Robotics in Cataract Surgery: Coming Soon?

Developments in robotic technology are poised to handle the growing volume of cataract surgery patients and meet their increasing expectations for precision outcomes. One day, the field may progress to reach a level of fully autonomous robotic procedures, but that is not likely to occur any time soon, said Pavel Stodůlka MD, PhD.

Providing an update on the current state of automation in cataract surgery and a look to the future, Dr Stodůlka said femtosecond laser cataract surgery (FLACS) represents an existing level of automation, and experience with FLACS has resulted in important lessons for the success of future innovations.

“We learned that OCT guidance brought reproducibility to capsulotomy and laser fragmentation reduces effective phaco time,” he said. “However, several clinical studies showed no clear superiority of FLACS, and we learned that cost and time matters.”

Robotic positioning with laser control represents the next step in automation of cataract surgery and is embodied by the investigational FemtoMatrix laser from Keranova. The laser provides robotic docking and has real-time OCT guidance to optimise energy delivery to different parts of the lens. Its beam, transmitted through the robotic arm onto a face mask, is multiplied to enable faster lens fragmentation and faster surgery.

“The lens is fragmented into 20,000 cubes in 20 seconds, and the majority of cases have been completed with zero ultrasound,” said Dr Stodůlka, who, together with Gilles Thuret MD, PhD (France), completed clinical studies to support regulatory approval of the laser in Europe.

The robotic arm has six axes of freedom, operates with 50 μm precision, and controls force on the eye during the procedure. The device also enables surgical workflow because, once the laser steps are done, the surgery can proceed by repositioning the robotic arm rather than the patient.

Robotic tool manipulation describes the next level of automation in cataract surgery and is represented by the robotic platform from ForSight Robotics. With this system, the surgeon sits at a console and performs surgery with real-time three-dimensional image guidance and advanced visualisation. The robotic arm has 14 degrees of freedom and mimics the surgeon’s hand movements. It offers motion scaling and tremor filtering. A first study in Europe is planned.

Mini fingers and multiple hands

Dr Stodůlka said that supervised autonomy in cataract surgery is on its way and is anticipated for its promise of delivering consistency and precision exceeding human physical limitations. Eventually, fully autonomous surgery may become a reality with the possibility that the robots will have microfingers capable of manipulating new surgical microtools and even be equipped with more than two hands, Dr Stodůlka proposed.

Looking back to the lessons learned with FLACS, he outlined several considerations for the successful introduction and adoption of robotic cataract surgery.

“Registries matter—all companies will need to get through the regulatory pathway with real-world data, benchmarking, transparency, and long-term monitoring. It will be important to define endpoints early, and it will be necessary to measure system impact, demonstrate value, and engage payers,” he said.

“Core takeaways from experience with FLACS showed that precision alone fails, workflow wins, economics decide, and there is definitely a psychological barrier on both the patients’ and surgeons’ side for fully autonomous robotic cataract surgery.”

Dr Stodůlka spoke on this topic during a symposium on AI, robotics, and surgical simulation co-sponsored by the ESCRS, ASCRS, and APACRS that was held during the 2026 ASCRS annual meeting in Washington, DC.

Pavel Stodůlka MD, PhD is founder, chief surgeon, and CEO of the Gemini Ey e Clinic, Zlin, Czech Republic, and senior lecturer, department of ophthalmology, Third Faculty of Medicine, Charles University, Prague, Czech Republic. stodulka@lasik.cz or Pavel.stodulka@lf3.cuni.cz