Robotics and AI are redefining precision in cataract surgery

Editor's Note

Laser cataract surgery is entering a new era where robotic systems and artificial intelligence (AI) work alongside surgeons to improve accuracy, efficiency, and patient outcomes. According to the July/August 2025 edition of Ophthalmology Times, recent advances in robotic integration, astigmatism management, and AI-driven imaging are minimizing variability, reducing complications, and helping more patients achieve clear vision after surgery.

In a three-part article series, Vance Thompson, MD, describes how robotic cataract laser systems automate key surgical steps without replacing surgeon expertise. Platforms such as ALLY (LENSAR, Inc) integrate diagnostics, imaging, and treatment planning directly into the OR, eliminating manual transfer errors. This streamlining improves precision, particularly in astigmatism management, where IntelliAxis software compensates for patient positioning and cyclorotation to ensure alignment within one degree of target. In a multicenter study, toric IOL implantation guided by robotic iris registration reduced residual astigmatism significantly, with 99% of eyes within half a diopter of intended refraction.

Next, Gary Wörtz, MD, emphasizes the impact of even minor astigmatism on visual quality, comparing it to a radio slightly off-station. Robotic laser arcuate incisions, guided by the Wörtz-Gupta formula, allow precise placement and depth adjustments that manual techniques cannot reliably achieve. Patients treated with laser arcuate incisions based on this formula were nearly twice as likely to reach 20/20 uncorrected vision and over three times as likely to achieve 20/25 or better compared with standard cataract surgery. This formula is available online and integrated with surgical planning software, offering surgeons an accessible tool to reduce residual astigmatism.

And Arjan Hura, MD, highlights AI’s role in tailoring surgical plans in real time. Deep-learning models trained on thousands of cataract images enable highly accurate segmentation of corneal and lens structures, improving intraoperative alignment for toric IOLs. AI also analyzes cataract density to customize laser energy settings and fragmentation patterns, reducing phaco energy use, case times, and postoperative corneal edema. Surgeons report fewer manual adjustments and greater consistency across procedures, leading to smoother recoveries and higher patient satisfaction.

Per the outlet, robotic systems also improve workflow by housing the laser in the OR rather than requiring patient transfers, reducing surgical time by up to 8 minutes per case while maintaining sterility. Enhanced visualization and real-time feedback support surgical teams, further improving safety and predictability.