Entering the World of Robotic-Assisted Cataract Surgery

The year 1961 marked the start of the modern robotics industry. The first in-human robot-assisted surgery was performed in 1985. Although nearly 40 years passed before the first in-human robotic cataract surgery was performed from start to finish, the success of that procedure and ongoing developments make Vance Thompson MD a believer that robotics will allow cataract surgeons to do more and achieve better outcomes.

“With robotics, we can imagine a future where every outcome is optimised and new manoeuvres become possible. Because of improved ergonomics, surgeons will not be fatigued at the end of the day and so their last procedure will feel like the first,” Dr Thompson said.

“Robotics has the potential to reduce training time, lower the dexterity threshold for cataract surgery, and equalise skill level. At a time when there are not enough ophthalmologists to keep up with the volume of patients needing cataract surgery, robotics will allow us to operate on more patients every day and over the course of our careers. Therefore, robotic cataract surgery holds promise for improving global eye health and eradicating preventable cataract-related blindness.”

Over the years, as robotic platforms permeated into other surgical specialties (e.g., general surgeon, urology, gynaecology, orthopaedics), the question remained whether they could be applied to ophthalmic surgery. For many reasons, the answer seemed to be yes, but several barriers remained.

“The eye seems more amenable to robotic surgery compared with other anatomic sites where robots were already being used because its anatomy and geometry are less variable. In addition, cataract surgery is a high volume, relatively consistent and routine procedure,” Dr Thompson said. “Nevertheless, working in the extremely small intraocular surgical space requires dexterous, miniaturised instruments, sophisticated remote centre-of-motion management to minimise tissue damage, and high precision because we are operating on delicate, micron-scale ocular tissues. Thus, it seems cataract surgery is a good candidate for robotic automation given the right technology.”

Dr Thompson said he has practised robotic-assisted cataract surgery on eye bank eyes using a system from ForSight Robotics and was surprised by how comfortable he felt despite working from a console remote from the globe. Watching the video of the first in-human robotic cataract surgery performed by Robert Ang MD, who also used a ForSight Robotics platform, Dr Thompson said he was amazed by the robot’s reaction time and that the entire procedure was completed under topical anaesthesia.

Dr Thompson rejected the idea that robots will completely replace human surgeons, noting the technology enables ophthalmologists to be better surgeons but cannot substitute for human decision making.

“I think robots bring advantages and will expand our abilities, but they cannot replace us considering that there is always a chance for unpredictable complications where human judgement and intervention are critical for appropriate and successful management,” he said.

“With robots, I think we will see improvement in surgical technique. Ultimately, I hope we will see improvements in outcomes and the advent of autonomous robots in the OR and our offices that will help us reach the goal of being able to do more with better outcomes.”

Dr Thompson spoke on this topic at the 2026 ASCRS annual meeting in Washington, DC.

Vance Thompson MD is the director of refractive surgery at Vance Thompson Vision, Sioux Falls, South Dakota, US. vance.thompson@thompsonvision.com