Challenging Refractions

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

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Refraction traditionally focuses on correcting lower-order aberrations (LOAs) like defocus and regular astigmatism.
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Higher-order aberrations (HOAs) significantly impact visual quality, causing complaints like glare and poor night vision despite 20/20 acuity.
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Wavefront aberrometry can identify elevated HOAs, but its clinical application is limited, complicating treatment options.
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Rigid gas permeable and scleral lenses can effectively mask corneal irregularities and reduce HOAs, improving visual quality.
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Understanding aberrations helps clinicians select appropriate lens modalities and set realistic patient expectations for visual outcomes.

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