Precise real-time observation of retinal features, ophthalmic biometric identification and prescription of aberration-specific contact lenses demand detection and eventual correction of ophthalmic aberrations at rates higher than those of micro-fluctuations and involuntary movements inherent to the eye. Detection and correction can be accomplished in a feedback-loop adaptive optical system comprising a wavefront sensor and a deformable mirror. The loop must operate at a frequency higher than 300 Hz, the maximum laser power entering the eye should observe safety regulations and the accuracy of aberration detection should be better than λ/4. This article presents recent advances in application-specific sensor design, in neural-network control algorithms and in randomized wavefront sampling planes. The results also indicate the potential of standard silicon-technology components to the medical scenario.