Challenging Refractions - Summary - MDSpire

Challenging Refractions

Dr. McKinnis describes what to do when visual acuity alone does not fully capture visual quality.

By
Ryan McKinnis, OD, FAAO
May 1, 2026
4 min

Optometric Management

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Objective:

To explore the impact of lower- and higher-order aberrations on visual quality and contact lens care.

Approach:

Key Findings:

HOAs significantly affect visual quality, leading to complaints like glare and poor night vision despite 20/20 acuity.
Traditional refraction methods are often insensitive to HOAs, complicating patient care.
Rigid gas permeable and scleral lenses can effectively reduce corneal HOAs and improve visual outcomes.
Incorporating HOA-correcting optics into lens designs can enhance patient satisfaction.

Interpretation:

Recognizing the role of HOAs in visual dissatisfaction is crucial for clinicians to improve patient outcomes and satisfaction.

Limitations:

Wavefront aberrometry is not routinely used in clinical practice.
Treatment options for HOAs can be complex and are not always straightforward.

Conclusion:

A comprehensive understanding of both LOAs and HOAs is essential for effective patient management and improved visual quality.

Sources:

Infinity Eye Care

Original Source(s)

Optometric Management

Challenging Refractions

by Ryan McKinnis, OD, FAAO
May 1, 2026

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