The Robotic Revolution in Cataract Surgery

Robotics-assisted cataract surgery can lead to better surgical outcomes, improved surgeon performance, opened doors to new surgical manipulations, increased patient throughput, and eventually lower surgery costs, according to Jean-Pierre Hubschman MD.

“Although there is currently perfect visualisation and high manoeuvrability in cataract surgery, robotics technology can help address multiple existing challenges and improve every surgical step,” said Dr Hubschman.

“Robotics-assisted cataract surgery also provides a solution for overcoming the current and increasing gap in supply and demand for cataract surgery services, as well as democratise superior outcomes by negating the impact of differences in surgeon skill sets.”

Dr Hubschman is co-founder of a company developing a fully integrated, image-guided, artificial intelligence-enabled microsurgery platform for cataract surgery. Named Polaris, the system reconstructs anatomy in real time and proposes a trajectory supervised and validated by the surgeon before being executed autonomously by the robotic platform.

Technical groundwork for the system began 14 years ago at UCLA, where Dr Hubschman is a faculty member in the ophthalmology and engineering departments. The platform has demonstrated capability for performing cornea incision, viscoelastic injection, lens extraction, and IOL implantation and achieved promising outcomes in preclinical research conducted in cadaver and porcine eyes.

Although details about the system remain confidential, Dr Hubschman said it combines four major components - microsurgical robotic arms that allow for more precise and accurate manipulations; image guidance combining optical coherence tomography, a digital microscope, and other sensors that reconstruct anatomy in real time; machine learning allowing for real-time tissue differentiation and continuous improvement; and automation for increased throughput and consistent outcomes.

Outperform human surgeons?

“Whether considering sensing, processing, or precision, the robotics system can outperform human surgeons on every metric,” Dr Hubschman said.

Comparisons between human surgeons and the robotics system show the maximum achieved precision for humans is 80 microns versus less than 5 microns for the robotics system. The robotic technology’s reaction time of less than 20 milliseconds far exceeds the 250-millisecond time for humans. The robotics system also overcomes human limitations in visualising microanatomy and depth perception sensing through its ability to simultaneously process input from multimodal imaging and provide much better detection of all anatomy.

“With its level of visualisation and precision, we believe this technology can drastically reduce the rate of posterior capsule rupture, allow for much better cleaning of the capsular bag, and achieve better refractive outcomes through a more accurate selection and positioning of the IOL,” he said.

Assuring colleagues that a robotics platform will not circumvent their role, he noted that even though it performs all steps autonomously, it does so with human supervision.

“This technology will not replace surgeons but allow them to do a better job and [perform] more surgeries in a shorter period,” Dr Hubschman emphasised.

“Surgery is an art, and today, depending on the surgeon, the outcomes may be very different from one to another. With robotics technology, we can make cataract surgery a science and allow every patient and every surgeon to achieve the best care.”

Dr Hubschman spoke during the 2023 ESCRS Congress in Vienna.

Jean-Pierre Hubschman MD is Professor in Ophthalmology and Mechanical and Aerospace Engineering, UCLA and chief executive officer and co-founder of Horizon Surgical Systems, Los Angeles, California, US.

jphubschman@horizonsurgicalsystems.com