Scleral lenses and PROSE: indications, complications, and future challenges

Scleral lenses (SLs) and prosthetic replacement of the ocular surface environment (PROSE) are the same device, designed to enhance the optical quality of irregular surfaces or ectatic corneas. They also improve the corneal surface epithelium and the ocular surface microenvironment for patients with severe ocular surface diseases, including dry eye. This review aims to provide a comprehensive overview of the indications for SL/PROSE, as well as an exhaustive analysis of the corresponding complications, their possible remedies, and future challenges in this rapidly evolving field of ophthalmology.

We conducted a review of the English language literature on the indications and complications of SL/PROSE devices using the following website search engines: National Library of Medicine's PubMed, Google Scholar, EMBASE, Web of Science, and Scopus for articles in English published from inception up to July 2025. The following scientific reports were considered for analysis: systematic reviews and meta-analyses, randomized controlled trials, cohort studies, case-control series, case reports, editorials, and short communications.

Research and development in SL/PROSE have made significant strides, broadening its applications, improving structural materials and designs, and adapting it to benefit a diverse range of patients facing numerous pathologies. These include keratoconus, post-refractive surgery ectasia, corneal transplantation, severe dry eye, and chronic cicatrizing ocular surface disorders, among many others. For patients suffering from these emerging pathologies, apart from medical therapy and surgical procedures there are limited treatment options. Currently, SL/PROSE offer a less invasive potential solution for many of these challenging conditions, raising hope and motivation within the field of corneal and ocular surface disease. However, they are not without potential complications, which differ significantly from those associated with soft contact lenses and rigid gas-permeable contact lenses. The most frequently reported SL/PROSE complications relate to improper lens adaptation and patients' handling.

While much of the existing literature has focused on the benefits and applications of SL/PROSE devices, the potential complications associated with their use have received less attention and aren't as widely explored.