The Safety of Diagnostic Ultrasound in Ophthalmology

The literature review presents information about ultrasound use in diagnosis, therapeutic and surgical treatment of eye diseases. Due to experimental studies it was proved that ultrasound of different power, intensity and exposure causes thermal, mechanical and biological effect on the eye tissue. Thermal effect caused by ultrasonic energy absorption by biological tissues, which is converted from acoustic energy into thermal energy. The mechanical effect is determined by the amplitude of ultrasonic pressure acting on the eye structures during the examination. For the safety of ultrasound scanning, such concepts as thermal (TI) and mechanical (MI) indices have been introduced, which allows to control the level of acoustic impact on tissues. Ultrasound diagnosis in ophthalmology went a long way from one-dimensional echography (A-mode) to the complex scanning in real time, which allows to visualize different structural elements of the eye. Ultrasound eye examination is non-invasive and highly informative and thereby one of the main instrumental diagnosis methods in ophthalmology. Combination of images in gray scale, highly sensitive color and energy Doppler, 3D and sonoelastography to date greatly increased the diagnostic capabilities of ultrasound for simultaneous qualitative and quantitative assessment the eye and orbit in normal and pathological conditions. Therefore general ultrasonic diagnostic systems are widely used in clinical practice, with obligatory correction of TI and MI values. Recommendations of the international professional organizations such as Food and Drug Adminisration (FDA) and American Institute of Ultrasound in Medicine (AIUM))are widely used for the ultrasonic examination of eye pathology, according to which the lowest levels of exposure and intensity of the output acoustic signal (TI and MI) should be set to get a high-quality image. There are still a lot of clinical and experimental studies to determine the optimal modes of ultrasound eye and orbit examination. However, the safety of ultrasound and its effect on eye structures are still need to be studied.

1. Игошев Б.М., Усольцев А.П. История технических инноваций: учебное пособие. М.: Флинта, 2013. 246 с. [Igoshev B.M., Usol’cev A.P. History of technical innovation: a tutorial. Moscow: Flinta, 2013. 246 p. (In Russ.)].

2. Lumb Ph. Critical Care Ultrasound: Expert Consult. Philadelphia: Elsevier Health Sciences, 2015.

3. Kutz M. Handbook of Materials Selection. NewYork: John Wiley & Sons, 2002. 403 p.

4. Donald I. Sonar: The story of an experiment. Ultrasound Med Biol. 1974:109–117.

5. Hackmann W. Underwater acoustics before the first world war. In: Seek and Strike. London: Crown, 1984. P. 1–10.

6. Hackmann W. Underwater acoustics before the first world war. In: Seek and Strike. London: Crown, 1984. P. 73–95.

7. Абрикосов И.А., Крылов Н.П. Практическая физиотерапия. М., 1961 [Abrikosov I.A., Krylov N.P. Practical physiotherapy. Moscow, 1961 (In Russ.)].

8. Фридман Ф.Е. Ультразвук в офтальмологии. М., 1973. С. 14–135 [Fridman F.E. Ultrasound in ophthalmology. Moscow, 1973. P. 14–135 (In Russ.)].

9. Петрищева Т.С. Фонофорез дексаметазона в терапии помутнений роговицы после вирусных кератитов. Трактат пятого Всесоюзного съезда офтальмологов. М., 1979;4:118–119 [Petrishcheva T.S. Phonophoresis of dexamethasone in the therapy of corneal opacities after viral keratitis. A Treatise of the Fifth All-Union Congress of Ophthalmologists. Moscow, 1979;4:118–119 (In Russ.)].

10. Мармур Р.К. Ультразвуковая терапия и диагностика глазных заболеваний. Киев: Здоровя, 1974. С. 30–36 [Marmur R.K. Ultrasonic therapy and diagnosis of eye diseases. Kiev: Zdorovya, 1974. P. 30–36 (In Russ.)].

11. Purnell E.W., Sokollu A., Holasek E. The production of focal chorioretinitis by ultrasound. Am J Ophthal. 1964:58.

12. Karlin D. Ultrasound retinal detachment syrgery. Trans Amer Acad Ophthalmol Otoiaryng. 1969;6:1061–1076.

13. Nakajima A. Ophthalmology congress in America. Ophthalmology (Tokyo). 1968;10:681–683.

14. Kelman C.D. Phaco-emulsification and aspiration. Am J Ophthal. 1967;64:23–35.

15. Ходжаев Н.С., Дыбенко Л.И., Завалишина Л.Э. К вопросу о возможных механизмах влияния ультразвука при факоэмульсификции на ткани глаза. Acta Biomedica Scientifica. 2011:179–181 [Hodzhaev N.S., Dybenko L.I., Zavalishina L.E. On the possible mechanisms of the influence of ultrasound in phacoemulsification on the eye tissue. Acta Biomedica Scientifica. 2011:179–181 (In Russ.)].

16. Азнабаев Б.М. Ультразвуковая хирургия катаракты — факоэмульсификация. М., 2005. 136 с. [Aznabaev B.M. Ultrasonic cataract surgery — phacoemulsification. Moscow, 2005. 136 p. (In Russ.)].

17. Краснов М.М. Клиническое применение ультразвуковой хирургии при отслойке сетчатки. Патология сетчатой оболочки и зрительного нерва. М., 1971. С. 30–32 [Krasnov M.M. Clinica lapplication of ultrasound surgery in retinal detachment. Pathology of the reticular membrane and optic nerve. Moscow, 1971. P. 30–32 (In Russ.)].

18. Краснов М.М., Голямина И.П., Танеева Л.И., Субботина И.Н. О принципах и возможностях применения низкочастотного ультразвука в офтальмохирургии. Вестник офтальмольмологии. 1969;5:20–26 [Krasnov M.M., Golyamina I.P., Taneeva L.I., Subbotina I.N. On the principles and possibilities of using lowfrequency ultrasound in ophthalmic surgery. Annals of Ophthalmology = Vestnik oftal’mologii. 1969;5:20–26 (In Russ.)].

19. Гундорова Р.А., Малаев А.А., Южаков А.М. Травма глаза. М., 1980. С. 130–143 [Gundorova R.A., Malaev A.A., Yuzhakov A.M. Injury of the eye. Moscow, 1980. P. 130–143 (In Russ.)].

20. Коновалов К.А., Давыдов Д.В., Рощин В.Ю. Сравнительный анализ применения методик пьезохирургии и механической остеоперфорации при моделировании декомпрессии орбиты. Офтальмологические ведомости. 2018;11(1):10–18 [Konovalov K.A., Davydov D.V., Roshchin V.Yu. Comparative analysis of the application of piezosurgery and mechanical osteoperforation techniques in the modeling of orbit decompression. Ophthalmology Journal = Oftal’mologicheskie vedomosti. 2018;11(1):10–18 (In Russ.)]. DOI: 10.17816/OV11110-18

21. Фридман Ф.Е., Гундорова Р.А., Кодзов М.Б. Ультразвук в офтальмологии. М.: Медицина, 1989. 256 с. [Fridman F.E., Gundorova R.A., Kodzov M.B. Ultrasound in ophthalmology. Moscow: Medicine, 1989. 256 p. (In Russ.)].

22. Gohr H., Wedekind T. Der ultraschallin in der medizin. Journal of Molecular Medicine. 1940;19(2):25–29.

23. Meire H.B. An historical review. In: Basic ultrasound. West Sussex: John Wiley & Sons, 1995. P. 1–7.

24. Holm H.H., Skjoldbye В. Interventional Ultrasound. Ultrasound Med Biol. 1996;22:773–789.

25. Levi S. The history of ultrasound in gynecology 1950–1980. Ultrasound Med Biol. 1997;23(4):481–552.

26. Mundt G.H., Hughes W.E. Ultrasonics in ocular diagnosis. Am J Ophthalmol. 1956;41:488–498.

27. Oksala A., Lehtinen A. Diagnostic value of ultrasonics in ophthalmology. Ophthalmologica. 1957;134:387–395.

28. Baum G., Greenwood I. The application of ultrasonic locating techniques to ophthalmology: theoretic considerations and acoustic properties of ocular media: Part 1. Reflective properties. Am J Ophthalmol. 1958;46:319–329.

29. Ossoinig K.C. Standardized echography: basic principles, clinical applications and results. Int Ophthalmol Clin. 1979;19:127–210.

30. Bronson N.R., Turner F.T. A simple B-scan ultrasonoscope. Arch Ophthalmol. 1973;90:237–238.

31. Coleman D.J., Lizzie F.L., Jack R.L. Ultrasonography of the eye and orbit. Philadelphia: Lea &Febiger, 1977.

32. Aburn N.S., Sergott R.C. Orbital colour Doppler imaging. Eye. 1993;7:639–647.

33. Guthoff R., Berger R.W., Winkler Р. Doppler ultrasonography of the ophthalmic and central retinal vessels. Arch Ophthalmol. 1991;109:532–536.

34. Lieb W.E. et al. Colour Doppler Imaging of the eye and orbit. Technique and normal vascular anatomy. Arch Opthalmol. 1991;109:527–531.

35. Williamson T.H., Baxter G.M., Dutton G.N. Colour Doppler velocimetry of the arterial vasculature of the optic nerve head and orbit. Eye. 1993;7:74–79.

36. Pavlin C.J., Sherar M.D., Foster F.S. Subsurface ultrasound microscopic imaging of the intact eye. Ophthalmology. 1990;97:244–250.

37. Pavlin C.J. et al. Clinical use of ultrasound biomicroscopy. Ophthalmology. 1991;98:287–295.

38. Byrne S.F., Green R.L. Ultrasound of the eye and orbit. Philadelphia, USA: Mosby Inc., 2002. 505 p.

39. Department of Health and Human Services, Food and Drug Administration Center for Devices and Radiological Health: Information for Manufacturers Seeking Market Clearance of Diagnostic Ultrasound Systems. USA. 2008. P. 9–10.

40. Health Canada. Guidelines for the Safe Use of Diagnostic Ultrasound. USA. 2001. P. 7–26.

41. Осипов Л.В. Ультразвуковые диагностические приборы. Практическое руководство для пользователей. М.: Видар, 1999. С. 230–243 [Osipov L.V. Ultrasound diagnostic devices. A practical guide for users. Moscow: Vidar, 1999. P. 230–243 (In Russ.)].

42. Medical Ultrasound Safety. Second Edition. AIUM. 2009:7–53.

43. Guidance for Industry and FDA staff. Information for Manufacturers Seeking Marketing Clearance of Diagnostic Ultrasound Systems and Transducers. Silver Spring. 2008. 64 p.

44. Волков В.Н. Основы ультразвуковой диагностики: Учебно-методическое пособие. М.: Мир, 2005 [Volkov V.N. Fundamentals of ultrasound diagnostics: Teaching-methodical manual. Moscow: Мir, 2005 (In Russ.)].

45. Sheiner E., Freeman J., Abramowicz J.S. Acoustic output as measured by mechanical and thermal indices during routine obstetric ultrasound examinations. Journal of Ultrasound in Medicine. 2005;24:1665–1670.

46. Forward H., Yazar S., Hewitt A.W., Khan J., Mountain J.A., Pesudovs K., McKnight C.M., Tan A.X., Pennell C.E., Mackey D.A., Newnham J.P. Multiple prenatal ultrasound scans and ocular development: 20-year follow-up of a randomized controlled trial. Ultrasound Obstet Gynecol. 2014;44(2):166–170. DOI: 10.1002/uog.13399

47. Zha L, Chen K.Q., Zheng X.Z., Wu J. The safety and feasibility of diagnostic acoustic radiation force impulse elastography used for eyes. A preliminary in vivo study. Med Ultrason. 2017;19(2):185–189. DOI: 10.11152/mu-996

48. Silverman R.H., Lizzi F.L., Ursea B.G., Cozzarelli L., Ketterling J.A., Deng C.X., Folberg R., Coleman D.J. Safety levels for exposure of cornea and lens to very highfrequency ultrasound. Ultrasound Med Biol. 1987;13(10):607–618.

49. Urs R., Ketterling J.A., Silverman R.H. Ultrafast Ultrasound Imaging of Ocular Anatomy and Blood Flow. Invest Ophthalmol Vis Sci. 2016;57(8):3810–3916. DOI: 10.1167/iovs.16-19538

50. Palte H.D., Gayer S., Arrieta E., Scot Shaw E., Nose I., Lee E., Arheart K.L., Dubovy S., Birnbach D.J., Parel J.M. Are ultrasound-guided ophthalmic blocks injurious to the eye? A comparative rabbit model study of two ultrasound devices evaluating intraorbital thermal and structural changes. Anesth Analg. 2012;115(1):194–201. DOI: 10.1213/ANE.0b013e318253622e

51. Слободин К.Э. Лучевая диагностика повреждений глаз: Руководство для врачей. СПб.: СпбМАПО, 2007. С. 52–54 [Slobodin K.E. Radiation diagnosis of eye injuries: A guide for doctors. St. Petersburg: SPbMAPO, 2007. P. 52–54 (In Russ.)].