title: Functional and visual improvement with prosthetic replacement of the ocular surface ecosystem scleral lenses for irregular corneas.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Ophthalmology, Doheny Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Lee
authors.forename: Gloria B
authors.initials: GB
authors.lastname: Chiu
authors.forename: Dianne
authors.initials: D
authors.lastname: Bach
authors.forename: Simon R
authors.initials: SR
authors.lastname: Bababeygy
authors.forename: John
authors.initials: J
authors.lastname: Irvine
authors.forename: Martin
authors.initials: M
authors.lastname: Heur
mesh_terms: D000704:Analysis of Variance; D003261:Contact Lenses; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D019736:Prostheses and Implants; D012030:Refractive Errors / Q000534:rehabilitation*; D054140:Refractive Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D012189:Retrospective Studies; D012590:Sclera / Q000601:surgery; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014792:Visual Acuity