title: Prosthetic replacement of the ocular surface ecosystem: impact at 5 years.
abstract: To determine the impact of prosthetic replacement of the ocular surface ecosystem (PROSE) treatment at 5 years.
  
  
  
  Retrospective review of clinical, manufacturing and quality databases at the Boston Foundation for Sight.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Boston Foundation for Sight, Needham, Massachusetts, USA Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Agranat
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Nicole R
authors.identifier: 0000-0003-4709-1731
authors.initials: NR
authors.lastname: Kitos
authors.affiliation: Boston Foundation for Sight, Needham, Massachusetts, USA.
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Jacobs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003315:Cornea / Q000601:surgery*; D003316:Corneal Diseases / Q000601:surgery*; D005137:Eye, Artificial; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D014792:Visual Acuity; D055815:Young Adult
keywords: Contact lens; Cornea; Ocular surface; Prosthesis; Vision