Clinical Scorecard: Addressing Higher Order Aberrations to Enhance Your Patients’ Lives
At a Glance
| Category | Detail |
|---|---|
| Condition | Higher Order Aberrations (HOAs) affecting vision |
| Key Mechanisms | Visual disruption caused by aberrations such as vertical and horizontal coma, spherical aberrations, trefoil, and secondary astigmatism, especially in corneal irregularities |
| Target Population | Patients with corneal irregularities, prior refractive or corneal surgery, and keratoconus |
| Care Setting | Optometry and specialty contact lens clinics utilizing scleral lens technology |
Key Highlights
- HOAs can be visually disruptive in patients with corneal irregularities, causing symptoms like ghosting, streaking, halos, and glare.
- Scleral lenses provide a stable optical surface enabling custom HOA correction beyond traditional GP lenses or glasses.
- Proper scleral lens fit stability (minimal movement and rotation) is critical for effective HOA correction.
Guideline-Based Recommendations
Diagnosis
- Detect HOAs using aberrometry or retinoscopy.
- Identify patients with symptomatic residual HOAs presenting visual complaints such as ghosting, streaking, halos, and glare.
Management
- Achieve a centered, stable scleral lens fit with appropriate back surface toricity and full haptic-scleral contact.
- Add HOA correction to the front surface of the scleral lens based on aberrometer data.
- Fine-tune HOA correction by remeasuring aberrations over the lens.
Monitoring & Follow-up
- Assess lens stability with blinks to ensure minimal movement and rotation.
- Evaluate residual HOAs post-correction to optimize visual outcomes.
Risks
- Inadequate lens fit or instability may compromise HOA correction effectiveness.
Patient & Prescribing Data
Patients with significant HOAs, especially those with keratoconus or corneal irregularities
Custom HOA-correcting scleral lenses can improve vision quality beyond traditional correction levels, potentially surpassing 20/20 vision.
Clinical Best Practices
- Screen patients with corneal irregularities for symptomatic HOAs.
- Ensure precise scleral lens fitting focusing on stability and centration before applying HOA correction.
- Utilize aberrometry data to customize HOA correction on scleral lenses.
- Educate patients on potential visual improvements and manage expectations.
References
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