Robots came relatively late to ophthalmology. The first robotic eye surgery was carried out by the University of Oxford in 2016 and involved dissecting membranes and injecting a therapeutic drug under the retina. After the surgery, Robert MacLaren, Professor of Ophthalmology at the University of Oxford, said: ‘This is a huge leap forward for delicate and technically difficult surgery…the robot has great potential for extending the boundaries of what we can currently achieve.’
Eye surgery requires microscopic precision due to tiny retinal vessels. Therefore, manual surgical procedures have reached their limitations as human vitreoretinal surgeons have an unavoidable physical tremor. However, there is no such problem in robotic surgery, and robots can also help guide surgical movement as well as keep blood vessels open to administer drugs. Using robots in eye surgery has improved patient outcomes and increased the range of treatments surgeons can offer. But compared to other surgical specialities, robots have been somewhat delayed in entering the field of ophthalmology.
Regardless of this delay, six companies are at the forefront of developing the latest robotic eye surgery tech.
1. Preceyes Surgical System
Preceyes Surgical System is a robotic assistant for eye surgery. The system provides surgeons with a precision better than 20 μm (micrometres) to position and hold instruments. Higher surgical precision aims to improve treatment outcomes. The robot makes the surgeon steady and precise and empowers them to establish new innovative surgical techniques, including delivering advanced therapeutics.
For retina surgery, the system is compatible with a wide range of 23G, 25G, and 27G instruments and can be used for patients under local or general anaesthesia. All movements are recorded for post-surgical evaluation and training.
Lensar’s ALLY (Adaptive Cataract Treatment System) combines imaging with dual-pulse femtosecond laser in a single system for cataract surgery. Doctors using the system can optimise their femtosecond laser and phacoemulsification treatments to reduce the overall energy delivered in the eye.
ALLY automatically categorises cataract density and identifies the nucleus location and lens layers. This enables a tissue-specific treatment, customised fragmentation patterns, and energy settings according to surgeon preferences.
3. Ophthorobotics AG
Ophthorobotics AG builds robots that give intravitreal injections, which combat age-related macular degeneration: the most common cause of legal blindness in the industrialised world.
The company has created a fully automated system that administers safe and highly precise injections into the eye. The technology uses specific sensors to identify and track patients’ eyes and screens them. The system can be remotely controlled and monitored by the doctor. Additionally, it helps to contribute to the availability of injection facilities and resources to address the growing numbers of patients with age-related macular degeneration.
4. University of California, Los Angeles
The Intraocular Robotic Interventional and Surgical System (IRSS) is the result of a research collaboration (that has lasted more than ten years) between the Mechatronics and Control Laboratory at UCLA and the Stein Eye Institute. The objective of the partnership was to develop a surgical platform capable of performing anterior and posterior ocular surgical procedures via teleoperation and automation.
The IRISS simultaneously manipulates two surgical instruments and can automatically alternate between multiple surgical instruments on each arm. The robot has an extensive range of motion that allows for anterior and posterior surgical instrument positioning. Also, dedicated master surgical manipulators and microscope-mounted cameras give a 3D vision of the surgical field to guide teleoperated procedures.
The project is currently at an advanced prototype stage, awaiting funds to conduct human trials.
5. Foresight Robotics
Foresight Robotics is an Israeli-based company that wants to address poor vision and limited access to excellent surgical eye care globally. Its ORYOM system leverages high-precision robotics, advanced visualisation, and cognitive data analytics to do just that. The platform is capable of curative and preventative ophthalmic surgeries for cataracts, glaucoma, subretinal delivery, and retinal diseases.
The surgical platform features a miniature 14-degrees-of-freedom microsurgical robot capable of executing delicate tasks with dexterity and manoeuvrability. And the hybrid kinematic structure allows any point within the human eye to be reached.
6. Johns Hopkins University
Johns Hopkins University’s Steady-Hand Eye Robot is a cooperatively-controlled robot assistant designed for retinal microsurgery. Cooperative control allows the surgeon to fully control the robot, with hand movements precisely dictating the robot's movements. The robot can be a valuable assistant during high-risk procedures by incorporating virtual fixtures to help protect the patient and eliminate physiological tremors in the surgeon's hand.
The university has developed three robots: Eye Robot 1, Eye Robot 2, and Eye Robot 2.1. They are used in two types of robot-assisted surgeries: retinal vein cannulations and retinal peeling.
Few companies are developing robotic eye surgery tech compared to other medical areas, but the potential is enormous. Ophthalmology is one of the most technology-driven branches of medicine, and, to date, most key advances have been made thanks to devices rather than drugs.
This technique-driven discipline can hugely benefit from the precision and accuracy that robotics can offer. Compared to traditional surgical techniques, robotic procedures provide higher levels of safety and efficacy and promise to revolutionise all types of ophthalmological procedures. Robots and artificial intelligence are at the forefront of an eye surgery revolution, so many more companies are likely to join the race.