Therapeutic ultrasound in ophthalmology: a comprehensive review

BACKGROUND: Therapeutic ultrasound has emerged as a promising noninvasive or minimally invasive modality in ophthalmology, offering novel solutions across a range of ocular disorders. This review summarizes the current advances in both the underlying biophysical mechanisms and their translation into clinical and experimental applications. METHODS: This review synthesizes and analyzes the current literature, focusing on the core mechanisms of therapeutic ultrasound and its present and emerging applications in ophthalmic care. RESULTS: The key biophysical mechanisms of therapeutic ultrasound include thermal effects, acoustic streaming, and cavitation. Established clinical procedures based on these mechanisms, such as phacoemulsification for cataract surgery and ultrasound cycloplasty (UCP) for glaucoma, have demonstrated clinical efficacy and safety. Meanwhile, emerging applications show substantial potential in preclinical and early clinical studies, including the treatment of meibomian gland dysfunction (MGD), HIFU-based corneal reshaping, photo-mediated ultrasound therapy (PUT) for retinal neovascular diseases, and ultrasound-based retinal prostheses (U-RP) for vision restoration. CONCLUSION: Despite these advances, challenges such as treatment protocol standardization, device miniaturization, and the need for large-scale clinical validation remain. Looking forward, integration with wearable technologies, artificial intelligence, and personalized theranostics is expected to further enhance the precision and scope of therapeutic ultrasound, positioning it as a transformative tool in the future landscape of ophthalmic care.