High-Order Aberrations in Cataract Surgery: Current Status and Future Perspectives: A Scoping Review

TL;DR

This review explores how high-order aberrations affect visual outcomes after cataract surgery and highlights factors like surgical techniques and lens design.

Contribution

The paper provides a comprehensive synthesis of current evidence on high-order aberrations in cataract surgery and identifies gaps for future research.

Findings

HOA profiles vary with surgical techniques and IOL designs.

Increased HOAs are linked to reduced contrast sensitivity, especially in low light.

Tear-film instability and pupil size influence wavefront aberrations dynamically.

Abstract

Background and Objectives: Due to the evolution of cataract surgery into a refractive procedure in which optimizing visual quality extends beyond achieving good visual acuity, high-order aberrations have been increasingly recognized as important contributors to postoperative visual performance. This scoping review aims to map and synthesize the available evidence on higher-order aberrations in the context of cataract surgery, with a focus on the surgical techniques, intraocular lens (IOL) design, measurement factors, and their association with the visual outcomes. Materials and Methods: A scoping review was conducted in accordance with the PRISMA-ScR guidelines. A search of electronic databases was performed using a predefined Boolean strategy, complemented by a manual screening of reference lists and independent searches. Studies evaluating higher-order aberrations (HOAs) before and/or after cataract surgery were included. Data were charted descriptively, and findings were synthesized narratively. Results: A total of 94 studies were included. The evidence shows that differences in HOA profiles are based on the surgical techniques, IOL designs (monofocal, multifocal, toric, and extended depth-of-focus), and measurement devices. Increased HOAs were frequently associated with reduced contrast sensitivity, especially under mesopic conditions. Tear-film instability and pupil size were additional factors contributing to dynamic changes in wavefront aberrations. Considerable methodological heterogeneity was observed across studies. Conclusions: The current body of evidence suggests a strong connection between corneal characteristics, IOL design, surgical techniques, patient-specific factors, and postoperative visual quality. HOAs play an important but not an exclusive role. Future research should focus on standardized measurement approaches, population-specific optical considerations, and personalized strategies to optimize visual quality after cataract surgery.

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