes are also extremely light sensitive (photophobia), and may be impossible to irrigate adequately with manual methods. With the Morgan Lens, the patient is able to close the eyelids while effective ocular irrigation is underway.

 

Is it difficult for the patient to tolerate the Morgan Lens during use?
The Morgan Lens is greatly preferred by patients--as well as health care providers--over manual irrigation or "patch and ship" treatments. This is because the Morgan Lens begins providing immediate relief to an injured eye, is quick and easy to insert and remove, and allows the patient's eyes to be closed during the irrigation process (in fact, even an eye that is tightly squeezed shut--the natural reaction to an ocular injury--can be effectively irrigated with the Morgan Lens).

Discomfort may result if the flow of irrigating fluid is not started before insertion (and continued through the entire process, including the removal of the lens), or, with some patients, when Normal Saline is used (Lactated Ringer's solution is recommended.)

Studies with the flexible MT2000 have shown an increase in patient tolerence when the Morgan Lens is used on healthy volunteers. An earlier study performed by BioScience Laboratories, Inc. on behalf of MorTan showed that the Morgan Lens was preferred unanimously over the manual irrigation method not only by all 10 of the medical personnel involved, but by the subjects as well, who rated the lens on ease of use and comfort.

 

How do I get trained to use the Morgan Lens?
To assist in the initial training, MorTan offers a Morgan Lens Training Tool, a competency assessment, an instructional video, and a PowerPoint presentation available for staff training. These are available from MorTan, or the presentations are on line.
CLICK HERE to view the In-House Instructional Video or CLICK HERE to link to the Morgan Lens PowerPoint presentation.

 

Why does MorTan recommend starting the flow of solution before inserting the Morgan Lens?
The Morgan Lens does not touch the surface of the eye whenever the solution is flowing but instead it floats on the fluid. As this is more comfortable for the patient, it is recommended that the irrigating solution be flowing any time the lens is in the eye.

For best results, MorTan recommends the following:
•Begin the flow before inserting the lens
• Use Lactated Ringer's solution
•Do not allow the fluid to run dry
•Continue the flow when removing the lens
•If the lens is temporarily removed to check the ocular pH, make sure to restart the flow before reinserting the lens.

 

Can the Morgan Lens cause a corneal abrasion?
It's important to remember that any significant corneal insult (acid, alkali, thermal, or actinic burns) or infection (corneal ulcer, abcess, Stevens-Johnson, etc.) causes corneal abrasions but the Morgan Lens actually treats the abrasion and prevents further damage.

Because the Morgan Lens floats on a cushion of fluid and does not rest on the cornea, used properly, there will be no injury resulting from the Morgan Lens.

Even if the Morgan Lens was inserted without irrigation (NOT RECOMMENDED--always start the flow of solution before insertion of the Morgan Lens, and continue the flow until the lens is removed) the patient will be more comfortable because the lens physically separates the (possibly damaged) lid tissue from the damaged cornea. With the solution flowing, offending material and damaged tissue is removed, the cornea is cooled, oxygen is brought to the area, and the lids are prevented from causing any further damage.

Improper handling or insertion of the Lens could, however, lead to minor corneal changes. To assist in the initial training, MorTan offers a Morgan Lens Training Tool, a competency assessment, and an instructional video. We also have a free PowerPoint presentation available for staff training. Please contact MorTan for details.

In addition, prolonged irrigation with Normal Saline may result in corneal staining and discomfort. MorTan recommends using Lactated Ringer’s solution.

 

Should I irrigate both eyes simultaneously, and how can this be done?
Approximately one-third of ocular burns are bilateral, and yet this often may be difficult to determine: the pain in one eye may mask the pain in the other, or nerve damage may have occurred, creating an analgesic effect (especially with alkali burns). For this reason, it is wise to irrigate both eyes unless there is a compelling reason to treat only one.

Bilateral irrigation is easily accomplished using the Morgan Lens Delivery Set (part number MT202), a modified IV set that connects two Morgan Lenses to one bag of irrigating solution. Please see our Accessories page for more information on this product.

How long should irrigation be continued?
There is no set rule on length of time for irrigation, as it varies depending on the type of injury being treated. The general guideline is to irrigate until the conjunctival pH is 7.5 to 8, although it is necessary to ensure that the pH of the anterior chamber is corrected, especially with alkali burns. Goldfrank's Toxicologic Emergencies recommends multiple checks of the lower fornix every 5 to 10 minutes following irrigation with at least two liters of solution per affected eye, continuing until the pH is between 7.5 and 8.

The article "Chemical Eye Injuries in the Workplace" by Pamela Lusk (AAOHN Journal, February, 1999, Vol. 47, No. 2) suggests irrigating with 2 liters of solution, removing the Morgan Lens and waiting 10 minutes, and checking the pH. The lens should be replaced (starting the flow before insertion) and the cycle repeated until the pH is in the range of 7.5 to 8.

MorTan's recommendations for irrigation times are shown in the chart on the Instructions for Use page.

 

Does the Morgan Lens contain any Latex?
The Morgan Lens, the Morgan Lens Delivery Set, and all of MorTan's packaging are latex free. According to the raw material provider for the Medi-Duct, their proprietary formulation may contain minute amounts of latex.

Materials used in the Morgan Lens include LDPE (Low Density Polyethylene) for the "lens" portion, silicone for the tubing (a synthetic rubber), and polypropylene for the luerloc. All of these materials are medical grade.

 

Is there a version of the Morgan Lens for children?
Users of the Morgan MT2000 Lens have shown that it can be compressed when caring for young children. The dimensions of the eye for adults and children are surprisingly similar except for the length of the palpebral fissure (the right to left opening between the lids.) However, the length of the palpebral fissure is of no significance when inserting the Morgan Lens--being just 18.5 mm by 23 mm, the Morgan Lens can easily be slipped through the fissure into a much larger area. If necessary, the Morgan Lens can be rotated slightly to slip through the palpebral fissure more easily.

 

Why does MorTan, Inc. recommend that Lactated Ringer’s solution be used during irrigation with the Morgan Lens?
The pH of human tears is approximately 7.1, much closer to the pH of Lactated Ringer’s (6.0 to 7.5) than Normal Saline (pH 4.5 to 7.0). Commercially-available balanced eye irrigating solutions are also available and may be used.

A recent study using human volunteers (unpublished, and performed independently from MorTan, Inc.) showed that patients found the Morgan Lens, when used with Lactated Ringer's solution, to be more comfortable than irrigation with sterile saline solutions or manual irrigation using either Lactated Ringer's solution, saline, or BBS. Other studies have shown that the prolonged use of saline can cause discomfort to the cornea as well as minor morphological changes to the surface of the eye.

Irrigation with essentially any solution, however, is better than no irrigation at all, so, while Lactated Ringer's is recommended, Normal Saline solution or a commercially-available balanced salt solution can be used if necessary.

 

Should contact lenses be removed before irrigating an injured eye?
Following a chemical burn, diluting the chemical is the number one priority, and time is of the essence. It can be very painful, traumatic, and difficult to remove the contact lenses until irrigation has been underway for a while because of the natural tendency to squeeze the eyelids shut in response to an injury (blepharospasm). In certain cases, the contact lenses may actually provide some degree of protection to the cornea, so it is recommended that irrigation be started immediately and removal of the contacts done later. Soft contacts, however, can retain chemicals and therefore, should be removed as soon as possible.

 

What are the contraindications to the use of the Morgan Lens?
There are only a few situations where the use of the Morgan Lens is not recommended.

Contraindications:
Do not use on protruding foreign bodies.
Do not use with penetrating eye injuries
Do not use with a suspected or actual rupture of the globe
Do not use anesthetic agents if there is a known allergy

Can the Morgan Lens be used to treat contamination from blood or bodily fluids?
Yes. Any exposure involving mucous membranes is considered “significant” and immediate irrigation is required. Experts recommend no less than 20 to 30 minutes of continual irrigation with water or saline (although we suggest using Lactated Ringer’s to improve patient comfort), starting as soon as possible after the exposure. Treatment should not be delayed to determine whether or not the patient has an infectious disease. Appropriate prophylactic regimens should be started promptly as well.

What insurance codes should be used with the Morgan Lens?
Unfortunately there isn't a specific code for irrigation with the Morgan Lens. Instead, we recommend you use one of the following for the procedure:
CPT Code 65205-Removal of foreign body (external) from eye but non-surgical
ICD9 Code 930.1 Conjunctive-foreign body
ICD9 Code 930.9 Unspecified external eye-foreign body

To bill for the Morgan Lens itself we suggest that you use a miscellaneous supply code such as 99070 or the HCPCS code V2797.
 

What is the cost of the Morgan Lens?
The Morgan Lens is very inexpensive. Since most emergency facilities have in stock the necessary irrigating solutions, IV delivery sets, ocular anesthetics, and collection devices, MorTan offers individual pricing so duplication of materials can be avoided. Please contact
the representatives at MorTan, Inc. for pricing information and to find out if you are eligible for certain discounts.

The following equipment is recommended for ocular irrigation using the Morgan Lens:

* 2 Morgan Lenses (often injuries will be bilateral, but the pain in one eye may mask the pain in the other)
* Topical Ocular Anesthetic (if available)
* Morgan Lens Delivery Set (a specialized I.V. delivery set which can be attached to two Morgan Lenses, simultaneously irrigating both eyes) or I.V. Tubing
* I.V. Solution for Irrigation (Note: MorTan, Inc. recommends the use of Lactated Ringer’s Solution for irrigation due to pH: Tears pH: approximately 7.1; Normal Saline pH: 4.5-7.0; Lactated Ringer pH: 6.0-7.5)
* Medi-Duct (a fluid management system designed for use during ocular irrigation), towels, blue pads, or other fluid collection device

More details on the Morgan Lens Delivery Set and the Medi-Duct can be found on the Accessories for Use page.

What other methods of ocular irrigation are available?
Manual irrigation: holding the patient's eye open while irrigating with the open end of an IV delivery set. Numerous studies have shown this method to be poorly tolerated by the patient, relatively uncontrolled and messy. It requires that the eyelids be held open by one of the persons providing the irrigation, preventing that person from performing any other function.

The Morgan Lens, however, is unique in that it is the only method for ocular irrigation that has been repeatedly proven to effectively irrigate the cornea, cul-de-sac, and under the eyelids. It is well tolerated by patients, and requires minimal attention from the health care provider. It provides the only method for truly effective, "hands free" ocular irrigation--no other eye irrigation method simultaneously irrigates under both eyelids as effectively and comfortably as the Morgan Lens.

 

What is the shelf life of the Morgan Lens?
Accelerated aging studies on packaged Morgan Lenses indicate a shelf life of at least five years with no change in properties or loss of sterility.

 

How can we decipher the lot number on a Morgan Lens package?
MorTan's lot numbers consist of two parts. The first seven digits represent the month and year of sterilization, followed by a three digit batch number (for example, 0307126 shows that the unit was sterilized in March (03) of 2007 (07) and is the 126th batch). Next is the ISO symbol for "Expiration Date" (an hourglass) followed by the year and month the device will expire. For example, 2012-03 shows that the device will expire in March of 2012.

 

Can the Morgan Lens be used for applications other than emergency eye irrigation?
The Morgan Lens was originally developed to treat corneal ulcers, corneal perforations, and severe ocular infections, and it has been used very successfully in all three categories.

Experimental investigations have been performed by the Departments of Ophthalmology and Microbiology at the University of Toronto which corroborates the clinical experiences with the Morgan Lens. These experiments include:

# Continuous flow delivery of gentamicin to the cornea. Rapid penetration into the aqueous humor was obtained.
# Pseudomonas was injected into corneas, and treatment of the subsequent keratitis was performed with the Morgan Lens. While pseudomonas generally perforates in a few hours, the infections healed without perforation by continuous perfusion of gentamicin with the Morgan Lens.
# Superficial keratectomy with removal of epithelium, basement membrane, and anterior stroma was performed. With the Morgan Lens, epidermal growth factor was perfused and substantial healing occurred in eight hours.

No corneal damage occurred (i.e. perforation, corneal ulceration) while treating with the Morgan Lens.

Many other experimental investigations have been performed showing the applications and advantages of the Morgan Lens, either on behalf of MorTan or independently. Please contact us for additional information on these or other studies.

© 2017 Whelehan Surgical,
  • Suite 12, Bunkilla Plaza, Bracetown Business Park, Clonee, Dublin 15, D15XC64, Republic of Ireland.
  • Phone: +353 1 806 8600
  • Fax: +353 1 834 2340
  • Email: info@tpwhelehan.ie

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