Advancements of ultrasound modalities and their clinical potential in ophthalmology

Ultrasound imaging has played an important role in ophthalmic diagnostics due to its real-time capability, safety, and cost-effectiveness. In recent years several novel ultrasound modalities have been applied to diagnosis of ocular diseases, including contrast-enhanced ultrasound (CEUS), photoacoustic imaging (PAI), 3-dimensional ultrasound (3D-US), microvascular flow imaging (MFI), super-resolution ultrasound localization microscopy (SRULM), ultrasound elastography, and high-frequency ultrasound (HFUS). These technologies offer improvements in spatial resolution, tissue characterization, and functional imaging. Specifically, CEUS, PAI, MFI, and SRULM allow for the evaluation of ocular blood flow and vasculature, while HFUS and elastography enhance the assessment of intraocular structures and tissue stiffness. 3D-US contributes to the volumetric analysis of ocular lesions. In parallel, the integration of artificial intelligence with ultrasound has enabled automated image interpretation and disease classification, with applications in various ocular diseases, such as retinal detachment, intraocular tumor, and glaucoma. Despite these advances, limitations remain, such as the difficulty in balancing image resolution with penetration depth. Further development in multimodal imaging, algorithm optimization, and clinical validation is needed. Therefore, we review the current progress in novel ultrasound modalities, explores the clinical potential of ophthalmic application, and outlines existing challenges as well as future research directions.