Patient ocular conditions and clinical outcomes using a PROSE scleral device

Published:March 18, 2013DOI:



      To determine the type and distribution of ocular conditions cared for in a clinic dedicated to scleral devices and to report the clinical outcomes afforded by this approach.


      Fifty-one charts of patients fitted unilaterally or bilaterally with a scleral device (Prosthetic Replacement of the Ocular Surface Ecosystem – PROSE) in a two year period were retrospectively reviewed. Patient demographics, ocular diagnoses, associated systemic conditions, best corrected visual acuity (BCVA) before and after fitting, Visual Function Questionnaire score (VFQ-25), and ocular surface disease index (OSDI) score were collected.


      All 51 patients were successfully wearing the PROSE device for a period of anywhere from weeks to years. The most common reasons for fitting were to relieve symptoms of moderate to severe dry eye syndrome (“DES”, n = 25), management of refractive problems (“refractive”, n = 23) with keratoconus being the most common (n = 14), and to manage other anomalies (“other”, n = 3). Best corrected visual acuity (logMAR) improved with the wearing of the PROSE device for both the DES (17 letters) and the refractive group (10 letters), but not the “other” group. No serious complications were recorded for any of the patients.


      The PROSE device is a useful option not only for the management of ocular surface disease and optical imperfections, but also for other ophthalmic conditions. Moderate to severe dry eye was the most common anomaly managed, followed by eyes with irregular corneal astigmatism. DES and refractive patients experienced improvement in visual acuity with wearing of the PROSE device.


      To read this article in full you will need to make a payment


        • Bowden T.J.
        Development of scleral contact lenses.
        Contact lenses: the story. 1st ed. Bower House Publications, Gravesend, United Kingdom2009 (p. 40–164)
        • Fick A.E.
        A contact-lens (translated by May CH).
        Archives of Ophthalmology. 1888; 17: 215-216
        • Pearson R.M.
        Kalt, keratoconus, and the contact lens.
        Optometry and Vision Science. 1989; 66: 643-646
        • Pearson R.M.
        • Efron N.
        Hundredth anniversary of August Müller's inaugural dissertation on contact lenses.
        Survey of Ophthalmology. 1989; 34: 133-141
        • Feinbloom W.A.
        Plastic contact lenses.
        American Journal of Optometry. 1937; 14: 41-49
        • Teissler J.
        Prothèses de contact en celluloïd.
        XV Concilium Ophthalmologicum. 1937; 4: 297-301
        • Fritz A.
        Verre de contact en substance organique et à moulage individuel.
        Bulletin of the Society d’Ophthal Belge. 1939; 78: 71-73
        • Thier P.F.X.
        Contactglazen, vervaardigd van harsproducten.
        Nederlands Tijdschrift Voor Geneeskunde. 1939; 83: 4161
        • Bier N.
        The tolerance factor and Sattler's veil as influenced by a new development of contact lens making.
        American Journal of Optometry and Archives of American Academy of Optometry. 1947; 24: 611-615
        • Ridley F.
        Contact glasses and veiling.
        British Journal of Ophthalmology. 1948; 32: 60-61
        • Jacobs D.S.
        Update on scleral lenses.
        Current Opinion in Ophthalmology. 2008; 19: 298-301
        • Ezekiel D.
        Gas permeable haptic lenses.
        Journal of the British Contact Lens Association. 1983; 6: 158-161
        • Rosenthal P.
        • Croteau A.
        Fluid-ventilated, gas-permeable scleral contact lens is an effective option for managing severe ocular surface disease and many corneal disorders that would otherwise require penetrating keratoplasty.
        Eye Contact Lens. 2005; 31: 130-134
        • Romero-Rangel T.
        • Stavrou P.
        • Cotter J.
        • Rosenthal P.
        • Baltatzis S.
        • Foster C.S.
        Gas-permeable scleral contact lens therapy in ocular surface disease.
        American Journal of Ophthalmology. 2000; 130: 25-32
        • Takahide K.
        • Parker P.M.
        • Wu M.
        • Hwang W.Y.
        • Carpenter P.A.
        • Moravec C.
        • et al.
        Use of fluid-ventilated, gas-permeable scleral lens for management of severe keratoconjunctivitis sicca secondary to chronic graft-versus-host disease.
        Biology of Blood and Marrow Transplantation. 2007; 13: 1016-1021
        • Rosenthal P.
        • Cotter J.M.
        • Baum J.
        Treatment of persistent corneal epithelial defect with extended wear of a fluid-ventilated gas-permeable scleral contact lens.
        American Journal of Ophthalmology. 2000; 130: 33-41
        • Mangione C.M.
        • Lee P.P.
        • Gutierrez P.R.
        • Spritzer K.
        • Berry S.
        • Hays R.D.
        Development of the 25-item national eye institute visual function questionnaire.
        Archives of Ophthalmology. 2001; 119: 1050-1058
        • Schiffman R.M.
        • Christianson M.D.
        • Jacobsen G.
        • Hirsch J.D.
        • Reis B.L.
        Reliability and validity of the ocular surface disease index.
        Archives of Ophthalmology. 2000; 118: 615-621
        • Pullum K.W.
        • Whiting M.A.
        • Buckley R.J.
        Scleral contact lenses: the expanding role.
        Cornea. 2005; 24: 269-277
        • Visser E.S.
        • Visser R.
        • Van Lier H.J.J.
        Advantages of toric scleral lenses.
        Optometry and Vision Science. 2006; 83: 233-236
        • Tan D.H.T.
        • Pullum K.W.
        • Buckley R.J.
        Medical applications of scleral contact lenses. 1. A retrospective analysis of 343 cases.
        Cornea. 1995; 14: 121-129
        • Pullum K.W.
        • Buckley R.J.
        A study of 530 patients referred for RGP scleral contact lens assessment.
        Cornea. 1997; 16: 612-622
        • Stason W.B.
        • Razavi M.
        • Jacobs D.S.
        • Shepard D.S.
        • Suaya J.A.
        • Johns L.
        • et al.
        Clinical benefits of the Boston ocular surface prosthesis.
        American Journal of Ophthalmology. 2010; 149: 54-61
      1. The epidemiology of dry eye disease: report of the epidemiology subcommittee of the international dry eye workshop (2007).
        The Ocular Surface. 2007; 5: 93-107
        • Pullum K.
        • Buckley R.
        Therapeutic and ocular surface indications for scleral contact lenses.
        The Ocular Surface. 2007; 5: 40-48
        • Stapleton F.
        • Keay L.
        • Edwards K.
        • Naduvilath T.
        • Dart J.K.
        • Brian G.
        • et al.
        The incidence of contact lens-related microbial keratitis in Australia.
        Ophthalmology. 2008 Oct; 115: 1655-1662
        • Cheng K.H.
        • Leung S.L.
        • Hoekman H.W.
        • Beekhuis W.H.
        • Mulder P.G.
        • Geerards A.J.
        • et al.
        Incidence of contact-lens-associated microbial keratitis and its related morbidity.
        Lancet. 1999; 354: 181-185
        • Nilsson S.E.
        • Montan P.G.
        The annualized incidence of contact lens induced keratitis in Sweden and its relation to lens type and wear schedule: results of a 3-month prospective study.
        CLAO Journal. 1994; 20: 225-230