Unlocking the Full Potential of Robotic Cataract Surgery

Two teleoperated robotic cataract surgery systems have already been used clinically, demonstrating advantages such as greater precision, faster response times, tremor cancellation, and improved standardisation. However, the technology still faces significant limitations, cautioned Yu-Hsuan (Alex) Huang MD, PhD, speaking at a symposium on artificial intelligence, robotics, and surgical simulation.

“Currently, robotic cataract surgery involves longer procedure times and is limited to certain surgical steps. It also lacks real-time monitoring of surgical conditions, cannot manage complications, and still requires human supervision. The absence of true decision-making capability remains the key bottleneck holding the field back,” Dr Huang said. “Advancing to a level where the system can fully perceive, understand, and respond to complications is the major challenge. The future of cataract robotics lies in perception and intelligence. That is the next frontier, and we are all building it together.”

Reaching its full potential

Dr Huang explained robotic surgery platforms can be classified by the level of human versus robotic control. At one end are robot-assisted tools that enhance the surgeon’s hand. The next level includes teleoperated systems in which a human remotely controls the robot—such as the platforms developed by ForSight Robotics and Horizon Surgical Systems that have already been used in humans.

Further along are cooperative systems where humans and robots share control. At the far end are systems capable of partial or full autonomy.

The feasibility of fully autonomous systems hinges on their ability to identify and manage complications. That ability fuelled Dr Huang’s vision in founding Xensur Medical, where artificial intelligence (AI) is being applied to advance robotic cataract surgery.

Dr Huang, who holds a doctorate in computer science in addition to being an ophthalmic surgeon, used Tesla’s Optimus robot to illustrate the strategy.

“Optimus can perform a wide range of physical tasks using a single neural network, having learned these skills directly from human demonstration videos. This approach enables and accelerates the acquisition of new capabilities,” he said.

“This is the direction AI is heading in the realm of surgical robotics. To train a robot, the first step is to capture how human experts perform the surgery.”

At Xensur Medical, the approach leverages two complementary technologies: AI-driven analysis of surgical recordings to interpret fluidics changes and real-time, high-precision tracking of surgical instrument trajectories to learn techniques directly from expert surgeons. These capabilities translate complex surgical data into actionable medical insights.

In contrast to teleoperated systems, where a human uses joysticks or controllers to manipulate a robotic arm, the Xensur system directly tracks surgeons operating real surgical instruments. In its current iteration, the platform achieves real-time, micron-level motion tracking inside the eye, capturing every tilt and rotation with high precision.

“Our technology generates ground-truth surgical data to train both robots and surgeons,” Dr Huang said, adding that “this high-quality data will define the future of surgery—transforming how surgeons learn and unlocking true robotic autonomy.”

Dr Huang spoke at the 2026 ASCRS meeting in Washington, DC.

Yu-Hsuan (Alex) Huang MD, PhD is director at Universal Eye Centre, Taipei, Taiwan, a board member of the Ophthalmological Society of Taiwan, and founder of Xensur Medical.