PROSE treatment improves Mackie stage in neurotrophic keratitis in study

According to a new announcement from BostonSight, PROSE treatment produced a statistically significant improvement in Mackie stage and visual acuity among eyes with neurotrophic keratitis (NK). The findings were presented in a poster at the Association for Research in Vision and Ophthalmology Annual Meeting in Denver, Colorado, May 3 to 7, 2026. The poster, "Mackie Stage Improvement in Neurotrophic Keratopathy with use of PROSE," was prepared by Ken Whang, Estelle Crowley, and Daniel Brocks, MD.

BostonSight noted PROSE devices have shown therapeutic benefit in a range of ocular surface diseases, though their use in NK across Mackie stages had not previously been studied. The Mackie Classification is a 3-stage grading system used to categorize NK severity based on clinical findings during eye examination. NK is a degenerative corneal disease caused by impaired corneal nerve function.

“The study concludes that PROSE treatment is an effective tool and should be considered when treating neurotrophic keratitis,” said Daniel Brocks, MD, Chief Medical Officer at BostonSight, in the release. “Neurotrophic keratitis is a stubborn disease, which has high risk of causing vision loss. These results illustrate the effectiveness of PROSE to save vision and induce prompt corneal tissue healing.”

The retrospective observational study analyzed data from November 2008 to September 2023 for 87 eyes from 87 patients with NK. Eyes were distributed across stages as follows: stage 0, n = 8; stage 1, n = 57; stage 2, n = 17; and stage 3, n = 5. Investigators used paired t-tests and Wilcoxon rank tests to evaluate changes in visual function outcomes before and after PROSE treatment. Statistical significance was set at a P value less than .05. Results showed a statistically significant improvement in mean Mackie stage and mean visual acuity after treatment. The average time to achieve the lowest Mackie stage was 31.18 days.

What the findings mean for ODs treating NK

The study authors concluded PROSE treatment is an effective option and should be considered when treating NK. The reported outcomes covered both anatomic staging, measured by Mackie stage, and visual function, measured by visual acuity. The analysis drew on nearly 15 years of patient data across all four staging categories represented in the cohort.

The release did not report new safety signals or adverse events associated with PROSE treatment in the study population. It also did not specify comparator therapies or provide confidence intervals for the reported outcomes.

"The study concludes that PROSE treatment is an effective tool and should be considered when treating neurotrophic keratitis," said Daniel Brocks, MD, Chief Medical Officer at BostonSight. "Neurotrophic keratitis is a stubborn disease, which has high risk of causing vision loss. These results illustrate the effectiveness of PROSE to save vision and induce prompt corneal tissue healing."

For optometrists managing NK, the findings position PROSE as a treatment to consider or refer for in cases across the Mackie staging spectrum. Availability and fitting of PROSE devices occur through PROSE treatment providers. The release did not address access or eligibility criteria beyond the studied indication.

References:

1. Whang K, Crowley E, Brocks D. Mackie Stage Improvement in Neurotrophic Keratopathy with use of PROSE. Poster presented at: Association for Research in Vision and Ophthalmology Annual Meeting; May 3-7, 2026; Denver, CO.

2. BostonSight announces key findings in use of PROSE for treatment of neurotrophic keratitis. News release. BostonSight. July 28, 2026. Accessed July 30, 2026. https://www.bostonsight.org/bostonsight-announces-key-findings-in-using-prose-for-the-treatment-of-neurotrophic-keratitis/