UK Keratoconus Self-Help and Support Association

Hi does anyone have any advice when piggybacking?

Started piggybacking last week - really comfortable but have noticed a bit of redness in the eye.

Could this be wearing them too long?

Thanks

Could be. I think with two lenses in the eye, a bit less oxygen gets through to the cornea. Hopefully some people who do piggy back can tell you more.
Anne

Could be, I've worn mine for up to 20 hours and they've been pretty red at times.

Wait for the first time you find you've taken the soft lens out first and wonder how the heck you managed that

Red eyes wearing contact lenses is a sign of poor oxygen transmission to the cornea and over wear.

This is because modern soft lenses have a similar oxygen transmission rate as an RGP lens, so when you add an RGP lens on top it becomes a lot hard for oxygen to move across the lenses. Some older soft lenses have a much lower oxygen transmission rates. Many optoms try and avoide prescribing piggybacking and soft lenses because of the lower oxygen transmission / permeability. If you are getting red eyes you really need to consider removing the lenses and resting your eyes, possibly irregating with saline or using a lubricating eye drop to help revitalise the eye. Consistent over wearing lenses and poor oxygen transmission leading to red eyes can result in extreme cases where the blood vessels grow in to the cornea which can cause visual problems and if you are in the unfortunate position of requiring a graft in later years, the risk of rejection is increased.

Basically red (sore) eyes as with any unusual red / sore point on the body is a sign things aren't as they should be and require action to be taken.

It is important to undersatnd under what conditions you get the red eyes. For example are you using a computer all day without many breaks? There are Display Screen regulation that require you to be assessed by your employer and part of this assessment requires corrective eye wear to be taken in to account along with environmental conditions, how the work station is organised, they software used etc.... The rgulations also state that frequent short breaks are better than infrequent long breaks.

The prescriprion may need changing slightly to allow for a better tear flow around and under the lenses or consider a soft lens for KC. The Kerasoft IC I use have about the same oxygen permeability as a RGP lens and actually give me better vision than an RGP lens and I can wear these all my waking hours, at least 16 and often 20 hours or more with no redening of the eyes after long wear times and using a PC.

Thanks Gareth

Wearing a soft lens under the RGP increases the comfort for me but I am keen to reduce the risk of complications further down the line. Would you have any advice? Is it safe to piggyback a few hours a day and then switch back to a single RGP?

I basically get redness whilst at work - at a PC all day and the combination of air con and the heating. I have tried drops but they only help a little. I am using Visotears which really help.

I would be keen to try different lens but how would I go about trying the Kerasoft IC? My hospital seem unwilling to try anything else other than RGPs.

Thanks

Hospitals try and resit using anything other than RGP lenses because they are mass produced so cheap to make, partly because fitting kits can be reused. Plus a vast majority of optomotrists in hospitals only know how to fit an RGP lens.

I basically bullied my hospital in to allowing me to try a soft lens for KC which at the time was the Kerasoft II which failed misserably I was very vocal on this forum about this and the manufacturer invited me to see them so they could understand why it didn't work. This coincided with their development of a new lens, the Kerasoft III which was a brilliant silicon hydrogel lens which was replaced by the Kerasoft IC. As I took part in the clinical trial, I managed to get a free set and turned up at the hospital wearing them and the hospital couldn't deny that the lenses out performed the RGP lens so now I get the lenses through the NHS.

For others I understand that they just have to keep nagging the hospital to try a different lens and keep pointing out the quality of life issues and the problems you have with RGP lenses either on their own or piggy backing. Once they are convinced of a clinical need they might try something different, but as mentioned they may be concerned about their ability to fit the lens or how well it will work. Bottom line is, no one knows if a particular lens is best for them until they have tried it.

The eye drops that I find best are Systane by Alcon and recently I tried Celuvisc and they were comparable to Systane, I haven't found any others that work. I put a drop in my eye first thing when I wake up and another drop in the back of the lens to wet it when I put the lens in my eye. As soon as I take my lenses out, I put a drop in my eye to help my eyes recover from a day at work piloting the PC.

On the office environment, get yourself a display screen assessment done and include your proximity to any air conditioning units and / or draughts. Keeping hydrated is good too, reduce the cups of tea, coffee etc that contain diuretics and have a glass of water on the go at all times. Initially you will go to the loo a lot as your body gets used to being better hydrated, but the plus side is it gives you a legitimate break from the computer and topping up the glass of water too. I find I get through a glass of water in about 45 - 60 minutes and the time it takes to go to the kitchen and back for a top up is all that is needed to rest the eyes so giving frequent short breaks.

Some people need to go to the extent of having a humidifier on their desk to help with air-conditioning, I needed this with RGP lenses but gave up when I could only tolerate RGP lenses for an hour which was also a trigger for me to switch to a different lens type. With the Kerasoft IC I could work in the factory where I work where humidity has to be kept below 20% relative humidity.

Changing from an RGP to soft lenses can take time depending on how long you have worn RGP's and the type of fit you have with them as they mould the cornea due to their rigidity. It took my corneas 6 - 12 months to demould's owe worked on one eye first. Got the best vision we could which was 6/6 and replace the lens when the vision approached 6/12 and go back to the best we could again.

Since ditching the RGP lenses, there is far less red on the topography of my grafted eyes!

Hi Kieran,

I don't think that piggybacking for part of the day is the answer. You need to find out what's causing the redness.

The oxygen permeability issue when piggybacking isn't the issue it once was as disposable silicon hydrogel lenses are used which have high permeability. However you may need to try a different brands of soft lenses to see which work best with your RGPs. I was checked every three months when I first started piggybacking to ensure that the lenses moved properly on the eyes and were well lubricated and that blood vessels weren't growing into my corneas.

I get 15 hours a day piggybacking. I take care to be hydrated and try to take regular breaks from the PC. I'm piggybacking my right RGP because of intolerance issues. The lens was fine for two or three weeks and then there'd be a day where after an hour I just couldn't wear it and I'd have to revert to an old RGP for a couple of weeks. I didn't like the old lens because of the ghosting whereas the lens I was intolerant didn't have any ghosting so I was keen to find a solution. The hospital optoms couldn't see what was causing the problem as the lens appeared to be an excellent fit and had suggested lubricating drops several times a day - this didn't work. So they suggested piggybacking and I haven't looked back.

What is interesting is that the High Street optician I see for my back up glasses has said that my corneas look clearer since I've been piggybacking.

So if you are hydrated, and you've been taken regular breaks from the PC, and your eyes are still red it would probably be a good idea to contact your hospital and see what they suggest.


Lia

Thanks Lia

The hospital are aware of the redness and said its dry eyes! I mainly get it at work as the air con is on and the heating even during summer! I find drops don't really work either.

I have a desktop humifier and try to drink as much water as possible

Seem to get redness still

It is quite common for air conditioning and heating to run in parallel, the idea is when it is hot the heating thermostat switches the heating off and the air conditioning then chills the air so that the work area is at a comfortable temperature, usually 21 degrees centigrade. When the temperature is below this, then the air conditioning turns off and the heating kicks in so you should get the two alternating with minimal overlap if the system is set correctly. this works best if all the radiators have correctly functioning thermostated radiators and people don't play with them!

I used to work in an office where one person was always cold and would wear thick jumpers outside when it was blazing sun with the temperature in high 20's, so they would crank up the radiator to full and you would have someone at the other end of the office who was always hot so crank the aircon as low as it would go, so causing a large temperature gradient across the office as the two systems fought to achieve what they had been set to. In the end we locked off all thermostats at the temperature most in the office agreed was comfortable (21C) and set the air-conditioning to the same temperature and blanked off the wall mounted controls and gave designated people the remote so if there was a problem, they could over ride or re-set the units.

When I went through the above exercise with the engineers at work, they said most problems arise when people keep changing temperature settings of radiators and air-conditioning units along with propping doors open or opening office windows for fresh air, so the local thermostated radiator tries to heat locally where the cool air is and the air conditioning tries to compensate, plus the air conditioning can go in to overdrive as it tries to cool the whole outside environment. The last office I was in, all the windows were sealed shut and those on the ground floor had an emergency break glass hammer every couple of windows and the window was designated as an emergency escape (if the door option was blocked) similar to the type of window you get on trains and buses.

Might be worth measuring the humidity around the office to see how it relates to your desk and see how constant it is. If the humidity is really low it would would be worth asking you employer why this is the case. Air conditioning will dry the air by the very nature that as air cools, the moisture condenses and is drained away from the system. I think modern systems can rehydrate the air after it has been cooled.

As many companies are trying to be greener, you can ask you employer about their heating / ventilation system and how it is run. With the approach we took at work it didn't please everyone (but then you never will) and with it running as it should we noticed a big saving in the energy bill for the offices this was implemented and the office air wasn't as dry.

The laboratory area were a different matter because they had to be at a pre-determined low humidity.

I don't like the hospital lens fitting services.

At my nearest eye hospital, they said that about 2% of all contact lens patients they see are Keratoconus related. So I feel they lack the experience of a unique condition per patient. They seem to think a 1 lens fits all solution.

They tried me with RGPs, im intolerant. They tried hybrids, but they ripped between the soft and hard bond. They only deal with Kerasoft ICs, they continually give me variable vision.

I see another private lens fitter, who is my local hospital lens specialist. He understands that theres no single lens to fit all corneas. Luckily he studied in keratoconus and lenses. He found that only the Kerasoft 2 lenses give me the most constant reliable acuity. He constantly looks around at new lenses from new companies, to see if they would suit any of his current patients. Unfortunately, he's close to retirement. He's semi-retired, and taking on no new cases. Just keeping the worst cases that need the extra help, lucky for me that I'm still on his list.

Basically its no 1 lens fits all. There are many types, styles of hard and soft lenses out there. Its all about going thru them to see which gives the best acuity. But its probably more cost effective for the NHS to just do the corneal grafting instead. Its a sad state of affairs really