Aberropia – Understanding and Managing Vision Beyond Refract

Aberropia is a form of refractive dysfunction not correctable by traditional lenses (sphere, cylinder) and is instead due to high-order aberrations (HOAs) of the eye. These aberrations interfere with the wavefront of light entering the eye, degrading visual quality despite "20/20" Snellen acuity.

First described in the early 2000s with the advent of wavefront aberrometry, Aberropia has gained clinical relevance with the development of precise wavefront-guided corrective modalities, such as custom scleral lenses.

Using Zernike polynomials, wavefront aberrometry quantifies the deviation of light as it travels through the eye’s optical system (cornea, aqueous, lens, vitreous). While defocus and astigmatism are low-order aberrations (LOAs), Aberropia is primarily associated with:

• Coma
   
• Trefoil
   
• Spherical aberration
   
• Secondary astigmatism
   

These aberrations cause:

• Ghosting
   
• Halos and glare (especially at night)
   
• Contrast sensitivity loss
   
• Reduced depth perception
   

• Corneal irregularities (e.g., keratoconus, post-surgical ectasia)
   
• IOL decentration or tilt
   
• Lens opacities and zonular weakness
   
• Ocular surface irregularity (e.g., scars, tear film breakup)
   

• Ovitz Wavefront Aberrometer and Oculus AXL Wave provide full-eye HOA mapping.
   
• RMS values in microns are used to quantify total HOA burden.
   
  • 0.3 µm RMS (4 mm pupil) = clinically significant
    
     

• Discrepancy between subjective visual quality and Snellen acuity
   
• Poor night driving performance
   
• Persistent glare despite refractive correction
   

• Contrast sensitivity
   
• Mesopic/photopic acuity comparison
   
• Modulation Transfer Function (MTF) analysis
   

  Type Cause Aberrations     Corneal Aberropia Keratoconus, ectasia, scars Coma, trefoil   Lenticular Aberropia IOL tilt, cataract Spherical aberration   Tear-film Aberropia Dry eye, SJS Irregular transient aberrations   Retinal/Neural Macular dysfunction Not true optical aberropia.

• Design Tools: Ovitz, Visionary Optics, Wave software
   
• Stabilization Techniques: Front toricity, prism ballast, quadrant-specific haptics
   
• Benefits:
   
  • Correct HOA up to 5th or 6th Zernike order
     
  • Custom optics over irregular cornea
     
  • Alignment maintained due to scleral landing
     
• Case Example:
   
  • HOA RMS 1.2 µm in a post-LASIK ectasia patient reduced to 0.2 µm post-HOA lens, improving contrast and night vision.
     

• Ideal for complex ocular anatomy
   
• Enables perfect centration—critical for rotationally sensitive HOA correction
   

• Lubrication can transiently improve tear film-related aberrations
   
• Punctal plugs, autologous serum may help in tear film stability
   

• Limited to anterior surface aberrations
   
• Works best when cornea is structurally stable (e.g., after CXL)
   
• Tools: WaveLight Contoura, Nidek CATz
   

• Aspheric or toric IOLs with adjusted SA profiles
   
• In post-refractive surgery patients, proper IOL centration is essential
   

• Stabilizes progressive keratoconus and reduces some coma
   
• Should be followed by HOA-optimized lens for visual rehabilitation
   

• Every 20/20 eye isn’t visually perfect: Aberropia often goes unnoticed unless specifically tested.
   
• Rotational stability is critical: HOA lenses are ineffective if decentered or unstable.
   
• Pupil size matters: Night vision complaints often correlate with large mesopic pupils revealing more peripheral HOAs.
   
• Scleral fogging can simulate aberropia: Assess for tear debris before attributing symptoms to HOAs.
   
• Oculus AXL Wave provides integrated biometry and HOA analysis—vital for pre-IOL planning in aberrropic patients.
   

• AI-driven wavefront lens design for real-time aberrometry data integration
   
• Smart adaptive optics in contact lenses
   
• Toric multifocal HOA lenses to address both presbyopia and aberrations
   
• OCT-guided scleral lens fitting for enhanced vault uniformity and centration
   

Aberropia represents a frontier where classical refraction ends and wavefront science begins. It bridges physics and clinical optics, demanding advanced diagnostics and highly individualized interventions. With wavefront-guided scleral lenses and tools like Ovitz and Oculus AXL Wave, optometrists can deliver a new level of visual clarity to patients whose needs go beyond 20/20.