Electrical neurostimulation shows potential as an innovative glaucoma therapy

At the annual Glaucoma 360 symposium in San Francisco, California, Sunita Radhakrishnan, MD, an associate at the Glaucoma Center of San Francisco, presented on electrical neurostimulation. While electrical stimulation therapy has a long history in neurology, it is relatively new in ophthalmology, with European clinicians leading the charge in electrical stimulation for glaucoma.

Dr Radhakrishnan discussed her presentation topic as well as other topics from the conference, such as the increasing awareness of dry eye's relationship to glaucoma. Hear her share the details on this promising therapy by watching the video, or reading the transcript below.

Editor's note: This transcript has been lightly edited for clarity.

Sunita Radhakrishnan: So I'm Dr Sunita Radhakrishnan. I'm an associate at the Glaucoma Center of San Francisco. My talk is on electrical neurostimulation for glaucoma. This is a relatively new topic for most of us, but actually electrical stimulation therapy has been around for a long time. There are hundreds of papers in the neurology space, not that much in ophthalmology. And the interest here is that this is one area where data is showing some improvement in visual function, and we have no other treatment [for glaucoma] that we have available at this time that can do that.

So for electrical stimulation therapy for the eye, the most data is on a particular type of stimulation called rtACS, which is repetitive, transorbital, alternating current stimulation therapy: rtACS. This has been around in Europe for at least a decade. It was first developed by [Professor] Bernhard Sabel, PhD, in Germany, and he offers this treatment in his clinic. There are a couple other centres using proprietary devices. There's also a commercially available device called EYETRONIC. So it's been available in Europe for some time, but it's not covered by insurance. The patients are paying for this.

In the trials that were done in Germany, there's just about three or four papers. There is some improvement in vision, but the subject group is, you know, a bunch of different kinds of optic neuropathies. And there was one retrospective study in 2022, again, from Germany, which focused exclusively on glaucoma, and...more specifically, patients with glaucoma who were progressing despite IOP lowering.

And what they showed was, 1 year post-rtACS, these patients had either stabilised or improved in their mean deviation, and we don't see that in glaucoma...Even with the best treatments, there is progression, and there's also no treatment, like I said, that can improve vision. So that's why there's some optimism about this treatment. But of course, we need lots more studies.

I'm excited to actually announce that we will be a site for a US study for the EYETRONIC device, and we expect to recruit this year. So I'm looking forward to the study and seeing if we can replicate the results that we've seen in Europe.

[When asked about other developments in the glaucoma space] I'll focus on what I see in clinic, and I think the number one is the explosion of MIGS options. I think that's been a game-changer. I do have a personal interest in glaucoma and dry eye. I think the awareness of dry eye in glaucoma patients has been increasing, and there's also a lot more preservative-free medication options, so that, I think has been very helpful in the clinic.

For diagnosis, I wish we had a better way to predict who is at the most risk for progression. It would be great to harness the power of AI to be able to tell, "Is a patient progressing or is this just test-to-test variability?" And then, of course, we're all waiting and waiting for neuroprotection. So I hope something will come on that side.