About PROSE Treatment

Download a copy of PROSE: Information for Patients and Doctors (updated 12/6/11).  This guide provides detail on the PROSE treatment process, the prosthetic devices used in PROSE and comprehensive indications for use.

What is PROSE?

Prosthetic replacement of the ocular surface ecosystem (PROSE) is a pioneering treatment developed by Boston Foundation for Sight to restore vision, support healing, reduce symptoms and improve quality of life for patients suffering with complex corneal disease. PROSE uses FDA-approved custom designed and fabricated prosthetic devices to replace or support impaired ocular surface ecosystem functions that protect and enable vision. For many patients with keratoconus or ectasia, PROSE can be an alternative to corneal transplant.

Benefits:

• Reestablishes a healthy and stable ocular surface environment that supports healing and reduces symptoms
• Improves blurry vision by masking surface corneal irregularities and transmitting a sharp image to the back of the eye
• Prevents damage by protecting and shielding the cornea and conjunctiva against the environment and eyelids

For many of the thousands of patients with conditions such as Stevens-Johnson syndrome, chronic ocular graft-versus-host disease (GVHD), Sjogren’s syndrome, keratoconus, dry eye, pellucid marginal degeneration, ocular trauma, complications of LASIK, or complications of cornea transplantation, PROSE can be the ideal, and sometimes only, treatment capable of restoring vision and dramatically reducing eye pain and light sensitivity.

PROSE Prosthetic Devices

The prosthetic devices created during PROSE are transparent domes, about the size of a nickel, made of gas-permeable plastic that allows oxygen to reach the ocular surface. Devices fit under the eyelids and rest on the sclera (the relatively insensitive white tissue) of the eye, vaulting the damaged cornea and creating a new smooth optical surface that protects the eye from the environment and blink trauma. The devices are filled with sterile saline at the time of insertion, creating a reservoir of fluid that continuously bathes the ocular surface with oxygenated artificial tears. PROSE doctors design and fit devices to each patient’s unique eye shape and to meet specific treatment goals.

PROSE creates:

• A new transparent, smooth optical surface over the irregular, damaged or diseased cornea
• An expanded artificial tear reservoir that provides constant lubrication while maintaining necessary oxygen supply

Zones and Functions

PROSE devices have three important zones performing different functions:

Optic Zone – replaces the optical power of a healthy cornea in combination with the fluid reservoir
Transitional Zone – assures sufficient vault over any cornea shape, independent of base curve
Haptic Zone – maximizes ocular surface system function by precisely aligning the shape of the haptic bearing with the shape of the patient’s eye

The mathematical description of contours using spline functions that are integral to the Design to Fit (DTF)™ CAD/CAM system allow prosthetic devices to be created of almost infinitely variable shapes with smooth transitions between zones.

PROSE Treatment Teams

PROSE interdisciplinary treatment teams include a cornea specialist ophthalmologist, an optometrist who has completed an intensive nine-week PROSE Clinical Fellowship at BFS, medical assistants, trainers, and prosthetic device manufacturing engineers and technicians. PROSE treatment teams work with each patient, his/her support system and other medical providers to form a collaborative care network in which all members work to understand each patient’s specific needs and reach treatment goals together.

PROSE Clinical Fellows use our proprietary DTF™ CAD/CAM system to directly control the design and assure that each prosthetic device precisely fits the patient’s unique eye shape and maximizes ocular surface system function. Devices are manufactured at our state-of-the-art lab in Needham, MA, using Precitech ultra-precision diamond Nanoform computerized numerical command (CNC) lathes, which are typically used to manufacture high-tech parts for the aerospace industry.

For Physician Referrals

If you would like to refer a patient please fill out our Physician Referral Form and fax it along with your last note to the attention of: New Patient Affairs at 781- 726-7311.

For emergency patient referrals or inquiries from medical professionals please call our Physician Referral Hotline at 781-726-6033 or email Nancy Lemist at doctorinquiries@bostonsight.org.