Focused Ultrasound Therapy
Focused ultrasound is a noninvasive, therapeutic technology with the potential to improve the quality of life and decrease the cost of care for patients with glaucoma. This innovative technology focuses beams of ultrasound energy precisely and accurately on the ciliary body in the eye without damaging surrounding normal tissue.
How it Works
There are a couple of ways in which focused ultrasound is being investigated to address glaucoma.
With the Eye Tech Care device, the focused ultrasound produces precise coagulation of a portion of the ciliary body, which decreases the intraocular pressure by reducing the production of aqueous humor. The result is a non-incisional treatment of glaucoma. The procedure does need to be done in the operating room, as anesthesia is needed.
A second mechanism of action is found in the device made by EyeSonix, which treats open angle glaucoma. The focused ultrasound energy is applied at several locations around the eye, which offer a mild inflammatory trigger to the trabecular meshwork and anterior chamber angle resulting in enhanced drainage of the aqueous humor.
The primary options for treatment of glaucoma includes a variety of medications, trabeculoplasty or more extensive surgery that may include implantation of a foreign body into the eye.
For certain patients, focused ultrasound could provide a noninvasive alternative to surgery with less risk of complications – such as surgical wound healing, infection, or implantation of foreign bodies into the eye – at a lower cost. It can reach the desired target without damaging surrounding tissue and is repeatable, if necessary.
There are currently no focused ultrasound clinical trials recruiting patients with glaucoma.
Regulatory Approval and Reimbursement
The Eye Tech Care device has regulatory approvals for use in Europe, the Middle East, China, Latin America (Mexico), and multiple locations in South-East Asia (Malaysia, Singapore, Thailand, Philippines, Indonesia, and Vietnam).
Nagar A, Daas A, Danieliute L, Alaghband P, Yu-Wai-Man C, Amon A, Galvis E, Lim KS. Effect of high-intensity focused ultrasound (HiFU) treatment on intraocular pressure and aqueous humour dynamics: 12 -months results. Eye (Lond). 2020 Nov 6. doi: 10.1038/s41433-020-01260-9.
Yu Q, Liang Y, Ji F, Yuan Z. Comparison of ultrasound cycloplasty and transscleral cyclophotocoagulation for refractory glaucoma in Chinese population. BMC Ophthalmol. 2020 Sep 29;20(1):387. doi: 10.1186/s12886-020-01655-y.
Anand N, Klug E, Nirappel A, Solá-Del Valle D. A Review of Cyclodestructive Procedures for the Treatment of Glaucoma. Semin Ophthalmol. 2020 Sep 16:1-15. doi: 10.1080/08820538.2020.1810711.
Marques RE, Sousa DC, Vandewalle E, Somers A, Melamed S, Nardi M, Figus M, Stalmans I, Abegao Pinto L. The effect of glaucoma treatment using high-intensity focused ultrasound on total and corneal astigmatism: a prospective multicentre study. Acta Ophthalmol. 2020 May 18. doi: 10.1111/aos.14467.
Marques RE, Ferreira NP, Sousa DC, Barata AD, Sens P, Marques-Neves C, Abegão Pinto L. High intensity focused ultrasound for glaucoma: 1-year results from a prospective pragmatic study. Eye (Lond). 2020 Apr 21. doi: 10.1038/s41433-020-0878-0.
Leshno A, Rubinstein Y, Singer R, Sher I, Rotenstreich Y, Melamed S, Skaat A. High-intensity Focused Ultrasound Treatment in Moderate Glaucoma Patients: Results of a 2-year Prospective Clinical Trial. J Glaucoma. 2020 Mar 24. doi: 10.1097/IJG.0000000000001497.
Hugo J, Matonti F, Beylerian M, Zanin E, Aptel F, Denis D. Safety and efficacy of high-intensity focused ultrasound in severe or refractory glaucoma. Eur J Ophthalmol. 2019 Sep 25:1120672119874594. doi: 10.1177/1120672119874594.
Rivero-Santana A, Pérez-Silguero D, Pérez-Silguero MA, Encinas-Pisa P. Pupil Ovalization and Accommodation Loss after High-intensity Focused Ultrasound Treatment for Glaucoma: A Case Report. J Curr Glaucoma Pract. 2019 May-Aug;13(2):77-78. doi: 10.5005/jp-journals-10078-1256.
Sousa DC, Ferreira NP, Marques-Neves C, Somers A, Vandewalle E, Stalmans I, Pinto LA. High-intensity Focused Ultrasound Cycloplasty: Analysis of Pupil Dynamics. J Curr Glaucoma Pract. 2018 Sep-Dec;12(3):102-106. doi: 10.5005/jp-journals-10028-1253.
Graber M, Rothschild PR, Khoueir Z, Bluwol E, Benhatchi N, Lachkar Y. High intensity focused ultrasound cyclodestruction versus cyclodiode treatment of refractory glaucoma: A retrospective comparative study. J Fr Ophtalmol. 2018 Sep;41(7):611-618. doi: 10.1016/j.jfo.2018.02.005. Epub 2018 Aug 20.
Giannaccare G, Vagge A, Sebastiani S, Urbini LE, Corazza P, Pellegrini M, Carmassi L, Bergamini F, Traverso CE, Campos EC. Ultrasound Cyclo-Plasty in Patients with Glaucoma: 1-Year Results from a Multicentre Prospective Study. Ophthalmic Res. 2018 May 16:1-6. doi: 10.1159/000487953.
Deb-Joardar N, Reddy KP. Application of high intensity focused ultrasound for treatment of open-angle glaucoma in Indian patients. Indian J Ophthalmol. 2018 Apr;66(4):517-523. doi: 10.4103/ijo.IJO_1024_17.
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.
Schwartz, D., Samples, J. & Korosteleva, O. Therapeutic ultrasound for glaucoma: clinical use of a low-frequency low-powerultrasound device for lowering intraocular pressure. J Ther Ultrasound 2, 15 (2014). https://doi.org/10.1186/2050-5736-2-15
Click here for additional references from PubMed.