Clinical Scorecard: Challenging Refractions

At a Glance

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.

References

• OM Ryan McKinnis, OD, FAAO