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

Area of Science:

• Ophthalmology
• Optics
• Refractive Surgery

Background:

• Cataract surgery has evolved into a refractive procedure, necessitating optimization of visual quality beyond basic visual acuity.
• High-order aberrations (HOAs) are increasingly recognized as critical determinants of postoperative visual performance.

Purpose of the Study:

• To systematically review and synthesize evidence on higher-order aberrations (HOAs) in cataract surgery.
• To analyze the impact of surgical techniques, intraocular lens (IOL) designs, and measurement factors on HOAs and visual outcomes.

Main Methods:

• A comprehensive scoping review adhering to PRISMA-ScR guidelines.
• Extensive database searches and manual screening of references identified 94 relevant studies.
• Data were charted descriptively and findings synthesized narratively.

Main Results:

• HOA profiles vary based on surgical techniques, IOL designs (monofocal, multifocal, toric, EDOF), and measurement devices.
• Increased HOAs correlate with reduced contrast sensitivity, particularly in mesopic conditions.
• Tear-film instability and pupil size dynamically influence wavefront aberrations.

Conclusions:

• Postoperative visual quality is strongly linked to corneal characteristics, IOL design, surgical methods, and patient factors.
• HOAs are significant but not the sole contributors to visual quality after cataract surgery.
• Future research should prioritize standardized measurements and personalized strategies for optimal visual outcomes.