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Spaces in the back of the eye below the retina measure just fractions of a millimeter—a tight spot for talented surgeons with steady hands to access even under the best of circumstances. If a sedated patient snores or moves slightly, surgery can become even more challenging. 

A new robotic eye surgery device developed by the John A. Moran Eye Center's Paul S. Bernstein, MD, PhD, and the ������ο��Ƶ of Utah aims to transform retinal surgery by increasing precision and safety. “Robotic surgery is the future, allowing us to go past the limits of what humans can do,” says Bernstein, a retinal specialist and scientist.

“This device, in particular, is important as many new therapies, including gene therapies for retinal diseases like age-related macular degeneration, must be delivered by subretinal injections into this minute space in the eye.” 

During eye surgery, patients are typically under some level of sedation but not general anesthesia. They may snore or make sudden movements, which can increase the risk of injury to the patient’s retina, a delicate layer of light-sensing tissue essential for vision. 

The noninvasive device consists of a helmet-like structure worn by the patient. A small robot is attached to the structure, which moves with the patient. A surgeon controls the robot by using a joystick device that filters out any hand tremors. 

Experiments have shown the device to be highly successful at preventing complications due to patient movement, says Jake Abbott, PhD, director of the robotics lab. 

“We think of our robots as tools for surgeons,” he says. 

Researchers have been testing the device on animal eyeballs resting on swim goggles worn by human volunteers. This allows them to evaluate the precision of the device under realistic conditions. 

“This patient-motion aspect has been neglected in a lot of other research,” says Nick Posselli, a graduate student in mechanical engineering who has worked with Abbott to develop the device over the past seven years. 

Since only a small number of surgeons are qualified to perform subretinal injections, the device could increase the number of surgeons who can perform them. 

“Retinal surgery is a technically difficult surgery and takes a while to master, so for people in the earlier stages of their career, having robotic assistance can make it safer and more effective,” Bernstein says. 

Bernstein praised the cross-disciplinary collaboration with ������ο��Ƶ of Utah engineers. The group anticipates publishing new results in the near future. 

“The next step,” he says, “is to refine the system that’s working well on these models so we can take it to the next stage, which is human use.”