In October 2024, Elon Musk rolled out the first prototype of an automatically driven completely driverless taxi which relies on artificial intelligence. We now have entered the era of robots with artificial intelligence. The concept of robots performing surgeries on human beings on their own does not sound like fiction anymore. It is not a matter of if but when it is going to happen. Let us discuss the existing literature and possible future of ophthalmic surgeries.1 Ophthalmology, due to its demand for micrometre level precision, is a potential platform for robotic augmentation. Physiological tremor, although negligible in most surgical fields, becomes significant when operating with the confined intraocular environment. Multiple studies have revealed tremor amplitudes ranging from ten to over a hundred microns at the instrument tip, which can influence the eventual outcomes in procedures such as retinal membrane peeling or vascular cannulation. Robotic surgical systems, with their inherent ability to filter tremor and scale motion, offer a compelling solution to this limitation.2–4 Early adaptations of ophthalmic robotic systems in surgery were largely driven by platforms designed for other specialities. These systems demonstrated feasibility in ophthalmic procedures such as corneal suturing and surface surgeries. However, their translation into intraocular surgery has been limited by instrument size, lack of fine microsurgical tools, and limitations in maneuverability. These challenges have driven the development of ophthalmology-specific robotic systems.5,6 Dedicated intraocular robotic platforms now represent a significant leap forward. Systems incorporating telemanipulation, real-time imaging integration, and micron-level precision have demonstrated the ability to perform complex steps of cataract and vitreoretinal surgery in experimental settings. Even capsulorhexis, which is a critical step in cataract surgery, requiring extreme surgical precision has been executed successfully. The ability of robotic systems to replicate this maneuver reliably highlights their potential to standardize surgical outcomes and reduce variability linked to surgical skill.6–8 A landmark development regarding this has been the recent demonstration of robotic cataract surgery using robotic platforms capable of dual-instrument manipulation. In 2024, complete cataract extraction was achieved in preclinical models, which involved all the conventional steps of capsulorhexis, lens fragmentation, and lens aspiration. This event has pushed the use of robotic systems and presented a foundational step toward actual clinical application.9 In parallel, robotic systems in vitreoretinal surgery have shown promising results in completing tasks that are otherwise at the limits of human dexterity. Retinal vein cannulation, subretinal injections, and membrane peeling have been successfully carried out by robotic systems with enhanced stability and precision. Some of these surgical platforms have already progressed to early human trials, emphasizing the feasibility and safety in selected ophthalmic procedures. The integration of intraoperative imaging, such as optical coherence tomography, further augments the surgeon’s ability to visualize and control instrument positioning in real time.4,10–12 Handheld robotic devices have also evolved significantly in the recent past. They actively compensate for tremor, thereby improving surgical accuracy without the need of a complete shift to console-based surgery. Despite these major advancements, there exists multiple barriers to practical adoption of robotic surgical systems. The huge cost of robotic systems, along with cost of acquisition, maintenance, and disposable components, remains a major hurdle in the actual worldwide surgical acceptance. On top of it, the increased setup time and need for specialized training before use also pose a practical challenge. The learning curve associated with robotic systems is significant, requiring not only technical proficiency but also adaptation to a fundamentally different mode of surgical interaction.13,14 At present, the robotic systems work on a master–slave paradigm, where the surgeon remains in control of the procedure. True autonomy, where a robot independently performs surgery without any human input, remains in its infancy and still has to undergo a lot of ethical, legal, and safety considerations. Issues such as intraoperative decision making, management of complication, and patient accountability are yet to be addressed.13 So instead of heralding the obsolescence of ophthalmic surgeons, robotics should be viewed as an extension of surgical capability. The role of an ophthalmic surgeon will possibly evolve from a manual operator to a supervisor of advanced robotic surgical systems, combining clinical judgement with technological oversight in the near future. In this context, adaptability and willingness to engage with technologies will be crucial for future ophthalmic surgeons. In conclusion, the newer robotic systems are well poised to reshape ophthalmic surgery by enhancing precision, reducing variability due to difference in human hands, and enabling surgical procedures previously beyond human capability. The recent progress in robotic cataract surgery underscores the pace of innovation in this field. However, the human surgeon remains central to surgical care not as a redundant entity but as an indispensable decision maker, controlling and guiding the sophisticated tools. The future of ophthalmology is not one of replacement, but of collaboration between human expertise and robotic precision.About the authorDr. Deepsekhar Das Dr. Deepsekhar Das (MD, DNB, MNAMS, FICO) is a dynamic ophthalmic surgeon and researcher currently working as an Assistant Professor of Ophthalmology at the National Cancer Institute, AIIMS, New Delhi. His areas of interest are: Ocular Oncology, Strabismus and Neuro-Ophthalmology. He completed his MBBS from Calcutta National Medical College, followed by both Junior and Senior Residency at the Dr. R.P. Centre for Ophthalmic Sciences, AIIMS, New Delhi. A prolific innovator with 3 patents to his credit, his work focuses on the cutting edge of robotic surgery and Artificial Intelligence in ophthalmology. Currently, he is the Principal Investigator (PI) for two ICMR-funded projects, including a landmark "First in the World" grant. He was a key member of the surgical team that conducted the world’s first successful drone-based transport and transplant of the cornea and amniotic membrane. His research portfolio includes the various surgical techniques for ocular brachytherapy, and use of AI in Ophthalmology.
Deepsekhar Das (Wed,) studied this question.