Keratoconus and High-Order Aberrations

Patients with Keratoconus often experience High-Order Aberrations (HOAs) in their vision due to inconsistently shaped corneas. HOAs have been difficult to treat with early technology, but today we are on the cusp of some truly revolutionary treatments.

Custom Scleral Contact Lenses

The technology that we have today allows us to accurately model the aberrations a patient sees and then design Scleral Contact Lenses that eliminate most of their HOAs. Put another way, our technology allows our Keratoconus specialists to “see what the patient sees,” enabling them to make precise corrections. Scleral lenses for HOA control have never been more successful.

scleral lenses for high order aberration

This is the output from the Marco OPD III showing the topography of an eye with Keratoconus, the optical path of light through the cornea (top left), pupil size and offset optics; the total aberrations (bottom middle) and the HOAs (bottom right) which is exactly glare that the patient sees.

What are High-Order Aberrations?

Conditions like myopia (nearsightedness), hyperopia (farsightedness) and astigmatism are referred to as Low-Order Aberrations and can usually be treated with conventional contact lenses or glasses. Misshapen corneas or lenses generally cause HOAs and result in a variety of visual issues, including:

  • Glare or streaks
  • Starbursts
  • Halos and rings
  • Night vision problems
  • Ghost images
  • Double vision
  • …and more

These issues occur because the misshapen cornea allows light to enter the eye from many angles. When the cornea has an inconsistent surface with high and low points, light entering through these angles causes the light to refract in inconsistent ways. Shine a flashlight through a cut crystal glass full of water, and you begin to get the idea; some light might go straight through the glass, but much of it will refract due to the cuts in the crystal.

Correcting HOAs has been difficult because of these inconsistencies in the cornea (and sometimes the lens).

Scleral Lenses for High-Order Aberrations

Most types of contact lenses can rotate or are not always placed on the eye in the same orientation. But Scleral Lenses are an excellent platform for treating HOAs because they remain stable on the eye. That means we can build specific features into different parts of the scleral lens to correct the inconsistencies in that part of the cornea.

But then the question is, how do we know what those inconsistencies are? How can we measure them precisely enough to design our contact lens prescription accurately?

Marco OPD III Wavefront Aberrometer

Here at the California Keratoconus Center, we have one of the largest collections of high-technology vision equipment on the West Coast and worldwide. One of the devices that we use to measure HOAs is the Marco OPD III Wavefront Aberrometer. It uses wavefront technology to measure not only the surface of the cornea but how light passes through it.

With the Marco OPD III, we can literally draw the aberrations, streaks and glare that a patient will see, then show it to the patient for confirmation. And with the same diagnostic data, we can design a scleral lens to correct these aberrations.

Seeing 20/20 With High-Order Aberrations

We are in the very early stages of this technology, and it is advancing fast. Today, we are working to combine the Wavefront data with data from the Eaglet Eye Surface Profiler to create even more precise scleral lenses for HOA control. This leads to higher precision, better vision correction and happier patients.

Some of our new patients can quite literally see 20/20 but still suffer from HOAs. Recently, we had a visit with a new patient who had been wearing conventional scleral lenses but still suffered from HOAs. She was happy with her vision but had severe glare at night. So we went to work.

She returned for her new DigiForm Scleral Wavefront Correcting Lenses that we designed for her using data from the Marco OPD III and Eaglet Eye Surface Profiler. After her first fitting, she is now reporting back to us that she can see more clearly than ever, and her night vision problems have virtually disappeared.

Another new patient visited us wearing the scleral lenses created for him by another Optometrist. He was seeing 20/50 with some visual artifacts and was happy. We used all our technological resources at the California Keratoconus Center and designed new scleral lenses for him. He now sees 20/25 with only minor shadowing…and he is thrilled.

Technology at the California Keratoconus Center

Very few Optometrist offices have even one of these advanced machines, and it is rare for them to have two. But here at the California Keratoconus Center, we invest heavily in new technology and the training to use it correctly. We work closely with the technology manufacturers to help advance their knowledge and then even help train new doctors at other practices to use the machines in new and innovative ways.

Treating Your High Order Aberrations with Wavefront Scleral Lenses

If you suffer from HOAs, there is no better facility for you to seek treatment than the California Keratoconus Center. We’ve been treating Keratoconus and other Corneal Dystrophies for over 35 years. Our approach is non-surgical whenever possible, and our first-fit success rate is 52%, with a second-fit success rate of 85%.

Located conveniently in the San Fernando Valley of Los Angeles, patients fly in from other cities, states and countries to visit us.

Please make an appointment today using our online form or call 818-891-6711. We are looking forward to helping you see more clearly with scleral lenses for High Order Aberration Control.