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Can PROSE lenses help in post-LASIK cases?

by | Mar 1, 2024 | Manuscripts | 0 comments

Kristi Sharma, B.Optom,

M.Optom Student, The Sankara Nethralaya Academy, Chennai, India

 

Introduction

Prosthetic Replacement of Ocular Surface Ecosystem (PROSE) lenses are a type of scleral lens used as a medical treatment device. It promotes healing, reduces discomfort and enhances the quality of life of people having severe corneal disorders. PROSE is effective in the management of ocular surface disorders, corneal ectasia and post-surgery corneas.(1,2) These lenses are available in diameter ranging from 13 to 23 mm, having an optic zone, a transition zone and a landing or haptic zone. (Figure 1)(3)

Figure 1: A schematic illustration of PROSE lens
Image Courtesy: https://www.oseyecare.com/services/dry-eye-disease/

 Goals of PROSE Lenses

The different goals of PROSE lenses are as follows(4):

  1. Improve visual functions
  2. Improve ocular comfort
  3. Support ocular surface

Figure 2: Steps involved in LASIK surgery
Image Courtesy: https://www.vrmny.com/procedures/lasik-eye-surgery/

LASIK stands for Laser Assisted In-situ Keratomileusis, (Figure 2) and it involves creating a flap on the cornea, remodeling the corneal tissue with the help of laser and repositioning the flap on the cornea.(5)  Some of the commonly seen complications of LASIK surgery are as follows-(5)

  1. Dry Eye: It is seen in 95% of the patients and occurs due to damage to the corneal nerves during the procedure.
  2. Ghosting of image or haloes: This happens due to higher order aberrations.
  3. Flap-related complications : It can include flap displacement or folds in the flaps
  4. Post LASIK ectasia: It is the bulging out of the cornea due to thinning of the cornea after LASIK.

How PROSE Lenses Help

PROSE lenses are custom designed for each individual’s eye and support the primary functions of the ocular surface and cornea.(6) These lenses are made of rigid gas permeable materials to provide crisp vision and better oxygen to the corneal surface. The design of the lenses allows them to land on the bulbar conjunctiva without putting any pressure upon the corneal surface. They have minimum movement, fluid ventilation and larger diameter for greater stability.(6)

Function of PROSE Lenses

  1. These lenses create a vault over the cornea which is filled with saline, providing lubrication over the entire cornea and reducing sensation of dryness.(7)
  2. The flap induced irregular cornea that results into aberrations and astigmatism is compensated by the highly specialised lens design, providing patients with improved vision.(7)
  3. In case of post-LASIK ectasia, the corneal irregularity leading to vision complaints is managed by the lens.(7)

Conclusion

Various studies have been conducted to understand the quality of management provided by PROSE lenses in patients having post LASIK complications.(8,9,10) They have reported PROSE lenses to be very effective in managing such conditions. This advancement in contact lens is of great help to people with unbearable ocular surface compromise, to provide them better comfort and quality of life.

 

References

  1. Papakostas, T. D., Le, H. G., Chodosh, J., & Jacobs, D. S. (2015). Prosthetic replacement of the ocular surface ecosystem as treatment for ocular surface disease in patients with a history of Stevens-Johnson syndrome/toxic epidermal necrolysis. Ophthalmology, 122(2), 248–253.
  2. Lee, J. C., Chiu, G. B., Bach, D., Bababeygy, S. R., Irvine, J., & Heur, M. (2013). Functional and visual improvement with prosthetic replacement of the ocular surface ecosystem scleral lenses for irregular corneas. Cornea, 32(12), 1540–1543.
  3. Le, H. G., Tang, M., Ridges, R., Huang, D., & Jacobs, D. S. (2012). Pilot Study for OCT Guided Design and Fit of a Prosthetic Device for Treatment of Corneal Disease. Journal of ophthalmology, 2012, 812034.
  4. Riccobono, K. et al. (2023). BostonSight PROSE (Prosthetic Replacement of Ocular Surface Ecosystem) and Scleral Contact Lenses. EyeWiki, American Academy of Ophthalmology.
  5. Rabin, R. C. (2018). Lasik’s Risks Are Coming Into Sharper Focus – Some patients who undergo the eye surgery report a variety of side effects. They may persist for years, studies show. The New York Times.
  6. Carrillo, C., Chayet, A. S., Dougherty, P. J., Montes, M., Magallanes, R., Najman, J., Fleitman, J., & Morales, A. (2005). Incidence of complications during flap creation in LASIK using the NIDEK MK-2000 microkeratome in 26,600 cases. Journal of refractive surgery (Thorofare, N.J. : 1995), 21(5 Suppl), S655–S657.
  7. Agranat, J. S., Kitos, N. R., & Jacobs, D. S. (2016). Prosthetic replacement of the ocular surface ecosystem: impact at 5 years. The British journal of ophthalmology, 100(9), 1171–1175.
  8. Mian, S. Z., Agranat, J. S., & Jacobs, D. S. (2016). Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) Treatment for Complications After LASIK. Eye & contact lens, 42(6), 371–373.
  9. Dimit, R., Gire, A., Pflugfelder, S. C., & Bergmanson, J. P. (2013). Patient ocular conditions and clinical outcomes using a PROSE scleral device. Contact lens & anterior eye : the journal of the British Contact Lens Association, 36(4), 159–163.
  10. Parminder, A., & Jacobs, D. S. (2015). Advances in scleral lenses for refractive surgery complications. Current opinion in ophthalmology, 26(4), 243–248.

 

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