Overview
- Ocular GVHD affects 60–80% of patients after bone marrow or stem cell transplant.
- Symptoms include dryness, burning, light sensitivity, pain, and blurred vision.
- Standard treatments may not fully resolve symptoms or protect the cornea.
- Scleral lenses and PROSE therapy create a fluid reservoir that hydrates and shields the eye.
- Studies show PROSE therapy improves comfort, vision, and quality of life.
- A survey reported a 97 percent success rate in ocular GVHD cases treated with PROSE.
Introduction
Graft-versus-host disease (GVHD) is a common complication after a bone marrow or stem cell transplant. In GVHD, immune cells from the donor attack the patient’s own tissues, including the eyes. Approximately 60–80 percent of patients with GVHD have ocular involvement. Patients with Ocular GVHD experience symptoms such as dryness, burning, photophobia, ocular pain, and blurred vision. Over time, the disease may damage the corneal surface and lead to complications such as persistent epithelial defects, filamentary keratitis, or even corneal ulceration.These complications often persist despite topical lubricants, immunosuppressants, punctal occlusion, or autologous serum tears. When this occurs, advanced options such as scleral lenses or PROSE treatment may be appropriate to restore comfort, protect the ocular surface, and improve vision.
Scleral Lenses: Therapeutic Mechanism
Scleral lenses are large-diameter, rigid, gas-permeable lenses designed to rest on the sclera and vault over the cornea. They are filled with preservative-free saline and create a protective fluid reservoir that continuously hydrates the corneal surface. This microenvironment shields the ocular surface from mechanical trauma and external exposure, promoting epithelial healing and improving visual clarity by correcting surface irregularities. This therapeutic treatment utilizing scleral lenses to heal the eye is also referred to as Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) or PROSE treatment.
Clinical Outcomes and Patient Experience
A survey reported a 97 percent success rate in ocular GVHD cases treated with PROSE, with significant improvements in cornea and ocular surface health, vision, and quality of life (bostonsight.org). A peer‑reviewed study in Clinical Ophthalmology (Dec 2021) confirmed that patients wearing PROSE or scleral lenses noted substantial reductions in dryness, ocular pain, and symptomatic burden. By providing sustained corneal hydration, mechanical protection, and visual rehabilitation PROSE and Scleral Lens therapy can reduce pain and improve quality of life.
