GSLS 2026: Seeking the best lens fit for patients with HOAs

Jason Jedlicka’s, OD, FAAO, presentation centers on the use of higher order aberration (HOA)–correcting scleral lenses and reviews retrospective, pooled data from multiple practices. These lenses have been used for several years, and the study aggregates outcomes from different clinics, practitioners, and patient types, including many with keratoconus as well as post‑surgical and other irregular cornea patients. Although this particular analysis does not separate results by condition, the speaker notes that a related poster at the same conference does so specifically for keratoconus.

Across all participating practices, outcomes were remarkably consistent, regardless of whether the fitter was very experienced or relatively new. All patients were fit with the same brand of lens and measured with the same aberration device, which added methodological consistency even as individual fitting styles varied. The data showed an average 60% reduction in higher order aberrations, and essentially every patient reported subjective visual improvement, confirming the robustness of the approach.

Jedlicka explained that low-level HOAs naturally fluctuate due to blinking and the tear film, so they focus on patients whose overall elevated HOA is driven mainly by 1 or 2 very high aberrations, rather than many mildly elevated ones. These patients gain the most because the problematic aberrations can be brought down into the normal range, producing a large perceptual benefit.

Clinically, HOA-correcting scleral lenses are positioned as a step beyond traditional rigid gas permeable (GP) lenses. Historically, some GP wearers could only reach 20/30 or 20/40 best-corrected vision due to residual HOAs. With HOA correction, many of these patients can now approach or achieve 20/20, potentially reducing the need for corneal surgery and raising the standard of care for irregular cornea management.

Ideal candidates are patients who:

• Are already successful scleral lens wearers (comfortable, good wearing time).
• Have one or two dominant HOAs with otherwise normal aberrations.
• Demonstrate rotationally stable scleral lens fits, since stability is crucial for accurate HOA correction.

Jedlicka acknowledged that not every optometrist, or even every specialty lens fitter, will implement this technology because the eligible patient volume is relatively small. However, he still stressed the importance of awareness and referrals—clinicians should at least know where to send appropriate patients to access HOA-correcting scleral lenses, as this approach can significantly improve outcomes and spare some patients from surgery.