What kind of learning curve was there for you in using the Polaris platform?
It was surprisingly natural. The system uses the same phaco foot pedal and microscope pedal that I’ve relied on for decades. The hand instruments were also designed to mimic what we already use. It’s virtually identical in size and shape to a phaco probe, so it felt instantly familiar; that familiarity made the transition seamless.
Polaris also uses a 3D visualization system. I operated with a 3D heads-up display – something we’ve already been doing for 8–10 years. Integrating real-time OCT was the real game-changer. I could see precisely how close I was to the capsule bag, confirm intraocular lens placement, and monitor the anatomy during every step. After a few cases, I found myself wishing I had this imaging technology in my own OR.
Which surgical steps showed the greatest precision or efficiency gains with Polaris?
The intraoperative OCT during phacoemulsification is a huge advance. You can imagine programming the robot so it physically prevents you from getting closer than, say, 50 microns to the posterior capsule – effectively eliminating a common source of complications. That kind of safety net could redefine cataract surgery precision.
How does the system handle unexpected intraoperative events or complications?
The surgeon is still in control at all points. If needed, I can walk over and complete the case manually, but that hasn’t been necessary. Even in challenging cases – for instance, when the nucleus doesn’t rotate easily or there’s some iris prolapse – the robot allows me to manage it the same way I would conventionally.
The exciting part is what comes next. Right now, the robot mirrors human technique: two hands, two instruments. But in the future, could we introduce a “third hand”? Imagine a robot-assisted tracheotomy or corneal transplant where a third instrument acts as an intelligent light pipe or manipulator. That’s where the real innovation lies – expanding beyond human constraints.
How does the system integrate into operating rooms?
During these procedures, the robot held my existing phaco probe while I used my standard phaco machine. That made adoption easy. Ultimately, full integration is inevitable – one system seamlessly controlling both the robot and phaco unit. For now, interoperability works perfectly well, but integration will simplify workflows even further.
How have patient outcomes compared with your standard procedures?
Incredibly well. I completed ten cases with the Polaris team, and all patients did beautifully – outcomes comparable to those in my Beverly Hills practice. No complications.
The potential lies in precision and speed. My own reaction time as a surgeon might be 160–200 milliseconds; an elite athlete’s might be 120. The robot’s reaction time? Around 20 milliseconds. My surgical precision is roughly 30 microns – about a third of a human hair. The robot is closer to 5 microns – one-twentieth of a hair. Combine that with OCT data showing exactly where the posterior capsule is, and you have a system that has the potential to make real-time micro-adjustments faster and more precisely than any human.
What would you say to practitioners who are still hesitant about robotic surgery?
Resistance to innovation is nothing new. When Charles Kelman introduced phacoemulsification, many thought it was unnecessary or even reckless. The same with excimer lasers – surgeons were happy with radial keratotomy and saw no need for LASIK. History shows us that progress often starts with skepticism.
Change is the only constant in ophthalmology. You don’t judge the future of the iPhone by looking at iPhone 1. Wait until you see iPhone 17. The technology will evolve – and we’ll all benefit from it. And don’t be afraid of it. Robotics won’t replace surgeons – it will make surgeons better. Think of it as aviation. I just flew back from Argentina and was grateful for my human pilot – but equally grateful for radar, autopilot, GPS, and all those technologies that make flying safer and smoother. Surgery should be no different.
These systems will elevate the baseline – allowing every surgeon to perform with the consistency of the best surgeons among us. It’s about augmentation, not replacement.
Dr. Uday Devgan of Devgan Eye Surgery (Beverly Hills and Los Angeles, California) is both an investor and stockholder in Horizon Surgical, the company behind the Polaris platform.
