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Functional and Visual Improvement With Prosthetic Replacement of the Ocular Surface Ecosystem Scleral Lenses for Irregular Corneas

Lee, Jennifer C. MD; Chiu, Gloria B. OD; Bach, Dianne BS; Bababeygy, Simon R. MD; Irvine, John MD; Heur, Martin MD, PhD

doi: 10.1097/ICO.0b013e3182a73802
Clinical Science

Purpose: To evaluate the Doheny Eye Institute Experience with Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) scleral lenses for the management of irregular corneas with outcomes based on visual acuity (VA) and visual function.

Methods: A retrospective chart review of 58 subjects (90 eyes) with irregular corneal surfaces referred to the Doheny Eye Institute for PROSE treatment between July 2009 and December 2011 was performed. The best-corrected VA before and after PROSE fitting was recorded. A functional assessment before and after PROSE fitting was also performed using the Ocular Surface Disease Index, a 12-item questionnaire that grades the severity of ocular discomfort and vision-related function.

Results: Keratoconus (43%) represented the largest group, and post-PK astigmatism (31%) represented the second largest group of patients with irregular corneas who had completed the PROSE treatment. Patients with keratoconus had the greatest improvement in VA after PROSE fitting with an 88% improvement in the logarithm of the minimal angle of resolution vision. Patients with post-PK astigmatism had the greatest improvement in Ocular Surface Disease Index scores with a 79% improvement observed after PROSE fitting.

Conclusions: PROSE scleral lenses offer improvements in the VA and function, and they could be an option for patients with irregular corneas who have failed conventional treatments before considering additional surgery.

Department of Ophthalmology, Doheny Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA.

Reprints: Martin Heur, 1450 San Pablo St, DEI 5702, Los Angeles, CA 90033 (e-mail:

Supported by Research to Prevent Blindness.

J. C. Lee and G. B. Chiu contributed equally to this study.

The authors have no conflicts of interest to disclose.

Received December 19, 2012

Accepted July 28, 2013

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.