Challenging Refractions

Understanding lower- and higher-order aberrations in refraction and contact lens care

By: Ryan McKinnis, OD, FAAO

Optometric Management May 1, 2026 Vol 61, Issue May-June 2026 Page(s): 23

Clinical Report: Understanding Lower- and Higher-Order Aberrations in Refraction

Overview

This report highlights the significance of recognizing both lower- and higher-order aberrations (HOAs) in refraction and contact lens care. It emphasizes that while traditional methods effectively address lower-order aberrations, many patients experience visual complaints due to HOAs, necessitating a more nuanced approach to patient care.

Background

Refraction traditionally focuses on correcting lower-order aberrations, which account for most refractive errors in primary eye care. However, as patient expectations for visual quality increase, clinicians face challenges with visual complaints that persist despite accurate correction of lower-order aberrations. Understanding and addressing higher-order aberrations is crucial for improving patient satisfaction and visual outcomes.

Data Highlights

No numerical data provided in the source material.

Key Findings

['Higher-order aberrations (HOAs) can significantly affect visual quality, even in patients with 20/20 acuity.', 'Traditional refraction methods are largely insensitive to HOAs, leading to unresolved visual complaints.', 'Rigid gas permeable and scleral lenses can effectively mask corneal irregularities and reduce HOAs.', 'Incorporating HOA-correcting optics into scleral lens designs can improve visual outcomes.', 'Multifocal contact lenses may introduce controlled aberrations that can affect contrast sensitivity.']

Clinical Implications

Clinicians should recognize when visual complaints are likely due to higher-order aberrations rather than residual lower-order aberrations. This understanding can guide the selection of appropriate lens modalities and improve patient communication regarding expected outcomes.

Conclusion

Addressing both lower- and higher-order aberrations in clinical practice is essential for enhancing visual quality and patient satisfaction. A comprehensive approach to refraction can lead to more effective management of visual complaints.

PentaVision

Optometric Management