Eyeworld

SUMMER 2026 | EYEWORLD | 33 C DIGITAL MOMENTUM by Liz Hillman Editorial Co-Director About the physicians David F. Chang, MD Altos Eye Physicians Los Altos, California Uday Devgan, MD, FACS Devgan Eye Surgery Los Angeles, California Boris Malyugin, MD, PhD Professor of Ophthalmology Joan & Jerome Snyder Endowed Chair in Cornea Diseases Assistant Medical Director UCLA Stein Eye Center Santa Monica Santa Monica, California Rodrigo Quesada, MD Clinica Quesada San Salvador, El Salvador Kevin L. Waltz, MD, OD Partner Central American Ophthalmic Research Consultants Indianapolis, Indiana Kevin Waltz, MD, OD, said his first im- pression of robotic cataract surgery was "Why bother? … We're already good." But then he thought further. "As you look at the universe of results, we're not as good as we need to be," he said. "As a profession, we're not as good and safe with cataract surgery as we would like." And while improving safety and efficacy is the primary goal of such a robotic system, the possible benefits go beyond that. David F. Chang, MD, said in an email to EyeWorld that while he was initially skeptical about the idea of autonomous and semi-autonomous robotic cat- aract surgery, he thought it was a concept worth pursuing, due in part to the worsening global shortage of cataract surgeons. "Even the highest income countries, such as the U.S., will face this shortage because we don't graduate enough residents to replace the number of retiring ophthalmologists every year. I've been extremely impressed by the current robotic hardware, which I've used to perform surgery in animal eyes located 15 feet away from my workstation," said Dr. Chang, who has worked with the ForSight Robotics system as chairman of its Clinical Advisory Board. "You operate using a 3D heads-up monitor, just like we currently can with systems such as the NGENUITY [Alcon]. It is quite plausible for machine learning AI software to learn from surgeons manipulating the same robotic arms to eventually be able to perform routine cases autonomously. This could potentially scale and democratize cataract surgery on a global level." Creating a competent cataract surgeon takes an incredible amount of time and resourc- es. "It's decades of effort," Dr. Waltz said. "You I magine this: A patient is undergoing cat- aract surgery, but the surgeon, who tradi- tionally would be seated inches from them, is a few meters away or someday even thousands of miles away. He or she is oper- ating via a robotic system intended to increase precision, safety, and access to care. Uday Devgan, MD, FACS, had this expe- rience performing the first-in-human robotic cataract surgery in 2025. "Since the instrumentation was modeled after our currently used cataract surgery tools, it was very natural. Even the shape of the joystick is the same as a traditional phaco probe," Dr. Devgan said of performing the procedure with the Horizon Surgical Systems Polaris platform. "For an experienced surgeon, the learning curve will be very natural and intuitive." Horizon and ForSight Robotics are two companies making headway in robotic cataract surgery, but surgeons say this technology is still a long way from becoming fully autonomous and mainstream. "Everything takes time. It was many years from Dr. Kelman's first phaco until widespread adoption, and yet now we cannot even imagine a cataract surgery without ultrasonic phaco. The same will apply to robotic-assisted cataract sur- gery. This is just the beginning, and the future may be far brighter than any of us can currently imagine," Dr. Devgan said. "Right now, robotic surgery is taking over in many other specialties, so why not ophthal- mology?" said Rodrigo Quesada, MD. "There has been some robotic surgery done in retina. … If you compare the robot and the human, the robot is better in many parts of the surgery, it's more exact, more precise. … I still think you will need the ophthalmologist to be behind it to manage the robot. It's something that is inevita- ble and coming in the future. … It's something that is going to essentially be the way we per- form more precise surgery in the future." Why robotic cataract surgery? Cataract surgery is already widely considered to be one of the safest and most effective elective procedures, so how could a robotic system im- prove upon that? The rise of robotic cataract surgery: where the field stands and where it's headed continued on page 34 "This could potentially scale and democratize cataract surgery on a global level." —David F. Chang, MD

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