- Last Updated: November 17, 2017
Glaucoma is a disease with elevated pressure within the eye, known as intra-ocular pressure. If the elevated intra-ocular pressure is left untreated, it can damage the optic nerve and eventually result in blindness.
Treatment is based on either decreasing the production of this fluid or eliminating it. Medication can be used to inhibit production of the fluid. Risks of the current treatment include difficulty in obtaining the proper dosing, resulting in eye pressure that is too low or too high. The medications are also absorbed in the blood, with unpleasant side effects.
Other treatment options include surgery which can be a trabeculectomy or shunt placements. Newer approaches called MIGs (minimally invasive glaucoma surgeries) use miniaturized tools and smaller incisions with the same goals as larger surgeries. Some of these techniques are being reviewed for possible approval in the US. Laser surgery is also an option, especially if the glaucoma is not too far advanced.
High Intensity Focused Ultrasound was tried for treating Glaucoma in the 1980s, but was not pursued due to technical reasons. However recent changes, including smaller transducers, resulted in reapplication for glaucoma. These initial studies have shown it to cause selective necrosis of parts of the ciliary body, resulting in sustained reduction of the intra-ocular pressure. This can be done under local anesthesia.
At present, there are no clinical trials in the US for glaucoma. Clinical trials are in place in Europe and Israel.
Regulatory Approval and Reimbursement
The EyeTechCare device has the CE approval in Europe and the CFDA approval in China.
De Gregorio A, Pedrotti E, Stevan G, Montali M, Morselli S. Safety and efficacy of multiple cyclocoagulation of ciliary bodies by high-intensity focused ultrasound in patients with glaucoma. Graefes Arch Clin Exp Ophthalmol. 2017 Oct 17. doi: 10.1007/s00417-017-3817-4.
Graber M, Khoueir Z, Beauchet A, Benhatchi N, Hammoud S, Lachkar Y. High intensity focused ultrasound as first line treatment in patients with chronic angle closure glaucoma at risk for malignant glaucoma. J Fr Ophtalmol. 2017 Apr;40(4):264-269. doi: 10.1016/j.jfo.2016.10.013.
Mastropasqua R, Fasanella V, Mastropasqua A, Ciancaglini M, Agnifili L. High-Intensity Focused Ultrasound Circular Cyclocoagulation in Glaucoma: A Step Forward for Cyclodestruction? J Ophthalmol. 2017;2017:7136275. doi: 10.1155/2017/7136275. Epub 2017 Apr 22.
Graber M, Khoueir Z, Beauchet A, Benhatchi N, Hammoud S, Lachkar Y. High intensity focused ultrasound as first line treatment in patients with chronic angle closure glaucoma at risk for malignant glaucoma. J Fr Ophtalmol. 2017 Mar 22. pii: S0181-5512(17)30073-6. doi: 10.1016/j.jfo.2016.10.013.
Giannaccare G, Vagge A, Gizzi C, Bagnis A, Sebastiani S, Del Noce C, Fresina M, Traverso CE, Campos EC. High-intensity focused ultrasound treatment in patients with refractory glaucoma. Graefes Arch Clin Exp Ophthalmol. 2017 Mar;255(3):599-605. doi: 10.1007/s00417-016-3563-z. Epub 2016 Dec 3.
Lafond M, Aptel F, Mestas JL, Lafon C. Ultrasound-mediated ocular delivery of therapeutic agents: a review. Expert Opin Drug Deliv. 2017 Apr;14(4):539-550. doi: 10.1080/17425247.2016.1198766. Epub 2016 Jun 27.
Aptel F, Denis P, Rouland JF, Renard JP, Bron A. Multicenter clinical trial of high-intensity focused ultrasound treatment in glaucoma patients without previous filtering surgery. Acta Ophthalmol. 2016 Aug;94(5):e268-77. doi: 10.1111/aos.12913. Epub 2015 Nov 7.