The Future of Eye Surgery

BARCELONA, Spain — Ophthalmology has lagged far behind other specialties in adopting automated technology for the operating room, but a team of researchers in California has reported early success with a robotic platform that can perform vitreoretinal and cataract surgeries.

Aya Barzelay-Wollman, MD, PhD, codirector of the Advanced Robotic Micro Surgery (ARMS) Laboratory at the University of California, Los Angeles (UCLA), reported at European Society of Retina Specialists (EURETINA) 2024 that the artificial intelligence–driven and image-guided microsurgical robot has demonstrated a high degree of accuracy in preclinical testing.

“The robot has a 1-micron increment of resolution, meaning I could command the robot to move at 1-micron increments,” Barzelay-Wollman told attendees at the meeting. She said the robot has 10-micron precision, 40-micron accuracy, a

The system uses a robotic arm developed by Tsu-Chin Tsao, PhD, codirector of the ARMS Laboratory.

“The robotic system is able to be super-human with elimination of tremor and increased resolution to the micron level, which is something that the human hand is just incapable of, and then this results in increased precision and accuracy,” Barzelay-Wollman told Medscape Medical News. She said the study represents “a pivotal leap” in developing a surgical robot for retina surgery.

The platform can be used for cataract and vitreoretinal surgery. However, the latter posed a problem for seeing the retinal pathology inside the eye. “The commercial surgical microscopes available today that use the top-down technology, when the scan is coming from outside the eye, provide a somewhat limited view,” Barzelay-Wollman reported at the meeting.

To overcome that problem, the UCLA researchers developed intraocular imaging probes that mount on the vitrector to provide a view inside the eye.

“Using our algorithms, we are able to obtain detailed anatomical data of the relevant ocular structures,” she said. When combined with intraoperative optical coherence tomography, which images the retinal layers, the algorithm feeds data to control the trajectory of the robot and performs a fully automated vitrectomy, she said.

She explained that the platform works in two modes: A fully automated mode in which the robotic arm performs the procedure with the surgeon sitting at the console and monitoring the steps; and a mode called teleoperation, or robotic assist, in which the surgeon uses a joystick to manipulate the robotic arm.

The research is in the preclinical phase, Barzelay-Wollman said, and must undergo in vivo studies on live animals and then get the US Food and Drug Administration clearance for a clinical trial before it’s done in humans.

Barzelay-Wollman had no relevant disclosures.

Richard Mark Kirkner is a medical journalist based in the Philadelphia area.