Fighting Back Against HOAs - Report - MDSpire

Fighting Back Against HOAs

This article will discuss the HOAs associated with keratoconus, how contact lenses can be used to correct aberrations, the efficacy of this correction, and the concept of neuroadaptation; it will conclude with cases of successful HOA reduction with scleral lenses.

  • By

  • Aaron Zimmerman, OD, MS

  • Jamie Kuzniar, OD

  • Trevor Fosso, OD

  • July 1, 2026

  • 20 min

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Fighting Back Against HOAs

Overview

Higher-order aberrations (HOAs) significantly impact vision quality, particularly in keratoconus. Advanced technologies like wavefront aberrometry enhance detection and management of these aberrations.

Background

Higher-order aberrations (HOAs) can severely affect visual quality and are particularly prevalent in conditions like keratoconus. Understanding and managing these aberrations is crucial for optimizing patient outcomes in refractive surgery and contact lens fitting. Recent advancements in diagnostic technologies have improved the detection and quantification of HOAs.

Data Highlights

No numerical data provided in the article.

Key Findings

  • HOAs are significantly elevated in keratoconus, with total HOAs found to be six times higher than in nonkeratoconic corneas.
  • The most prevalent HOA in keratoconus is coma, particularly vertical coma, which differentiates keratoconic corneas from normal eyes.
  • Corneal tomography and wavefront aberrometry can detect subtle or subclinical keratoconus before overt clinical signs appear.
  • Corneal and scleral GP lenses can effectively correct anterior corneal HOAs by creating a regular refractive surface.
  • HOAs are highly dependent on pupil size, with larger pupils resulting in higher HORMS values.

Clinical Implications

Eyecare professionals should utilize advanced diagnostic tools to detect and quantify HOAs in patients with keratoconus.

Conclusion

The management of higher-order aberrations is essential for optimizing visual outcomes in patients with keratoconus. Continued advancements in diagnostic technologies will enhance the ability to tailor treatments effectively.

Related Resources & Content

  1. Contact Lens Spectrum, 2025 -- Practice Pearls: Is HOA Correction the Real Deal?
  2. Eyecare Business, 2024 -- AOA Shares Update Regarding Inquiries into Alleged Vision Plan Abuses
  3. Ophthalmology Management, 2009 -- Defeating Denial Double-Talk
  4. ESCRS Recommendations for Refractive Surgery
  5. Ophthalmology Management — Taking on Tardy Payers
  6. https://www.escrs.org/media/ooama3sf/full-extended-guideline-24092025.pdf
  7. ESCRS:European Society of Cataract and Refractive Surgeons (ESCRS) Recommendations for Refractive Surgery
  8. Table of Contents page: Ophthalmology
  9. Correlation between effective optical zone and higher-order aberrations in keratorefractive lenticule extraction and wavefront-guided laser in situ keratomileusis | Scientific Reports
  10. Within-cohort associations between corneal epithelial remodeling and anterior corneal higher-order aberrations after FS-LASIK and KLEx (SMILE): a two-cohort descriptive study | Scientific Reports
  11. Tolerance to intraocular lens decentration and tilt in five presbyopia-correcting intraocular lenses: SS-AS-OCT-based study - PubMed

Original Source(s)

Fighting Back Against HOAs

  • by Aaron Zimmerman, OD, MS, Jamie Kuzniar, OD, Trevor Fosso, OD

  • July 1, 2026

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