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Home » Treatments » Cataracts » Piggy Back Intraocular Lens Exchange

Piggy Back Intraocular Lens Exchange

This treatment is for people with complex prescriptions or for those that have already had Monofocal Cataract surgery.


This treatment involves two different intraocular lenses (IOLs) being inserted into the eye, one inside the natural lens capsule (the same as Cataract surgery) and the other in front of it, in the posterior sulcus which is located behind the iris (coloured part of the eye). Advanced Vision Care was one of the first eye clinics in the UK to offer Piggy Back Intraocular Lens Exchange treatment and we are currently the leaders in this field.

This treatment is designed for patients with:

  • Monofocal lenses (after having undergone Cataract treatment on the NHS or at other clinics) and want to correct their near vision
  • Corneal abnormalities (like Keratoconus)
  • Complex prescriptions and unusual complications


Usually NHS providers only offer the basic type of intraocular lens (IOL) implants: Monofocal lenses which only correct distant vision. However, at AVC we only offer truly bespoke treatments and we provide you with intraocular lenses best suited to your needs. The type of lens that you will be suitable for is dependent on your lifestyle and visual needs and will be determined at the consultation after a comprehensive examination.

Advanced Vision Care uses revolutionary Trifocal piggyback IOLs. These correct all fields of vision, distant, near and intermediate, enabling our patients to be glasses free after treatment.

Rest assured that Trifocal piggyback lenses do not work like varifocal glasses or multifocal contact lenses and adaptation is much easier and occurs completely naturally. These next generation Trifocal piggyback IOLs offer a better quality of vision because the transmittance of light through the lens implant is extremely efficient, this improves intermediate vision with minimal glare and halos at night.

At AVC we have no affiliation with any lens manufacturers which is why we are able to provide the largest selection of lenses and are able to correct any prescription range. We are renowned for being able to treat patients found unsuitable by other clinics.

Types of IOL Implants

We offer two different types of IOLs for Piggyback lens treatment, which can give you clear vision at different distances:

  • Monofocal: Available in both spherical and toric (for astigmatism) designs, this is single focus intraocular lens (IOL) which gives clear distance vision, and glasses are needed for reading and computer.
  • Piggyback Trifocal: Available in both spherical and toric (for astigmatism) designs, the layered concentric circular design corrects each prescription issue with each layer, enabling for simultaneous correction of near, distance and intermediate vision leaving patients largely glasses free. This is the ideal lens for patients who have already had cataract surgery on the NHS and want to be free from varifocal or reading glasses.

Lenses Available at AVC

Advanced Vision Care is a completely independent surgeon led clinic and have no affiliation with any manufacturers or paid consultants enabling us to choose the best lenses to fit our patients’ visual and lifestyle needs. We have access to the two most commonly used Trifocal Piggyback IOLs:

  • Sulcoflex (Rayner Intraocular Lenses, East Sussex, UK) – available in spherical and toric (for astigmatism) designs

  • Add-On (HumanOptics, Erlangen, Germany) – available in spherical and toric (for astigmatism) designs


This is used to capture a digital reference image of the eye during the initial assessment which is used to create a surgical plan. This equipment is also used throughout the treatment allowing the surgeon to see all incisions and alignments in real time, improving accuracy and minimising errors especially whilst correcting an astigmatism.

RLE / CLE and Cataracts Technology - The VERION Image Guided System

AVC is the first clinic in the UK to possess this equipment and it is the newest phacoemulsification system available (this breaks up and removes the natural lens). It allows for smaller incisions and is able to optimise every phase of the lens removal. The device also controls the intra-ocular pressure throughout the treatment and enhances the control of the surgeon, consequently improving the patient’s outcome and accelerating the recovery process.

CLE and Cataracts Technology - centurion vision system

The Lux-OR LX3 with Q-VUE Ophthalmic Microscope is designed to provide superior visualisation throughout the surgical procedure, this microscope is able to expand the visual field with a highly stable, 6x greater red reflex zone, providing excellent visual detail with superior visualisation of the retina.

CLE and Cataracts Technology - ophthalmic microscope

Treatment Process

Piggy Back Lens Treatment Process

The first implant replaces your natural lens if it has not already been replaced in a previous Cataract surgery. The second lens that can implanted is a Piggyback IOL (intraocular lens) and is situated behind the iris (the coloured part of the eye).

First implant (natural lens replacement):

The treatment takes 20 to 30 minutes per eye and each eye is treated individually, one day after the other. The process is as follows:

Second lens implant

Once your prescription is stable after treatment (usually 3 to 6 months), the second implant in the posterior sulcus (behind the coloured part of the eye).


Please scroll within the section faqs

This treatment is used as an additional lens implant for patients with:

  • Complex prescriptions
  • Corneal abnormalities (like Keratoconus)
  • Patients who have had cataract surgery with monofocals on the NHS (or elsewhere) and want to get rid of reading and/or distance glasses or varifocal Glasses .

A piggyback IOL placed in front of the existing intraocular lens implant, in the posterior sulcus, which is located behind the iris (coloured part of the eye).

No pain is felt as anaesthetic drops are used to numb the eye. However some discomfort or pressure can be felt during the procedure.

Generally you will need 3-5 days off work (for most office jobs). Two for the treatment and one or two days afterwards to rest. Patients are able to perform most day to day tasks one day after surgery without any difficulty. Your working environment will also be taken into consideration and our surgeon will advise on what precautions should be taken at your consultation.

The lens implant is inside the eye where there are no nerves or sensation, so it cannot be felt. It will not feel like a contact lens and you will be completely unaware that it is there, apart from experiencing greatly improved vision.

Monofocal implants focus light to only one point, meaning they correct distance vision only and glasses will be needed for near vision. This type of lens is usually used for people with corneal abnormalities as it gives them the best possible quality of vision.

A Trifocal implant has more than one point of focus, enabling clear distance, intermediate and near vision. It has revolutionised the results of treatment and allows for patients to be glasses free, even if they’ve had a cataract operation on the NHS.

Why choose AVC

First Class Treatments

We offer the gold standard in laser treatment, using only the safest and most advanced technology to provide outstanding results. AVC has the fastest treating excimer laser available on the market, treatment typically taking only 3 to 5 seconds. We are first and only clinic in Europe to have a transparent theatre, which is used for purposes of training and allows families to watch surgery.

First Class Surgeons

Advanced Vision Care’s Medical Director and lead surgeon, Dr CT Pillai is one of the few surgeons in the country that has both a corneal and refractive fellowship. He has over 25 years of experience as an ophthalmic surgeon and his expertise is highly sought after.

First Class Service

We provide our patients with the best possible care, and constantly surpass expectations. All appointments from the consultation to treatment and aftercare can be performed at the AVC clinic on Harley Street and for those that would prefer to have their check-ups closer to home we have the largest independent optometrist network in the country, so you can enjoy incredible aftercare at a more convenient location.

"Having worn glasses and contact lenses for many years, my new lenses have given me such freedom and I feel very privileged to have had the opportunity to have this procedure."

Anne Brown

"I now have 20/20 sight (from approx. -8.00) and am extremely happy.
A big thank you to everyone at Advanced Vision Care."

Phil Scott

"My vision has improved by the day. I have so much more confidence in myself and it’s all thanks to the surgery and people behind it. I could not be more happier."

Marium Hussain

"I couldn’t have picked a better clinic to take care of me and my eyes, and would like to thank everyone of you for making this happen. I have been recommending AVC even before the surgery and will continue to do so."

Sinduja Chandrapalan

"I didn’t think at 70 that I’d be able to see, thread a needle and doing all the things… without putting my glasses on. Best thing that I’ve ever done! I would definitely recommend AVC to anyone interested in vision correction of any kind."

Barbara Rouvray

See the world as it's meant to be seen.

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