Therapeutic Ultrasound for Glaucoma (TUG) as a possible Neuroprotective Treatment for Glaucoma

Abstract Purpose: To evaluate the potential for a low power, low frequency non-invasive ultrasound to offer neuroprotection to glaucoma patients. Methods: This a retrospective study of patients previously treated with the TUG device on one eye and the contralateral eye as a matched control. The study is an analysis of the imaging taken of these eyes before and after the TUG treatment with the specific finding of changes in the Retinal Nerve Fiber Layer (RNFL)Several small studies were previously performed using the TUG device for glaucoma from 2009 through 2014. The largest of these studies was a one year prospective, controlled 2 branch study. It was published in 20145. A total of 43 patients were treated in these small studies to evaluate intraocular pressure effect by the TUG device. A few charts reviewed did not have an image of the contralateral eye. Some parts of the analysis focused on the effect of the treated eye relative to time after treatment. Therefore, comparison was not available, but valuable information was found. A change from HRT imaging to OCT imaging took place, and for this reason there was a decrease in the cohort number to 31 whose data allowed comparison between the treated and non-treated eyes. Only those whose imaging was performed on the same instrument before and after treatment were included. All patients selected for these studies had open angle glaucoma including pigmentary, pseudoexfoliation, trauma and post complicated intraocular surgery. Typically, only one eye was treated with the TUG device. The eye with the higher intraocular pressure was chosen to be treated. If the intraocular pressures were equal, a coin flip determined which eye was to be treated. Usually, a decrease in intraocular pressure was observed in the treated eye, with a smaller effect found in the non-treated eye. If there were an increase in the intraocular pressure at some time after treatment, the patient was given the option of pharmaceuticals, laser treatment or additional TUG treatments to lower the pressure again. Results: A total of 31 patients whose records were still available who met the additional criterion of having imaging on the same imaging instrument (either HRT or OCT) before and after TUG treatment. Most of this group of patients had only one treatment with the device in one eye. Comparison of the Treated eye to the non-treated eye revealed a mean increase in the RNFL after treatment of +11.8% and a decrease in the non-treated eye of –5.1%. The comparison was p<0.0017Conclusion: This small retrospective study reveals a new potential treatment for glaucomatous optic nerve damage with the use of the TUG low power ultrasound.