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April 26, 2025
1 min read
Key takeaways:
- Shock waves have been used in medicine for a long time.
- Extracorporeal shock wave therapy may improve lens elasticity, lens clarity and lens volume.
LOS ANGELES — The future of refractive surgery could see ophthalmology welcome sound waves as a therapeutic tool, according to a speaker at the American Society of Cataract and Refractive Surgery meeting.
In the Roger F. Steinert, MD, Refractive Lecture during Refractive Day, Ronald R. Krueger, MD, highlighted some of the biggest breakthroughs over his career in ocular surgery and looked to the future to see what might come next. In addition to procedures such as laser sclerociliary translocation and kerato-lenticule extraction (KLEx, also known as SMILE), he said extracorporeal shock wave therapy (ESWT) could have several applications in ophthalmology, including presbyopia and cataracts.
“Who could have thought extracorporeal shock wave therapy can be used to disaggregate hard tissues and soften them?” he said. “We know the lens gets hard over time. The sclera gets hard over time. Could we use this? The problem is we in ophthalmology think about light and surgical tools as lasers. We don’t think about sound and surgical tools as shock waves.”
Krueger said shock waves have been used in medicine for a long time, including in lithotripsy for kidney stones since the 1980s. This technology has even been used in some form in ophthalmology.
“If you look back to the earliest posterior capsulotomies that we did with the YAG laser, we were using shock waves to sever that,” he said. “But we were using intracorporeal lasers where the shock wave and the energy on the spark and the ionization and the thermal change was happening inside the eye, not delivering it from the outside in.”
In presbyopia, Krueger said ESWT has shown promise in improving lens elasticity in porcine models. In cataracts, it helped improve lens clarity and lens volume.
Krueger said he could see ophthalmologists doing accommodation restoration procedures within 5 years using a mechanism to deliver shock waves into the eye from the outside.
“If it can disaggregate these tissues and it can end up reducing some of the lens volume, might we be able to actually treat early presbyopes annually with this to keep their accommodation, to reduce the compaction that comes with age, to restrict the fact that lens fibers degrade with compaction and ultimately to retard cataract formation?” Krueger said.
Sources/Disclosures
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Krueger RR. The laser vision correction journey: Step into my time machine. Presented at: American Society of Cataract and Refractive Surgery meeting; April 25-28, 2025; Los Angeles.
Disclosures:
Krueger reports consulting for Alcon and serving as an unpaid chief medical officer for Senogen.
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