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Eda Dou, Yvonne Wang, Ryan St Clair, Michelle Lee, Mark Rosenblatt, Priyanka Sood, Ana Alzaga Fernandez, Christopher Starr, Jessica Ciralsky, Kimberly Sippel; Patient Experience During the Fitting Process for the Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) Device. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5323.
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To determine time to full-time wear, and also the time and difficulty of device insertion and removal in patients newly fitted with the PROSE device.
Patients referred to the Weill Cornell Department of Ophthalmology for PROSE fitting from July through November 2012 were enrolled in the study. Patient diagnosis was categorized into 1) ectasia/irregular astigmatism, e.g. keratoconus, pellucid marginal degeneration, post-laser vision correction ectasia, and 2) severe ocular surface disease, e.g. Sjogren’s syndrome, graft-versus-host disease, Stevens-Johnson syndrome. Patients were given a diary to record daily wear time, amount of time needed for insertion and removal, and difficulty of insertion and removal throughout the fitting process. Patients were also asked if they required an assistant for the insertion/ removal process. Patients were instructed to identify the amount of time needed for insertion and removal by circling ≤5 minutes, 5-15 minutes, or >15-30 minutes. Difficulty of insertion and removal was rated by patients on a scale of 1-5 (1=no difficulty; 5=very difficult).
20 patients (36 eyes) were included in the study. Patient age ranged from 26-76 years, with a mean of 56. Fourteen patients were referred for ectasia/irregular astigmatism and six for severe ocular surface disease. On average, patients achieved all day (12 hours) PROSE wear seven weeks after initial fitting. 56% of patients required ≤5 minutes to insert the device, 33% required 5-15 minutes, and 4% required >15-30 minutes by the 2-week mark. 70% of patients required ≤5 minutes to remove the device, 30% required 5-15 minutes, and no patients required >15-30 minutes. Mean rating for difficulty of insertion was 1.5, while removal was rated 1.4, by week two. Assistants were not required at any time.
Apprehension towards learning to insert and remove the PROSE device constitutes a barrier for many patients, as well as referring ophthalmologists. Our study shows that all patients, including the elderly, were able to learn to insert and remove the device by themselves quickly and with relative ease.
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