Internal high-order aberrations of the human eye

The reporting of high-order aberrations (HOAs) stemming from the internal optics has garnered increased attention in recent years. This is attributed to evidence, suggesting their significant role as an optical factor affecting image quality in the retina, particularly notable in patients who have undergone postcorneal or crystalline lens surgery. However, most studies focus on total or high-order corneal aberrations of the eye, and little is known about HOA from the internal optics. We conducted a systematic review of articles referenced in three databases published until December 31, 2024. Among the 24 articles included, 14 comprised experimental studies. The majority of them concluded that lenticular aberrations compensate for corneal aberrations in young patients. From the age of 45 years onward, this compensation is lost, coinciding with the onset of cataract development. Internal optics HOAs increase with age due to increased refraction of the lens nucleus, especially with the formation of nuclear and cortical cataracts that induce different HOAs. Relying solely on corneal topography for refractive procedures is inadequate as a preoperative assessment. We propose that keratorefractive or refractive lens exchange procedures should be tailored to incorporate an aberration profile, taking into account the compensation of optical structures that diminishes with age.