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Robotics in cataract surgery

What does the future look like for technology and cataract surgery?

Aidan Hanratty

Posted: Friday, March 16, 2018

© 1951 – Twentieth Century Fox Film Corporation

Robots have a mixed history in popular culture. From the giant Gort in The Day the Earth Stood Still (above) to the terrifying Daleks of Dr Who, from Ted Hughes’s Iron Man to Futurama’s Bender, they have been at turns terrifying, menacing, compassionate and comical. In the real world, their history is more mundane. While we may think of robots as being humanoid in appearance and nature, that’s not necessarily a given.

An editorial in the Paris Innovation Review defined robots as such: “[They] have a material existence inasmuch as they are endowed with perception (via sensors), can make decisions (via appropriate use of processors) and can undertake physical actions (using integrated motors).” The key example of a robot that has made inroads into the everyday is that of robotic vacuum cleaners like the iRobot Roomba or Dyson 360 Eye, and we can see the onset of driverless cars in our media and television.

Automation has led to greater efficiency in the areas of manufacturing, agriculture and communications, to name but a few. Such advances, however, are happening at different paces across the healthcare sphere. In some places, computers and iPads have replaced front-end staff, allowing patients to check-in digitally. In surgery, things are not quite there yet.

In a recent Eye Contact interview, Dr Richard Packard was asked if he saw robotics coming into the area of cataract surgery. He doesn’t see it happening any time soon.

“When you’re dealing with cataracts and the patients, patients are patients. And you can’t necessarily predict the way that their tissues are going to behave. We also know that there’s a significant cohort of complex patients out there that robots will simply not be able to deal with. The other issue is that if there is a problem during surgery, even if you’re a robot, your ability to adapt to the situation that you find yourself in is going to be quite difficult.”

Other doctors are more wary. Sorcha Ni Dhubhghaill MD believes that surgeons live under the same threat of automation as those in other industries. “If I think long term, I believe that a sophisticated diagnostic algorithm will eventually replace the clinician’s diagnosis just as a sophisticated robot will replace the surgeon.”

She believes that the current technical limitations, as envisaged by Dr Packard, will be overcome in time by improvements and refinements. “I don’t think it is unreasonable to think that a robot will ultimately be able to perform every move a surgeon can, but better, with no tremor and no need for a lunch break.”

Where next for the surgeon, so? Dr Ni Dhubhghaill believes a pivot is necessary. “While the robots are seeking to perfect the established techniques, the humans will have to innovate and introduce new ideas.” Human-robot co-operation will ensure the value of each working towards an enhanced patient experience.

“I would envision a robo-surgeon and innovative ophthalmic surgeon working as a team. The robot to provide the best results technically and the ophthalmologist to push the boundaries of the technology.”

Where the patient fits in remains to be seen. Would automated surgery be cheaper than the current standard? Would such a robot have automated colleagues, such as robot anaesthetists and nurses?

O brave new world, that has such… machines in ‘t!