Lower-order aberrations (LOAs) include defocus and regular astigmatism; higher-order aberrations (HOAs) include coma, trefoil, and spherical aberration.
Target Population
Patients experiencing visual complaints despite 20/20 acuity, particularly those with irregular corneas or post-refractive surgery.
Care Setting
Optometric practice focusing on refraction and contact lens care.
Key Highlights
Visual acuity does not fully capture visual quality; patients may report glare, halos, and poor night vision.
Higher-order aberrations (HOAs) can significantly impact contrast sensitivity and visual clarity.
Traditional refraction is largely insensitive to HOAs, necessitating alternative assessment methods.
Rigid gas permeable and scleral lenses can mask corneal irregularities and improve visual outcomes.
Proper patient selection and expectation management are crucial for successful outcomes with multifocal lenses.
Guideline-Based Recommendations
Diagnosis
Utilize wavefront aberrometry to identify elevated HOAs when visual complaints persist.
Management
Consider specialty contact lenses, such as rigid gas permeable or scleral lenses, for patients with significant HOAs.
Monitoring & Follow-up
Regularly assess visual quality and patient satisfaction, especially in those with irregular corneas.
Risks
Increased dysphotopsias and reduced contrast sensitivity may occur with multifocal lenses in patients with preexisting HOAs.
Patient & Prescribing Data
Patients with refractive errors and visual complaints not resolved by traditional correction methods.
Incorporating HOA-correcting optics into scleral lens designs can enhance visual outcomes.
Clinical Best Practices
Recognize when visual quality issues extend beyond traditional refraction.
Communicate realistic outcomes to patients regarding their visual expectations.
Utilize appropriate lens modalities based on individual aberration profiles.
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