Contact Lens Care & Compliance

Piggyback Lens Care

BY MICHAEL A. WARD, MMSC, FAAO

A 31-year-old woman arrived at our service, complaining of irritation and inability to wear her piggyback lens system. She had undergone bilateral LASIK the previous year, but without the intended result, and continues to have symptoms of residual irregular astigmatism not adequately correctable with spectacles or soft contact lenses.

She was subsequently fitted into a piggyback (tandem GP/soft) contact lens system that provided good visual acuity. Unfortunately, she experienced redness, foreign body sensation, and limited wearing time. She reported that the lenses would feel fine initially, but she experienced redness and irritation within the first hour or two of wearing.

The Diagnosis

The contact lens evaluation revealed a well-fitted GP lens on top of a well-fitted silicone hydrogel base soft lens. Her lens care consisted of Boston Advance Daily Cleaner (Bausch + Lomb [B+L]) with water rinse followed by Boston Advance CF Conditioner (B+L) overnight for her GP lens. She used Renu (B+L) multipurpose solution (MPS) to care for her Acuvue Oasys (Vistakon) soft lenses. In the morning she would place both lenses directly from the storage containers onto the eye.

The likely source of her irritation was toxicity created from the GP lens care product contaminating the base soft lens. I changed her care system, and her symptoms resolved without refitting her lenses.

What to Consider

When choosing lens care solutions for piggyback lens systems, consider these factors: 1) You can use soft lens care products with GP lenses; 2) you should not use GP lens care products with soft lens materials; and 3) GP and silicone hydrogel lenses require daily cleaning to provide best vision and comfort.

For the base soft lens, you must choose between a single-use or a multiuse product. A single-use high-Dk silicone hydrogel lens is an excellent choice because it lessens lens care procedures.

When using reusable soft lenses and soft 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, then store the soft lens separately in soft lens MPS.

Morning

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

• Rinse lens cases, tissue wipe, and air dry.

When using reusable soft lenses and peroxide-based lens disinfection, follow these steps:

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 or preservative-free artificial tears as a wetting agent for the GP lens before placing it on the eye. To avoid potential toxic contamination of the soft lens, do not use GP wetting/conditioning solution when placing a GP lens over a soft lens.

Single-use, daily disposable silicone hydrogel lenses work well as the base lens in piggyback lens systems and simplify lens care. Use soft lens MPS or preservative-free artificial tears for wetting the GP lens upon application. CLS

Mr. Ward is an instructor in ophthalmology at Emory University School of Medicine and Director, Emory Contact Lens Service. You can reach him at mward@emory.edu.