PROSE (Prosthetic Replacement of the Ocular Surface Ecosystem) Treatment

Corrects Vision and Treats Ocular Surface Disease Symptoms

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Overview

Duke Health is among the major medical centers in the U.S. to offer PROSE (prosthetic replacement of the ocular surface ecosystem). The treatment uses special custom-fitted devices worn in the eyes. It can correct vision, reduce discomfort, and improve quality of life for people with ocular surface disease or damaged corneas (the outer layer of the eye) when other treatments have failed.

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What Are PROSE Devices?

Treatments Overview

PROSE devices are transparent domes about the size of a nickel that are worn in the eyes daily and removed at night. They rest on the sclera (the white part of your eye) and over -- not on -- the cornea. This creates a smooth surface over the distorted, damaged, or diseased cornea. PROSE devices are made of gas-permeable material and must be filled with preservative-free saline solution each day before they are applied.

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How Does PROSE Work?

Treatments Overview

PROSE devices are custom designed for each person based on factors such as eye shape, underlying eye conditions, and treatment goals. The objectives of the customization process are to achieve a comfortable fit, relieve symptoms, and improve vision.

While PROSE does not cure ocular surface disease or corneal disfigurement, it treats symptoms associated with these conditions. PROSE can be the best -- and sometimes the only -- treatment that can restore your vision and relieve eye pain, severely dry eyes, blurry vision, and light sensitivity.

Duke Eye Center

Learn about the care offered here so you can prepare for your appointments.

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Is PROSE Right for You?

Treatments Overview

If you have tried other treatments such as over-the-counter and prescription eyedrops, punctal plugs -- tiny devices that block tear ducts and keep eyes moist -- or specialty contact lenses without success, PROSE may be an option for you. People with the following conditions may benefit from PROSE:

A distorted corneal surface caused by corneal disease including keratoconus and ectasia or by scarring after corneal transplant, infection, or injury
Ocular surface disease such as dry eye syndrome, blepharitis, Sjögren's syndrome, Steven-Johnson syndrome, and graft versus host disease (GVHD)

PROSE Exam, Custom Design, and Follow-Up

Treatments Overview

The PROSE process involves many steps and is more time-consuming than a traditional contact lens exam and fitting. Multiple visits that last several hours are often required to achieve the best results.

PROSE Exam

Description

Your doctor will review your health history, test your vision, and assess your eye health. Measurements of your eye’s shape and curvature will be taken to help determine the appropriate curvature, size, and other requirements for your PROSE devices. Your eyes' ability to produce tears will also be evaluated.

Non-customized PROSE devices will be placed in your eyes and your doctor will then assess the comfort and the fit. Based on these results, you and your doctor will determine if the PROSE treatment is the right choice for you.

PROSE Custom Design

Description

Using computer software and the information from your exam, your doctor will design your customized PROSE devices. The information is sent to a lab, where the devices are individually made.

Follow-Up Appointments

Description

During your follow-up appointment, you will receive your PROSE devices and be taught how to insert, remove, and care for them. You will wear the devices for two to three hours. Then your doctor will evaluate the fit and effectiveness as they did in your first exam and make any necessary adjustments.

You will return within a few days to a few weeks depending on your schedule so your doctor can check your progress and fine-tune your PROSE devices. This process is repeated until your lenses fit comfortably and provide the best vision correction and symptom relief possible. Some people achieve these results after a few visits, but changes can be made to your PROSE devices for up to six months.

Related Treatments

Why Choose Duke for PROSE

Specially Trained PROSE Experts

Description

Only major medical centers with expertise in treating complex corneal disease can fit patients with PROSE devices. Duke is one of a handful of centers in the U.S. -- and the only one in North Carolina -- to offer these services. Our PROSE providers have completed advanced training in corneal disease and specialty contact lens fitting, as well as a PROSE fellowship.

A Personal Approach

Description

Poor vision and eye pain are stressful and can limit your daily activities. We work with you to establish realistic goals and help you achieve the best vision possible. Our staff provides training on how to take care of your new PROSE devices -- and your eyes.

Dedicated Financial Coordinators

Description

Many insurance companies cover the costs of PROSE if it is medically necessary. Our financial coordinator can help you manage any paperwork required by your insurance company.

Best Eye Hospital in North Carolina

Where you receive your care matters. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our ophthalmology program is ranked seventh in the nation and is the highest-ranked program in North Carolina, according to U.S. News & World Report for 2023–2024.

This page was medically reviewed on 10/05/2022 by

Corina Busuioc, OD | Optometrist