Abstract
Purpose :
Prior studies have shown that the prosthetic replacement of the ocular surface ecosystem (PROSE, BostonSightTM, Boston, MA, USA) benefits patients with exposure keratopathy by providing surface lubrication that improves vision and comfort. Exposure keratopathy can occur secondary to lagophthalmos after certain oculoplastic procedures. The purpose of this study was to determine if visual acuity varies over time with PROSE wear in patients with exposure keratopathy after blepharoplasty or ptosis repair.
Methods :
This was a retrospective interventional case series including 7 patients (12 eyes) treated between August 2011 and March 2016 within the PROSE treatment program at Weill Cornell Medical College. Patients were included if they had developed lagophthalmos and subsequent exposure keratopathy after undergoing blepharoplasty or ptosis repair. Patients were excluded if they had worn other scleral lenses prior to PROSE treatment or were too young to participate in Snellen visual acuity measurements. The primary outcome was corrected visual acuity measured prior to PROSE use, at the initial PROSE fitting, and at 3, 6, and 12 months after PROSE wear.
Results :
Average age was 69 (±15) and all patients were female. Five patients (9 eyes) had undergone blepharoplasty and 2 patients (3 eyes) had undergone ptosis repair. Pre-PROSE visual acuity improved from 0.39±0.29 logMAR to 0.20±0.14 logMAR at initial PROSE fitting (Z = -2.39, p = 0.02), 0.17±0.13 logMAR at 3-months (Z = -2.86, p = 0.004), 0.18±0.17 logMAR at 6-months (Z = -2.38, p = 0.02), and 0.23±0.17 logMAR at 12-months (Z = -1.72, p = 0.09). Average time to best corrected visual acuity (BCVA) with PROSE was 3.8 months. Compared to pre-PROSE visual acuity, the mean BCVA was 0.11±0.08 logMAR (Z = -2.98, p = 0.003). All patients reported improved vision and comfort with PROSE wear.
Conclusions :
In patients with exposure keratopathy secondary to lagophthalmos after blepharoplasty or ptosis repair, PROSE wear causes the most significant improvement in visual acuity within the first 3 months of use, with little change in visual acuity beyond this time period. Visual acuity improved from a baseline of 20/50 to 20/30 by 3 months, with a BCVA of 20/25 achieved at 3.8 months.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.