Prosthetic replacement of the ocular surface ecosystem: impact at 5 years

Br J Ophthalmol. 2016 Sep;100(9):1171-5. doi: 10.1136/bjophthalmol-2015-307483. Epub 2015 Dec 7.


Background/aims: To determine the impact of prosthetic replacement of the ocular surface ecosystem (PROSE) treatment at 5 years.

Methods: Retrospective review of clinical, manufacturing and quality databases at the Boston Foundation for Sight.

Results: 121 patients who completed treatment and had 5-year follow-up data were identified from a cohort of patients (n=199) seen in consultation for PROSE treatment from January 2008 to June 2008. Mean age was 52 years, M:F=56:65. The primary indication for treatment was ocular surface disease (OSD) in 64 patients and distorted corneal surface in 57 patients. At 5 years, continued device wear was confirmed in 89/121 (73.6%) patients. Discontinuation of wear was confirmed in 32/121 (26.4%). There was an increased likelihood of continued device wear at 5 years in patients with distorted cornea (84%) compared with those with OSD (64%), (p=0.0121, χ(2)). National Eye Institute Visual Function Questionnaire (NEI VFQ-25) composite score increased for patients wearing PROSE devices at 6 months (Δ=+23 points, mean=82, p<0.001, two-tailed t test) with no significant decline among those still wearing a device at 5 years (Δ=-4 points, mean=78, p=0.22, two-tailed t test). At 5 years, those wearing (mean=78) had a higher NEI VFQ-25 than those not wearing (mean=70, p=0.029, two-tailed t test).

Conclusions: PROSE treatment offers continued benefit, as defined by improved visual function and continued device wear at 5 years, in patients with complex corneal disease. Patients with distorted cornea have a higher rate of continued wear at 5 years than patients with OSD, although this is not true among all subgroups within OSD.

Keywords: Contact lens; Cornea; Ocular surface; Prosthesis; Vision.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Cornea / surgery*
  • Corneal Diseases / surgery*
  • Eye, Artificial*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Prosthesis Design
  • Prosthesis Fitting
  • Retrospective Studies
  • Surveys and Questionnaires*
  • Time Factors
  • Visual Acuity*
  • Young Adult