About our Treatment

Prosthetic replacement of the ocular surface ecosystem (PROSE) is a pioneering treatment model developed by the 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.

Benefits:

• Reestablishes a healthy and stable ocular surface environment that supports healing and reduces symptoms.
• Improves vision by masking surface corneal irregularities.
• 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, pellucid marginal degeneration, ocular trauma, complications of refractive surgery, 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.

A PROSE prosthetic device is a transparent dome, about the size of a nickel, made of specialized plastic that allows oxygen to reach the cornea. At the time of insertion, it is filled with sterile saline that remains in the reservoir while the device is being worn during waking hours.

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.

PROSE interdisciplinary treatment teams include a cornea specialist ophthalmologist, an optometrist who has completed an intensive 9-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 Design to Fit™ 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-200 and 250 lathe/milling machines, typically used to manufacture high-tech parts for the aerospace industry.

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 DTF™ CAD/CAM system allow prosthetic devices to be created of almost infinitely variable shapes with smooth transitions between zones.