Is the piggyback system right for you?
Vision correction options for KC patients continue to grow. Although scleral lenses are currently getting most of the attention, they aren’t for everyone. Some patients might do better with other choices such as piggybacking, to achieve good vision and comfort. Piggybacks are often used when GP lenses do not center well on the cornea or cause irritation or ‘lens awareness’.
The piggyback system consists of a rigid gas permeable (RGP or GP) lens sitting on top of a soft contact lens. This combination offers the clear vision of a GP lens without the discomfort that many patients feel wearing hard lenses. The soft contacts act as a shield and a cushion to provide additional comfort.
The ideal soft contact lens to piggyback is a silicone hydrogel lens (daily, monthly, or two-week replacement). A daily disposable lens is often preferable to avoid having to manage cleaning and maintenance for multiple sets of lenses. Whatever the choice, it is essential that the solution used for the GP lenses is compatible with the soft lens it sits atop. New soft contacts are made of materials that promote better oxygen transmission, necessary for healthy eyes, and are made of materials which allow the lenses to drape instead of cling, helping the fit on irregular corneas.
For a veteran GP lens wearer experiencing discomfort, doctors will often prescribe a soft lens with an insignificant or minimal amount of correction so the patient can continue to wear their previous GP lenses. If a patient doesn’t have time to put in the soft lenses, they will still achieve good vision wearing their GP lenses alone.
What to Consider: Piggybacks can be costly, both in time and money.
Two different types of lenses may mean two different cleaning systems and soaking solutions. As a member of KC-Link reported, “It’s a process to get used to as far as keeping my eyes from drying out, but it has been much easier wearing RGP with soft contacts underneath.” You will need to carry four lenses instead of two, and if you are someone who travels with a reserve set of contacts, you may find you bag filled with lens cases and product. Some patients adopt a single piggyback when only one eye becomes CL intolerant.
Adequate tear exchange and corneal hypoxia become more of a concern when a patient is wearing not one, but two, contact lenses on each eye. It is important to follow your doctor’s directions about lens care and how long to wear contacts if you hope to avoid redness, dryness, and swelling that can accompany lack of adequate oxygen to the cornea.
What Makes Piggybacks a Good Option?
Piggybacks are a great option for patients who find that GP lenses provide good vision, but are uncomfortable or whose cones are decentered, and are willing to spend additional time and money to solve the problem.