contact lens care
Choosing Piggyback Lens Care Products
BY MICHAEL A. WARD, MMSC, FAAO

Silicone hydrogel materials have revolutionized the soft contact lens industry. As a group, these materials offer superior oxygenation to the cornea, perform well in dry eye conditions and may be associated with a lower incidence of severe corneal infection. Silicone hydrogel lenses have also revitalized the use of GP/soft contact lens (SCL) tandem lenses and dramatically increased their success over the use of HEMA-based tandem lens fits.

The current generation of silicone hydrogel and GP materials has broadened our armamentarium of contact lens correction options. Older piggyback lens systems using HEMA-based soft lenses had limited success largely because of barrier-induced hypoxia.

Using silicone hydrogel soft lenses with high-Dk GP lenses has proven quite successful, particularly for use over irregular corneal surfaces such as keratoconus, penetrating keratoplasty and following refractive surgery.

Selecting Lens Care

When choosing lens care for GP/SCL lens systems, consider these three factors:

1. You can use soft (silicone hydrogel) lens care products with GP lenses.
 
2. You should NOT use GP lens care products with soft lens materials.

3. GP and silicone hydrogel lenses require regular cleaning and rinsing.

Step-by-Step Cleaning

I've found the following lens products work well with GP/SCL tandem lens systems.

When using soft multipurpose (MPS) lens disinfection, follow these steps.

Evening

• Remove the GP lens and clean it with a GP daily cleaner (Boston Advance Formula Cleaner [Bausch & Lomb], Optimum Extra Strength Cleaner [Lobob Laboratories]). Thoroughly rinse the cleaner from the lens as directed.

• Store the GP lens in a soft lens MPS.

• Remove and rub/rinse, store the soft lens separately in soft lens MPS.

Morning

• Rinse lenses with fresh MPS and place soft lens and GP lens on the eye.

• Rinse lens cases and leave open to air dry.

When using peroxide-based lens disinfection, follow these steps. (Note: UltraCare (AMO) is contraindicated for use with PureVision (Bausch & Lomb) lenses.)

Evening

• Remove and clean/rinse the GP lens using a GP daily cleaner as described above.

• Store GP lens in peroxide disinfection system according to product instructions

• Remove, rub, rinse and store the soft lens separately in the peroxide disinfection system according to product instructions.

Morning

• Rinse soft and GP lenses and place both on the eye. The GP lens surface may not wet properly when taken directly from the peroxide care system. Use a soft lens MPS as a wetting agent for the GP lens before placing on the eye.

Do not use GP wetting solution when placing a GP lens over a SCL lens to avoid contaminating the SCL.

Rewetting Drops

When choosing rewetting drops:

• Only use drops that are approved for use on soft lenses such as Blink Contacts Lubricant Eye Drops (AMO) and Aquify Long-Lasting Comfort Drops (CIBA Vision).

• Limit preserved drops and medications to four times a day over lenses. If more frequent rewetting is indicated, use preservative-free drops.

Mr. Ward is an instructor in ophthalmology at Emory University School of Medicine and Director, Emory Contact Lens Service.