Eyeworld

SUMMER 2026 | EYEWORLD | 35 C Contact Chang: dceye@earthlink.net Devgan: devgan@gmail.com Malyugin: boris.malyugin@gmail.com Quesada: rquesadaeyemd@yahoo.com Waltz: kwaltz56@gmail.com manner." The system was recently used to per- form 12 in-human cases from start to finish at a center in Manila, Philippines. Dr. Malyugin said the core of every robot- ic technology is its micromanipulator, which depends on precision and the degree of freedom allowed to the manipulator performing the sur- gical maneuvers. Dr. Malyugin said the ForSight Robotics platform has 14 degrees of freedom for the delicate tasks of cataract surgery. What's next All the physicians interviewed said it's still a long way off before robotic cataract surgery (especially a fully automatized version) is main- stream. Even then, such technology will never replace the human surgeon. Dr. Malyugin said he thinks the rollout of robotic cataract surgery in the future will be staged where the surgeon is controlling the systems more at first before the technology transitions to be more autonomous. "Like the idea of a self-driving car, there are some self-driving cars around already, but we're still driving cars by ourselves; we think that at some point these cars will be driven by artifi- cial intelligence," he said, envisioning a similar process for robotic cataract surgery. Even if robotic systems become autono- mous to perform cataract surgery, this won't eliminate the need for the surgeon. "You will still need an ophthalmologist to oversee and back up a group of fully autono- mous robotic stations," Dr. Chang said. "Drivers and pilots can override and resume control of a self-driving car or airplane on autopilot. Perhaps the surgeon would confirm proper completion of each major step (e.g., capsulotomy) prior to permitting the next step to occur. Imagine a high-volume surgeon needing to perform twice as many cases per day to meet the increas- ing surgical backlog. Having robot 'assistants' simultaneously performing the steps would be a way to increase each ophthalmologist's capac- ity. Ophthalmologists would still do the more complex cases." Dr. Malyugin also said the human surgeon will be needed for complex cases. "We still have quite a number of cases with complicated sce- narios, where something unexpected happens, and the condition of the eye does not allow us The Polaris system, according to Dr. Dev- gan, is designed to perform the entire cataract surgery. During the first-in-human procedures, standard OR staffing was used, but he envisions a future where fewer staff would be needed because the robot could reduce certain needs. Dr. Waltz said he was brought in to help with safety, compliance, and in gaining clinical evidence, getting the system from "strong lab work to operating on people safely. … I'm not an expert in robotics. I'm an expert in getting safe experiences in humans." During the first cases, Dr. Waltz said the surgeon sat at a pilot station to drive the robot performing the surgery; the next cases had the surgeon doing most of the surgery while driving the robot but also allowed the robot to do a little bit of sculpting. "We had the robot make some decisions because we wanted to see how well it made decisions," he said. Dr. Quesada was involved in the screening of candidates for the procedure and postop care. He said he felt confident offering the opportuni- ty to be part of the first robotic cataract surger- ies after seeing the procedure safely performed in many cadaver eyes. He said the postops for the first-in-human cases looked amazing. "It performed 10 cases, and all 10 were perfect surgeries with 20/20, 20/25 vision. All of the patients were happy with the result," he said. While he got to be involved with this stage of the research, Dr. Quesada acknowledged the decades of work that has brought the robotic system to this point. "One of the main inventors of this robot was almost crying when he saw his baby perform an actual cataract surgery in a human. It's a wonderful team to work with. They're very professional, and safety was the main priority." From these first cases, Dr. Waltz said the re- search team collected data that will be analyzed to see how the robot can be improved. "We'll make sure it's safe. We'll come back and do it again and again," he said. For the ForSight Robotics system, Dr. Malyugin, who consults for the company, said it has been used in several hundred cataract procedures in animal eyes, and the first-in-hu- man has been completed. "I was able to do all the steps of the surgery from incision to IOL implantation to incision sealing," Dr. Malyugin said. "The system is very robust and allows me to provide all these steps in a very consistent continued on page 36

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