Cataracts are the single largest factor for blindness in India, accounting for nearly 63% of the total burden of vision impairment in the country, according to the All India Institute of Medical Sciences. India has among the world’s highest proportion of blind people, numbering nearly 12 million, as against 39 million globally, which makes India home to a third of the world’s blind population. Over 81% of blindness or visual impairment is seen in people aged 50 years and above.
Compounding the problem further is the national shortage of ophthalmologic surgeons. According to the International Society of Manual Small Incision Cataract Surgeons (ISMSICS), there are nearly 10 million people in need of cataract surgery in India, and there is a need to double the number of surgeries. India is short of nearly 500,000 doctors, based on the World Health Organisation norm of 1:1,000 population (basis, an IndiaSpend analysis of government data). With more than 740,000 active doctors at the end of 2014, India’s claimed doctor-patient population ratio of 1:1,674 is worse than that of Vietnam, Algeria and Pakistan.
Robot-assisted surgeries
Given the increased use of robotics in medical surgeries and the recent development of Artificial Intelligence (AI), two questions that confront medical specialists are how these evolving technologies can be leveraged for cataract surgery and, how successful they will be. Cataract surgery is poised for greater automation with an increasing use of robotics. Robot-assisted surgeries are already at the service of surgeons with complex eye operations. Axsis, a new surgical robot which was developed in 2016, and designed to perform cataract surgery, is the first of a new generation of sleeker, cheaper medical robots. Armed with tiny, flexible, worm-like arms, it is controlled with joysticks that provide tactile feedback. It has an internal algorithmic autopilot that, in theory, keeps the surgeon who’s piloting it from making avoidable errors.
It’s only to be expected that these technologies will converge to deliver the ultimate robotic, and possibly autonomous, device for cataract surgeries. The LenSx Laser is the world’s first U.S. Food & Drug Administration approved laser for cataract surgery. It automates the critical steps of cataract surgery and does away with the need of a hand-held Knife. It also uses AI. But it is still not completely autonomous.
Now, medical researchers in the U.S. have created a robot that can autonomously operate on soft and live tissue with skills rivalling those of highly qualified surgeons. Operating on internal organs is tricky because soft tissues move and slide around, making it hard for a robot to keep track of where things are. The robot has been practising on pig carcasses and with some help from humans, is getting better with each operation. A 3-D camera and the ability to see near-infrared wavelengths help it see better than any human. It will soon start to be tested on human patients. It will perform comparatively simple procedures, such as those linked to infections of the gall bladder and appendectomies. In time, advanced versions could be working on more critical procedures such as the heart, the brain or the eyes. AI programmes will enable them to analyse and learn not only from each surgery they perform but also from other robots and humans, processing billions of bytes of data fed into machine-learning algorithms.
Potential benefits
It stands to reason that the increased use of autonomous robotics could eventually even help bring down costs of expensive medical procedures. It could potentially help address the shortage of doctors across medical practices. So, does that mean that the day is not too far when you’re ushered in to a room with the words, “The robot will see you now?” That is still some time away and even the most ardent proponents of technology believe that humans will continue supervising medical robots. Expect surgeons and robots to increasingly work together on complex operations, learning and helping each other in the near future.
Dr. Sridhar Prasad is with Alcon India. He works with doctors and trains them on new procedures to ensure best outcomes
