“The enemy of perfection is good.”  Nate Jessiman told me about this quote from Voltaire, which an eyecare practitioner had told him during a visit. “This quote is terrible,” Nate said. “It’s a crutch for not trying to do more. I want to continue to see advances.  Good is not good enough.” Nate was diagnosed with keratoconus in his late teens. Now, 25 years later, he has his first pair of PROSE devices with SmartSight HOA® correction and can see well –not perfect – but well.  

Getting a keratoconus diagnosis 

More than 20 years ago, keratoconus wasn’t as well known. When he was first evaluated by an optometrist in his teens, the provider thought Nate was on drugs, because that seemed to be the most likely cause of ghosting, blurriness, and double vision, also known as higher-order aberrations (HOAs). Nate’s keratoconic corneas don’t have prominent bulging, but the condition is advanced enough to cause significant HOAs in his vision.  The aberrations impacted his ability to recognize faces from a minor distance. “I knew there was something wrong with my eyes. So, I went to Ocala (Florida) about 2 hours from where I lived, and spoke with a specialist.  That was when I finally got the keratoconus diagnosis.” Over the years, he saw multiple eye care practitioners. Scleral lenses really didn’t become commercially available until the last 15 years, so Nate and the eye care community were dealing with limited options.  When he finally was fit with scleral lenses, the results were mixed, including redness with lens wear and general poor tolerance. After his most recent scleral lens fit, he says, “I almost got in an accident twice on the way home and so I stopped wearing the lenses. The doctor said there was only one more tweak she could do to the lens – and the difference was barely noticeable.” After searching online for experts and watching lectures by Dr. Bita Asghari about how keratoconus patients should be managed and fit with HOA lenses, Nate sought out Dr. Asghari at the Needham PROSE Clinic. “It’s all about the HOAs with keratoconus,” said Nate. “It also depends on your level of severity. Mine is mild to moderate but the ghosting, the star bursting, the halos, the double/triple images, they’re terrible.”

PROSE Treatment Process 

In October 2022, Nate traveled to Needham for his first PROSE treatment.  He spent five days in Needham with Dr. Asghari, who first worked on the fit of the PROSE devices, which can take multiple fittings. Once the final fit was achieved, she made an HOA lens with no power or prescription to work on the aberration correction. “She put the HOA lens on and then scanned my eye with the iTrace machine aberrometer to get an accurate curve of the cornea [to determine residual HOAs].” After the scan is complete, the data is entered into BostonSight’s proprietary software to design the final HOA correcting lens. Nate says the process with Dr. Asghari was excellent. “She’s fantastic. Very thorough with the fit. We discussed the visual outcomes for each lens progression. She thought I saw better with the eighth lens, but I liked a prior pair better, and I left with the lenses I felt best with. I don’t have any irritation, and I can wear the lenses all day long. I only take them out midday to do a cleaning and a rinse and to give my eyes a rest,” he says.

Insurance and Treatment Cost 

Nate says he understands why a lot of local optometrists can only go so far. “Insurance is a big factor, because scleral lenses are not always seen as medically necessary.  They are also often billed under vision insurance, whereas a treatment like PROSE is billed as a medical treatment.” As for traveling to Needham, Nate used a program called PALS (https://palservices.org/), which provides discounts for medically related-flights.  “That was wonderful,” he said, “and it really helped.” Overall, Nate is very happy with his PROSE experience. “They are the best lenses I’ve ever worn for comfort and vision. The vision is not perfect,” Nate says, “but they are the best lenses yet.”