How Does PROSE Differ From a Scleral Lens?
April 20, 2025
Did your ophthalmologist recommend PROSE, an acronym for “prosthetic replacement of the ocular surface ecosystem”? If so, you may wonder how PROSE differs from a scleral lens. Read on to learn the differences and similarities.
The History of PROSE
PROSE is a scleral lens prescribing system by BostonSight, a nonprofit organization based in the Boston area, with fourteen satellite prescribing locations in the US as of 2025. Scleral lenses are custom rigid surface contact lenses prescribed to restore vision in specific situations where conventional soft contact lenses and eyeglasses fail. Scleral lenses also bathe the eye surface with moisture which is therapeutically advantageous for several eye conditions as well. BostonSight was founded in 1992 by the late Dr. Perry Rosenthal, MD, originally as the Boston Foundation for Sight. Dr. Rosenthal led the development of the Boston Scleral Lens with the initial FDA approval granted in 1994. He was a leading pioneer in scleral lens development. Today, Boston Scleral Lens is called PROSE.
PROSE is a Scleral Lens
Much of the early ophthalmologic literature on scleral lenses was synonymous with Boston Scleral Lens, now known as PROSE. This is why some ophthalmologists still refer to all scleral lens broadly as PROSE, even though this is not technically correct. This is analogous to how you might call every make of facial tissue a “Kleenex”, or every photocopier a “Xerox”, even though doing so is not technically correct.
Today, every major gas permeable contact lens lab produces scleral lenses. There are probably over 50 different proprietary scleral lens designs today, including PROSE. Other common scleral designs include Zenlens, Onefit MED+, BostonSight SCLERAL, Maxim, Jupiter, Europa, Latitude, Elara, Custom Stable, SynergEyes VS, Atlantis, Delta, EyePrintPRO, and EyeFitPRO. In other words, every PROSE lens is a scleral lens. However, not every scleral lens is a PROSE.
Who Needs PROSE?
You might wonder which proprietary scleral lens or brand is best. If you have heard the expression, “It’s not the arrow, it’s the archer”, that applies here. It is not so much the proprietary lens design (“the arrow”) that matters, although that is what the uninitiated believe. It is more important that you select a scleral lens practitioner (“the archer”) with experience and expertise. Your scleral lens prescriber will determine a lens design suitable for your unique situation and then maximize its capabilities to bring you a desirable outcome.
Today, most scleral lens candidates do not travel to Boston or one of the satellite PROSE clinics. In most large metropolitan areas, patients that benefit from scleral lenses can find a Fellow of the Scleral Lens Education Society. Finding a scleral lens clinic close to you is valuable because scleral lens prescribing is a process which can span several visits, and ongoing routine scleral lens examination each year is needed. That said, some patients will still get referred to a PROSE clinic where their specific expertise or novel technology is required. For example, a minority of patients need a large 23.0 mm diameter scleral lens for optimal outcomes. For such cases, your eye care provider will refer you to one of the excellent PROSE clinics.
ReVision Optometry is a referral-based practice in San Diego providing contact lens services for patients with keratoconus. To schedule an appointment, request your appointment online, or call our office at 619.299.6064.