GSLS 2026: Real-world applications of wavefront-guided scleral lenses for HOAs

This year’s Global Specialty Lens Symposium (GSLS) 2026 is bringing the latest in specialty lens fitting techniques, strategies, and lens technology innovations from January 7-10 in Las Vegas, Nevada. In part of a paper session during the conference, Jason Jedlicka, OD, is 1 of 5 practitioners that will be presenting their posters. In Jedlicka’s poster, “A Custom Wavefront-Guided Scleral Lens System For Higher Order Aberrations: Real-World Early Experience From a Retrospective Multicenter Case Review,” which delves into a specialty lens that is growing in popularity. Jedlicka sat down with Optometry Times to detail what attendees at the conference took away from the presentation.

Can you please give a quick overview of the presentation you gave at GSLS?

Jason Jedlicka, OD:

So the presentation is talking about higher order aberration (HOA) correcting in scleral lens wearers. This is something that we've been doing for a few years now, but still growing. And the presentation is a retrospective look at data that came from a number of different practices that was pooled and collected to see what the actual patient experience was and the actual outcomes with these HOA-correcting scleral lenses for patients who wore them.

Was there any distinction in different findings between different types of patients, for example, keratoconic or post-surgery patients?

Jedlicka:

So in this particular study, we didn't tease that information apart. Probably the majority of our patients were keratoconic to begin with. They tend to be the patient population that seems to benefit the most from these so most of them were but there were also patients who were post-surgical and had other different types of correction needs that were combined into this. This particular look, we didn't separate out the data by condition, but I have a poster at the same conference that does talk specifically about keratoconus, separately from the larger combined view.

What were some of the findings from this study and what were some that were surprising to you?

Jedlicka:

I think what's interesting is that we again pooled data from different practitioners, offices, different locations that were doing this, and the data was really consistent even among different practices. So it didn't necessarily matter whether you were a seasoned fitter, or you were a newer fitter, or what, necessarily, type of patient you had when you when you have enough volume of patients, the data is very consistent across different offices. The improvements that we saw were significant improvements, 60% improvement in higher order aberrations, which is going to make a difference. I think the data showed that pretty much every single patient in the study had a subjective improvement in their vision. So the data was good. The data was consistent, and even though they came from different locations, the data was similar between different practitioners fitting now these were all fit in the same type of lens, same brand of lens, same device being used to measure aberration. So there were some consistencies between the study, between different locations. But again, you have different practitioners, fitting them with their own individual techniques and so. But even despite that, the data, again, was really consistent between offices.

So taking the data from the study, what would you say would be some of the best ways to identify the best candidate for this particular type of scleral lens?

Jedlicka:

Well, with current level of technology that we have, it's pretty clear that there are some variations in higher order aberration that occur just through the natural linking of the eye and the tear layer. And so when we measure HOAs, we see low levels of all types of HOAs coming through the visual system. And as you take them over and over again, some of those are there sometimes and they're not the next so we know that low levels of HOAs are variable. So for our patients who benefited the most, and this is something that we always bring in, what we're looking at is when we look at the whole profile of HOA plot that shows each type of aberration, the patients who tend to benefit the most are patients who have low levels of most aberrations, but maybe have one or two that are really significant off the off the charts, so to speak, as opposed to that patient who has the same cumulative HOAs, but it's because several of them are in the low to moderate range. So we're looking for is, we're looking for a cumulative HOA that's elevated, but predominantly because of just 1 or 2 particular aberrations that are significant, rather than the whole host of aberrations, which are all slightly elevated, because we again, when we do correct HOAs, a lot of the lower level HOAs don't get corrected. So when we've got one that's really high, we know we can bring that high one all the way down into the normal range. It's going to have a much more significant impact for our patient.

So given the data that was compiled through the study, how can ODs apply what we have learned through the study to their daily practice if they're fitting scleral lenses?

Jedlicka:

I think the exciting thing is that this works, and patients definitely notice a difference. And so we talk about if you had a patient who had an irregular cornea or really would benefit from [gas permeable, or] GP lens correction, we wouldn't leave them in glasses. We would say, “You can see a lot better with GP lenses. Would you like to try GP lenses?” And we would fit them, and we'd expect a noticeable improvement in their vision. But often, in the past, even with GP lenses, we were limited in in the best-corrected acuity. Not everybody who wears GPs gets 20/20 vision, right? Some people get 20/30 and that's just as good as we could get them because of their underlying HOAs that we're still manifesting even through their GP lens.

The difference now is that we can also then correct those HOAs. And so to me, it's no longer enough to say, “Well, I can fit you in a GP and get you from 20/80 with glasses up to 20/30 when I've got something that will get you all the way to 20/20.” So I think it's going to reset our standard for what's a good outcome for our patients and where we should be able to get our patients corrected to I think it's going to save a lot of patients from surgery, because there are going to be patients who may be with their old GP lenses were 20/40, best-corrected, and so fighting vision and opting for, then cornea surgery to try to fix that, where now we may be able to get that patient to 20/20 with an HOA correcting lens. So I think it's going to create a new level of standard of care for providing for those patients. It's going to save a lot of patients from surgery.

And you know, this may not be something that it's certainly not something that every optometrist is going to want to do, because the volume of patients who need this isn't that great, and it may not even be something that everybody who fits specialty lenses wants to do, because the volume of patients may not be that great, but it's something that you should be aware of, and at least know where they can be referred to, if that patient really could benefit from higher order aberration correction, know where they can go-to get it to help that patient get their best outcome.

Do you have anything we haven't touched on that you wanted to add?

Jedlicka:

I just think, again, that there are some patients that are really good candidates for this, and those are patients that have shown they are already can be successful with a lens, meaning maybe they're already in with scleral lenses, comfortable, happy, good wearing time, good outcome in general, but maybe just lacking that optimal visual endpoint that they we think they could have. Those patients are really the good candidates. Again, those are patients that have maybe 1 or 2 aberrations that are particularly outside of range, and the rest are pretty normal. Those are also patients that have what I would say are rotationally stable lenses, lenses that are very stable on their eye and don't move around a lot, don't spin those patients again. To get this vision correction, you've got to have a stable fit. So even in the case now where we say there's a lot of lot of application for HOA lenses, not every single patient necessarily may be a candidate for them because of limitations with how their lenses fit in and so on. So again, it's something that as we go forward, we're going to get better, I think, at getting better outcomes. But we are still at a point now where for many of our patients, this is something that we can offer them.