Eyeworld

34 | EYEWORLD | SUMMER 2026 ATARACT C Relevant disclosures Chang: ForSight Robotics Devgan: Horizon Surgical Systems Malyugin: ForSight Robotics Quesada: Horizon Surgical Systems Waltz: Horizon Surgical Systems brought up was femtosecond laser-assisted cata- ract surgery (FLACS). "I think as a first step, robotic surgery will be introduced as something like a premium feature for cataract patients," said Boris Malyugin, MD, PhD. "Following that, I think there will be a need to understand and assess the benefits of the technology in real-world sce- narios with multicentered randomized clinical trials," he said. "If these benefits are proven, I think the next step for robotic surgery will be wider adoption for regular cases covered by insurance." "There will be a time and a place when we'll learn how to fit this sophisticated surgical device into our cost structure," Dr. Waltz said, comparing it to when he used to make LASIK flaps with a microkeratome. He was hesitant to switch to a femtosecond laser because he was doing well with the microkeratome, howev- er, once he tried it and saw the difference, he couldn't go back, even though use of the laser cost him more to do the procedure. "We'll make those decisions as the parameters become clear. It's not clear how much a robot is going to cost. It's not clear what the insurance industry is going to think about that." From a cost standpoint, Dr. Chang said that robotic-assisted procedures would need to reach critical volumes for the cost to come down. The first-in-human robotic cataract surgery Dr. Devgan performed the first-in-human robot- ic cataract surgeries at the Clinica Quesada in El Salvador in 2025. He said the procedure felt natural because the instrumentation of the Polaris system was modeled after current cata- ract surgery tools. Beyond what felt natural, Dr. Devgan said he was able to perceive things he normally could not see, such as using OCT to judge the depth of the phaco groove while sculpting the nucleus and to determine if the IOL haptics were both in the capsular bag. Overall, he said the technology created "more precision within the eye … beyond the level that I could achieve on my own." "The surgeon is in control the entire time. [It's] important to emphasize that this is ro- botic-assisted cataract surgery where the robot will make me, the surgeon, a better version of myself," Dr. Devgan said. have this highly skilled system to do cataract surgery that's expensive to replicate and sup- port, so what if you could make it so that the surgeon could be more efficient and safer by providing a robot to assist them? The robot's not going to make the decisions, but if you had an ophthalmologist making the decisions, and they're supervising the robot, you could poten- tially get to a place that would be very interest- ing for the ophthalmologist, the patient, and the system." Dr. Quesada said he thinks robotic cataract surgery could someday extend ophthalmol- ogists' careers as they age. "You're going to have the opportunity to be a surgeon for many more years because your abilities with time go down, but with the robot, it will be getting better each time. The machine also has artificial intelligence, so it keeps learning really fast. You can study and you can practice, but you cannot learn as fast as the robot," he said. Dr. Chang said robotic-assisted cataract surgery is the first step, where surgeons perform the procedure by controlling robotic arms. "This might offer improved ergonomics for the sur- geon," he said. "We might discover tactile bene- fits to operating without gloves, and the work- station would have features to steady our hands, dampen microtremors, and enable more precise maneuvers with our non-dominant hand." The economics of robotic cataract surgery When the economics for robotic cataract surgery was considered, a common reference that was continued from page 33 Dr. Devgan performed the first-in-human robotic cataract surgery in 2025 using the Horizon Surgical Systems Polaris platform. Source: Uday Devgan, MD, FACS

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