In short: after cataract surgery or refractive lens exchange, some people are left with a prescription the implant did not fully correct. A piggyback lens adds a second, supplementary lens rather than exchanging the first. The American Academy of Ophthalmology’s EyeWiki describes the modern supplementary lens as one engineered for fixation in the ciliary sulcus, placed in front of the lens in the capsular bag; a 2024 review in Graefe’s Archive explains that the older technique of putting two lenses inside the bag was largely abandoned because of opacification between the lenses. Precision Vision London offers the procedure at Harley Street.
What a piggyback lens is
The 2024 review by Khoramnia and colleagues defines the approach as using a second intraocular lens to supplement an implant already placed in the capsular bag. Two lenses inside the bag led to interlenticular opacification — material forming in the space between them — in roughly a third of cases, so purpose-designed supplementary lenses are now placed in the ciliary sulcus instead, outside the bag and in front of the first lens. EyeWiki lists the practical advantages: the procedure avoids the trauma of exchanging the first implant, carries no risk of rupturing the capsule or losing vitreous during an exchange, does not require the power of the first lens to be known, and is reversible and adjustable.
Who a piggyback lens suits
Precision Vision London says the procedure is for patients who have had cataract or lens replacement surgery and still experience vision problems, including those with monofocal lenses who want better near or intermediate vision, those with corneal abnormalities, and those with complex prescriptions. EyeWiki’s indications are similar: residual short- or long-sighted error after cataract surgery, residual astigmatism, presbyopia correction (adding a multifocal element to a monofocal implant), ametropia after a corneal transplant while sutures remain, extreme long-sight or very small eyes beyond the range of a single lens, and temporary correction in growing or unstable eyes. The review adds keratoconus and refractive changes caused by silicone oil to the list.
Whether a supplementary lens, a laser enhancement or a lens exchange is the better route for you is decided at a consultation with corneal and lens measurements. Laser enhancement after lens surgery is covered separately on our laser enhancement page.
Piggyback lens versus lens exchange
Left with a prescription after cataract or lens surgery? A lens consultation with fresh measurements is where the options are weighed.
Request a consultationHow the procedure is done
Precision Vision London describes piggyback lens surgery as a procedure under local anaesthetic taking 15 to 30 minutes: “A small, self-sealing incision is made, and the supplementary piggyback lens is gently placed in the ciliary sulcus — just in front of the existing IOL.” The clinic says most patients return home the same day, that visual improvement is often noticed within a few days, and that vision stabilises fully over a few weeks. At Precision Vision London the procedure is performed by Dr CT Pillai.
Risks
Precision Vision London’s page does not list complications, so the risks here come from the clinical literature. EyeWiki names interlenticular opacification, pigment dispersion and iris chafing, uveitis-glaucoma-hyphaema syndrome, raised eye pressure, capture of the lens optic by the pupil, decentration and tilt, rotation of a toric lens, endothelial cell loss, glare and haloes with multifocal designs, and difficulty with a later YAG laser capsulotomy. The 2024 Graefe’s review reports that with properly designed sulcus lenses the complications seen were mild light disturbances, transient raised pressure and minor pigment dispersion, and that serious problems such as opacification between the lenses and iris damage were avoided. Your surgeon explains the risks that apply to your eye before you decide.
What a piggyback lens costs
Precision Vision London says its consultation for lens, cataract and ICL treatments is free, with a £300 fee that is deducted from your surgery cost if you proceed. The clinic does not publish a fixed price for piggyback lens surgery; it quotes after the assessment and offers payment plans. For comparison, Precision Vision London lists lens replacement from £3,150 per eye for a monofocal lens and from £3,700 per eye for a multifocal lens. Sapphire Eye Care, the other clinic group listed here, does not list a supplementary lens procedure.
Sources: Precision Vision London: piggyback intraocular lenses and pricing, read 7 October 2026; EyeWiki: Secondary Piggy-Back Lenses (American Academy of Ophthalmology, reviewed 7 August 2026); Khoramnia R et al., Polypseudophakia: from “Piggyback” to supplementary sulcus-fixated IOLs, Graefe’s Archive for Clinical and Experimental Ophthalmology, 2024.
Piggyback lens FAQs
A second, supplementary lens implant placed in the ciliary sulcus, just in front of the lens you already have from cataract or lens replacement surgery, to correct a remaining prescription. Precision Vision London describes it as fine-tuning vision and reducing dependence on glasses or contact lenses.
EyeWiki says a supplementary lens avoids the trauma of exchanging the implant, removes the risk of capsule rupture and vitreous loss that an exchange carries, does not need the power of the first lens to be known, and is reversible and adjustable. An exchange is still chosen when the first lens itself is the problem.
Precision Vision London says the procedure takes 15 to 30 minutes under local anaesthetic, most patients return home the same day, visual improvement is often noticed within a few days and vision stabilises fully over a few weeks.
EyeWiki lists interlenticular opacification, pigment dispersion and iris chafing, raised eye pressure, lens decentration or tilt, rotation of a toric lens, endothelial cell loss, glare and haloes with multifocal designs, and difficulty with a later YAG capsulotomy. A 2024 review found that properly designed sulcus lenses avoided the serious complications and caused mainly mild light disturbances, transient raised pressure and minor pigment dispersion.
Precision Vision London does not publish a fixed price; it quotes after your assessment. Precision Vision London says its lens consultation is free, with a £300 fee deducted from the surgery cost if you proceed.