BLOG: Stymie robots, stifle science
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Wouldn’t it be wonderful if a device could automate even portions of cataract surgery, removing some of the unavoidable variability that occurs with the human hand?
Results would be more consistent and precise. There would likely be benefits in safety. The unprecedented levels of precision would inspire exciting innovation in implant and other surgical device design.
As we discussed in the cover story of this issue of Ocular Surgery News, at least three companies are now pursuing robotic solutions that could change the way we do cataract surgery. But didn’t we already live through this history? Didn’t femtosecond laser-assisted cataract surgery (FLACS) offer exactly the same promises? What failed?
I would argue that femtosecond lasers did not fail. A number of studies have shown safety benefits, less inflammation, less trauma to the corneal endothelium and more precise refractive outcomes relative to manual surgery. Patients eagerly accept FLACS, with adoption rates well more than 50% in many practices using balanced patient educational materials.
If there was a failure, it was in the population of us surgeons to adopt FLACS as a better method of surgery. True, the added cost of FLACS is considerable, and it takes more time. True, the marginal benefits on safety are not overwhelming, but weren’t these true of the early days of phacoemulsification? Would phaco have advanced and become standard of care if not for the pioneers who continued to invest in and refine the techniques and technology in a then easier regulatory environment?
Today, FLACS is used in fewer than 20% of cataract cases across the U.S., according to the ASCRS member survey. This anemic market has driven little innovation in the science of FLACS, and there is a questionable place for promising new implants like the “bag in the lens” technology being explored in Europe without enough surgeons using lasers to create the needed ultraprecise capsulotomies.
“Better is the enemy of good” in practicing medicine. Expecting too much of any first-generation breakthrough risks stifling the evolution of truly promising technology. If further robotic tools for cataract surgery do indeed come to market, I hope we are wise enough as a specialty to give them a warm reception. We owe it to our patients to give them a chance.
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