Varsha Singh, B.Optom, M.Optom Student, 

The Sankara Nethralaya Academy,Chennai, India

Scleral lenses are redefining modern approaches to eye care as they offer significant benefits for patients with irregular corneas or ocular surface disease, providing stable and comfortable vision. However, the challenge of post-lens tear reservoir turbidity, leading to cloudy vision and interruptions in wear, highlights the need for ongoing advancements in lens design and care strategies to enhance their long-term comfort and effectiveness. ⁽¹⁾ 

Figure1: Reverse Piggyback Scleral lens (created by author using Canva)

To address these challenges, the concept of reverse piggyback scleral lenses as an innovative solution (Figure 1). This approach involves placing a soft contact lens over a scleral lens, which does not affect tear exchange as it does not alter the interaction between the scleral landing zone and the conjunctiva. ⁽²⁾

Overcoming the Challenges of Scleral Lens Wear

Reverse piggyback scleral lenses help to overcome common challenges associated with scleral lens wear. They effectively address midday fogging (lens becomes cloudy or fogged up after several hours of wear due to the accumulation of moisture or debris between the lens and the corneal surface, causing a decrease in visual clarity) by reducing post-lens fluid volume and blocking particle ingress, which enhances both vision and comfort throughout the day. Additionally, these lenses improve tear retention and reduce lens drying by acting as a barrier, ensuring consistent hydration, and minimising discomfort. For patients struggling with wettability issues, reverse piggyback lenses help overcome hurdles during over-refraction by eliminating inconsistencies in surface wetting, resulting in a more stable and reliable fit. Furthermore, they enhance visual acuity by providing a smooth, stable surface that reduces distortion, ultimately improving overall optical clarity. These benefits make reverse piggybacking lenses a powerful solution to the challenges often encountered with scleral lenses. ^(3,5)

Double Lenses: Double the Trouble or Benefit?

The first thing that comes to mind when thinking about reverse piggyback lenses is whether they are safe, if they pose extra risks, or if they will worsen the condition, among other concerns. Double lenses do not necessarily mean double the trouble. Evidence suggests that the risk of corneal oedema with reverse piggyback lenses is minimal when compared to scleral lenses, making them a safe and reliable option. ⁽⁶⁾

Special Consideration

Patients must use two distinct care solutions: one for soft contact lenses (SCLs) and another for scleral lenses. This distinction can lead to confusion, as patients may struggle to remember which solution to use for each type of lens. Such confusion can result in improper lens care or even non-compliance, increasing the risk of eye infections, discomfort, or other complications. Therefore, it is important to clearly communicate the differences between the two solutions and emphasise the importance of following the prescribed regimen to maintain eye health and prevent potential issues.

Conclusion

Reverse piggyback scleral lenses offer a comprehensive solution to the common challenges associated with traditional scleral lenses, including midday fogging, tear retention, and vision clarity. By adopting this approach, both patients and practitioners can effectively address these issues, ensuring a more comfortable, stable, and long-term solution for complex ocular conditions.

References

1. Fogt, J. S. (2021). Midday Fogging of Scleral Contact Lenses: Current Perspectives. Clinical Optometry, 13, 209–219.
2. Bliss, V. H., Branjerdporn, N., Ooi, P. J., Teo, L. M., Tu, J., Yeh, J., Collins, M. J., & Vincent, S. J. (2023). Corneal oedema during reverse piggyback scleral lens wear. Ophthalmic and Physiological Optics, 43(5), 1065–1069.
3. THREE OF a KIND. (2023, December 15). PentaVision. https://clspectrum.com/issues/2023/july/three-of-a-kind/
4. Serramito, M., Privado-Aroco, A., Batres, L., & G, G. C. (2019). Corneal surface wettability and tear film stability before and after scleral lens wear. Contact Lens and Anterior Eye, 42(5), 520–525.
5. Walker, M. K., Bergmanson, J. P., Miller, W. L., Marsack, J. D., & Johnson, L. A. (2015). Complications and fitting challenges associated with scleral contact lenses: A review. Contact Lens and Anterior Eye, 39(2), 88–96.
6. Bliss, V. H., Branjerdporn, N., Ooi, P. J., Teo, L. M., Tu, J., Yeh, J., Collins, M. J., & Vincent, S. J. (2023b). Corneal oedema during reverse piggyback scleral lens wear. Ophthalmic and Physiological Optics, 43(5), 1065–1069