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Background {#Sec1} ========== Limbal stem cell deficiency (LSCD) is a condition induced by a number of diverse factors, ranging from genetic abnormalities to accidental limbal injuries. It develops when the epithelial stem and precursor cell systems of the limbal zone undergo numerical or functional degradation, thereby compromising the regenerative capacity of the corneal epithelium \[[@CR1]--[@CR5]\]. Ensuing central corneal epitheliopathy results in reduced visual acuity, chronic inflammation, corneal pain, photophobia, epiphora, and blepharospasm, which when bilateral, may progress to full blindness. A consensus for the classification and grading of LSCD has been recently proposed \[[@CR6]\]. Worldwide, the prevalence of LSCD is estimated to be between 1 to 9 cases per 100,000 individuals \[[@CR7]\]. For unilateral LSCD the autologous transplantation of culture-expanded limbal epithelial cell (CLET) from these biopsies, represents a promising treatment with success rates of about 70--80% \[[@CR8]--[@CR17]\]. For the more critical bilateral LSCD in spite of the hindrance presented by potential immune-rejection, allografts from semi-compatible donors are being implemented \[[@CR18], [@CR19]\]. To date, no specific international consensus on standards for the use of objective clinical parameters has been established. To contribute to the development of such standards, we have now subjected our clinical CLET work, completed under the guidelines for good laboratory practices (GLP) to a battery of recognized objective and patient-declared subjective outcome criteria. Methods {#Sec2} ======= Clinical metrics {#Sec3} ---------------- Best-corrected visual acuity (BCVA) was determined using a standard printed Snellen eye chart with the patient 6 m away. Results are presented as the logarithm of the minimum angle of resolution (LogMAR) scale; the 0 and 1 LogMAR values correspond to 20/20 and 20/200 BCVAs in the popularly known Snellen scale, respectively. Slit-lamp photos were obtained from all patients during each pre and postoperative visit. Ocular surface score (OSSs) were calculated using the Clinical Outcome Assessment in Surgical Trials (COASTL) assessment tool \[[@CR19]\]. We used the sum of scores for four parameters, corneal epithelial haze, superficial corneal neovascularization, corneal epithelial irregularity, and corneal epithelial defect. Each parameter was graded between 0 and 3, thus rendering OSS values from 0 (best) to 12 (worst). All OSS parameter determinations were performed by a single researcher (OBS) according to the slit lamp examination and anterior segment photography. For the Schirmer's test without topical anesthesia, we measured the advance of fluid on the filter paper 5 min after insertion of the filter paper into the conjunctiva. Recommended cutting values are 5 and 10 mm \[[@CR20]\]. Subject evaluation of changes in the extent of visual loss in the affected eye and in ocular pain was graded separately by using a 0--10 scale in response to the question "Using the endpoints that are marked as guides, how would you rate overall diseased eye's visual quality / pain?". In these grading scales, for subjective visual loss zero means perfect vision and for ocular pain zero means no pain. Finally, we used two wide scope questionnaires for subjective patient evaluation of outcomes. The Ocular Surface Disease Index (OSDI) \[[@CR21]\] is a 12- question set that