Abstract-This paper discusses the implementation of fast wavefront sensors based on the Hartmann-Shack method in standard complementary metal-oxide semiconductor (CMOS) technology and evaluates the impact of the capabilities and limitations of this technology on the wavefront sensor performance. Aiming at fast operation ( 1 kHz), we compare the applicability of either conventional or dedicated image sensors and investigate how current custom concepts can complement each other. To date, three different custom CMOS-sensor layouts have been implemented. Besides being able to operate at faster rates than conventional sensors, these devices demonstrated the ability to achieve high wavefront-detection accuracy and the potential for use in low-light applications (e.g., ophthalmic diagnostics). The goal is to identify the most important practical issues related to using standard CMOS technology in wavefront sensing.Index Terms-Adaptive optics, complementary metal-oxide semiconductor (CMOS) technology, image sensor, optical profiling, very large scale integration (VLSI), wavefront sensor.