Assessment of the Prosthetic Replacement of Ocular Surface Ecosystem (PROSE) scleral lens on visual acuity for corneal irregularity and ocular surface disease

Ocul Surf. 2018 Apr;16(2):254-258. doi: 10.1016/j.jtos.2018.01.003. Epub 2018 Feb 6.


Purpose: To describe changes in visual acuity in patients fit with the Prosthetic Replacement of Ocular Surface Ecosystem (PROSE) with irregular corneas compared to those with ocular surface disease, as well as describe patient demographics and fitting indications for PROSE at an academic medical center.

Methods: A retrospective chart review from 2010 to 2016 on a total of 825 eyes from 493 patients fitted with a PROSE lens, and grouped by etiology, either irregular cornea/dystrophy or ocular surface disease and associated sub-etiologies. We compared best corrected visual acuity (BCVA) before and after PROSE fitting.

Results: The irregular cornea group (n = 262 eyes) included corneal scar (n = 57), dystrophy (n = 17), post-operative corneal irregularity (n = 70), and primary ectasia (n = 118). The OSD group included 563 eyes. For all etiologies combined, mean BCVA prior to PROSE fitting compared to after improved by 0.28 logMAR (p < .001). In the irregular cornea group, the mean BCVA improved by 0.46 logMAR (p < .001), while the improvement in BCVA for the OSD group was 0.20 logMAR (p < .001). All etiologies in the irregular cornea group demonstrated improvement in BCVA (p < .05) with the exception of post-PRK (n = 2). BCVA improvement was found for all sub-etiologies in the OSD subgroup (p < .05).

Conclusions: PROSE treatment had a positive impact on visual acuity for a wide range of corneal irregularities and ocular surface disease, suggesting that PROSE lenses may offer improvements in visual acuity without risks inherent to surgery.

Keywords: Corneal irregularity; Ocular surface disease; Scleral lens; Visual acuity.

MeSH terms

  • Contact Lenses*
  • Cornea / surgery*
  • Corneal Diseases / pathology
  • Corneal Diseases / physiopathology
  • Corneal Diseases / surgery*
  • Corneal Topography
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Prosthesis Design
  • Refraction, Ocular / physiology*
  • Retrospective Studies
  • Sclera / pathology
  • Sclera / surgery*
  • Visual Acuity*