Novel scleral lens proves cost-effective

In the December issue of the American Journal of Ophthalmology Brandeis University researchers published a paper about the highly precise scleral lens, to treat severe cornea or ocular surface disease, the Boston Ocular Surface Prosthesis (BOS-P).

The lens is custom fitted to the eye, vaulting the cornea while submerging the entire corneal surface in a pool of oxygenated artificial tears. Designed to improve vision, reduce eye pain, mitigate light sensitivity, and heal and protect the ocular surface, the lens is used in patients with eye diseases including keratoconus, Stevens-Johnson syndrome, dry eye syndrome, and chronic graft vs. host disease. The BOS-P is also useful in patients whose visual acuity is compromised after many types of eye surgery.

The studies were conducted by a team of researchers at the Heller School of Brandeis University that included William B. Stason, MD, a senior scientist, Donald Shepard, PhD, a professor and researcher, Moaven Razavi, MS, a research associate and PhD candidate, and Deborah S, Jacobs, MD, an ophthalmologist at the Boston Foundation for Sight and Harvard Medical School.

The clinical study assessed visual acuity and visual functioning in 69 patients before and after being fitted with a BOS-P. Using a scale from the National Eye Institute, the researchers reported highly significant improvements in visual functioning scores (from 57.0 to 77.8 on a scale of 0 to 100). Gains in visual acuity were also highly significant.

The economic analysis was then undertaken to assess the cost-effectiveness of the scleral lens for each patient fitted, as well as the economic value of resulting improvements in visual function. The researchers based the economic benefits on improvements in visual functioning and converted these to quality-adjusted-life-years (QALYs), a standardized measurement of health. The average cost-effectiveness of the prosthesis was $24,900 per QALY (a favourable value) and the average benefit-cost ratio was 4 to 1, and even higher, 5.6 to 1, in patients with especially severe eye disease.

The research team commented: “We were pleasantly surprised by the outcomes of our studies, because the scleral lens is an expensive device, but it turned out to be both cost-effective and offer a significant improvement in quality of life.”