Custom Piggyback (PB) Lens Systems:
For patients experiencing reduced comfort or minor epitheliopathy with a best-fit corneal GP, a PB lens system can be utilized. This approach uses a GP lens to improve visual acuity, while the underlying soft lens provides corneal protection, cushioning the cornea from the GP lens and improving comfort. The PB lens system may be best utilized when other options have failed and GP lens is the appropriate first lens option. Patients may be apprehensive to adopt this modality due to the perceived difficulty of wearing and caring for two lenses. Daily disposable standard soft lenses can be used to as the cushion to simplify care. On occasion a custom soft lens option, such as a cosmetic/prosthetic soft lens or a soft lens with a central excavation (allowing the GP lens to rest in a depression in the soft lens surface), can be used to improve cosmesis, reduce glare, or improve lens centration.