Your eye may look smooth and uniform, but it could have subtle dips and valleys. Those shape shifts can change the way light moves through your eye, and that could reduce your visual acuity.

Major alterations in eye shape are known as higher order aberrations (HOAs). They can lead to bothersome vision difficulties your doctor can't fix with glasses or contact lenses. (Learn more)

Your vision issues may be affected by:

Working with a talented doctor is critical. Planning done before any eye surgery and therapies given for dry eye can ensure that you see as clearly as possible despite the presence of HOAs.

cartoon eye doing exercises

How Aberrations Alter Vision

Your eye is a delicate organ that's designed to focus light on a tiny area of cells near the optic nerve. HOAs alter focusing power, and that can lead to bothersome symptoms your doctor can't fix with glasses.

Look closely at a pencil on your desk. You can see that implement because your eyes take in the light around it, and that image moves through the eye and is pointed at the macula. The tighter the beam is focused on the macula, the crisper the image will seem to you.

Higher order aberrations change the way light moves. A few strands of light will point near, but not on, the macula.

Researchers writing in The Optometrist say that people with HOAs can still read, knit, and do close work. They can also see items at a distance. But they can struggle with:

  • Light vision.
  • Haloes around bright lights.
  • Blurred images.
  • Glare.

Traditional vision solutions, like glasses and contacts, correct for problems shared by every cell in the eye. For example, prescription glasses for nearsightedness put a powerful lens in front of the entire eye, so the focusing power of the whole organ is changed.

HOAs touch only one small part of the eye. A lens made for the entire organ won't fix the problem. In fact, it might make the issues feel even more noticeable.

Instead, doctors must determine what's causing the HOA. In some cases, they can correct it with simple solutions.

Can Dry Eyes Make Them Worse?

woman with dry eyes

Each time we blink, we add nutrition and protection to our eyes. If we don't blink often enough or our tears are thin or otherwise ineffective, our eyes are unprotected, and that can make HOAs worse.

Think of higher order aberrations as ridges and valleys on the surface of the eye. A lack of tears could lead to:

  • Pulling. Tight, dry tissues tend to shrink. Deepening gaps can form when tissues aren't plump.
  • Clumping. Dry tissues stick together, leading to more hills and lumps on the eye's surface.
  • Tearing. Micro-sized tears form when there isn't enough fluid to keep the eye lubricated. Those can heal as valleys or ridges.

Eyedrops can work wonders. Researchers writing in the Journal of Ophthalmology report that two weeks of treatment with lubricating eye drops lead to a measurable decrease in HOAs in those with dry eyes.

Your doctor can measure tear production with a simple, in-office test. If your eyes are dry, eyedrops can be part of your daily routine. In time, your eyes could heal enough to make your HOAs easier to ignore.

Can LASIK Surgery Make Them Worse?

LASIK will not make higher order aberrations of the eye worse if you choose an experienced surgeon who uses the latest technology.

Traditional LASIK without pre-surgical mapping can make higher order aberrations worse, especially in people with nearsightedness. But newer procedures are customized, and they can help your doctor correct some HOAs.

In a standard LASIK procedure, your doctor measures your refractive error and uses a laser to slice away a corresponding amount of tissue from your cornea. The incision is smooth and even, and it moves across the front of the eye in one plane.

The American Academy of Ophthalmology reports that HOAs can potentially increase after this type of surgery, especially in people with nearsightedness. In fact, the more nearsighted you are, the more likely you'll have an HOA after the procedure, the organization says.

Waveform LASIK is different. Here, doctors use a tool to create a map of the eye's surface. Then, they follow that topography during your surgery. In some cases, doctors can determine where an HOA is located and shave off tiny bits of tissue to make its impact disappear.

When this technology was introduced in the 2000s, researchers got excited. In an article in Ocular Surgery News, an expert expressed his hope that this surgery would lead to "super-normal visual acuity." That hasn't happened quite yet.

Experienced doctors using this technology can reduce HOAs. That's why it's crucial for you to talk with your surgeon before you schedule LASIK. Make sure you're working with someone who understands your eyes and your needs, so you'll get advanced care that leads to better vision.

Can Cataract Surgery Make Them Worse?

Cataract surgery involves replacing a lens that sits inside the eye. There are many different types of lenses for your doctor to choose from, and some can make an HOA harder to ignore.

Some lenses used in cataract surgery scatter focal points. A lens like this helps you to use different parts of the eye, so you can focus on things both near and far without slipping glasses on and off. These lenses can seem ideal for someone who wants a glasses-free future, but if you have an HOA, they could be a poor choice for you.

Consider this: A lens with a key focal point could sit beneath your HOA. When that happens, that spot will always produce a blurry image. If this is the portion of the lens you planned to use for distance vision, this could be frustrating.

Doctors writing in the journal Investigative Ophthalmology and Visual Science say it's crucial for patients to have waveform testing before cataract surgery, so their doctors will know where HOAs are and can make a good lens recommendation. Without that test, you may not have the data you need to choose the right lens solution.

An opthamologist is listening to the patient in an exam room.

Talk With Your Doctor

It's important to talk with your doctor before any kind of surgery. But if you've been living with blurred, uncomfortable, or unusual vision for years, it's especially important to be clear with your doctor.

Talk about your:

  • Symptoms. Do you see better or worse in low light? What happens when you drive? Do you have blurry patches, or is your entire visual field askew?
  • Expectations. Will you be satisfied with slightly better vision, or do you hope for perfection?
  • Concerns. What worries you about the solution your doctor proposes? What would make you feel better?
  • History. What have you tried in the past, and how did that help or harm your eyes?

Together, you and your doctor can find a solution that's right for you and your eyes.

References

How to Reduce Higher-Order Aberrations. (May 2014). The Ophthalmologist.

Changes of Corneal Wavefront Aberrations in Patients After Treatment With Artificial Lubricants. (February 2016). Journal of Ophthalmology.

Higher-Order Aberrations. American Academy of Ophthalmology.

Wavefront-Guided LASIK Can Decrease Aberrations and Increase Visual Acuity. (2000). Ocular Surgery News.

Incidence and Type of Higher Order Corneal Aberrations in the Cataract Population. (June 2013). Investigative Ophthalmology and Visual Science.