Robotic Cataract Surgery in Pune: What the Laser Really Does, and Is It Worth It?

Almost every week in our clinic in Kharadi, Pune, a patient asks me whether they should have “robotic cataract surgery”. They have seen the hoardings, the WhatsApp forwards or a hospital package that costs far more than standard surgery, and they are worried that normal surgery is somehow old or unsafe. In this guide I explain, in plain language, what the “robot” actually is, which parts of the surgery it does and does not do, why it costs more, and how to decide what is right for your eyes.

The short answer.

No robot operates on your eye. What is sold as “robotic cataract surgery” is usually laser-assisted cataract surgery, where a femtosecond laser does a few of the early steps. The cataract itself is still broken up and removed by the surgeon with the same ultrasound probe used in standard surgery, called phaco. The laser machine is very expensive, so the surgery costs much more, but for most patients the final vision is about the same as with good standard phaco. It is a reasonable option for some eyes, not a better surgery for everyone.

What you hear.

These lines sound reassuring, especially to someone nervous about eye surgery. But they describe something that does not exist in eye clinics today. Let’s look at what actually happens in the operation theatre.

First, what is standard cataract surgery (phaco)?

A cataract is when the natural lens inside your eye turns cloudy. The surgery removes the cloudy lens and puts in a clear artificial lens (an IOL).

In phacoemulsification, or phaco, the surgeon:

1. Makes a tiny opening at the edge of the clear front window of the eye (the cornea), about 2 to 3 mm wide
2. Makes a neat, round opening in the thin bag (capsule) that holds the lens
3. Uses a fine ultrasound probe to break the cloudy lens into small pieces and gently suck them out (“emulsification” means turning it into a soft mush)
4. Cleans the bag and places the new folded lens inside it

This is done under eye drops or a small anaesthetic, usually in 10 to 20 minutes, and no stitches are needed. It is one of the safest and most successful operations in all of medicine.

What does the “robot” actually do?

The machine behind the “robotic” label is a femtosecond laser (femto laser). The surgery is properly called femtosecond laser-assisted cataract surgery, or FLACS.

Before the main surgery, your eye is held still with a gentle suction ring, called docking. The laser scans your eye and, as planned by the surgeon, does some or all of these steps:

• Makes the small openings in the cornea
• Makes the round opening in the lens capsule
• Cuts or softens the cloudy lens into pieces, so less ultrasound is needed later
• Makes small relaxing cuts in the cornea to reduce mild astigmatism, if planned

This part takes a few minutes. Then you are moved to the regular operating microscope, and the surgeon does the rest by hand, just as in standard phaco.

Who does what

Swipe sideways to see every column

Step	Standard phaco	“Robotic” (laser-assisted) surgery
Openings in the cornea	Surgeon, with a fine blade	Laser
Round opening in the lens capsule	Surgeon, by hand	Laser
Breaking the cataract	Surgeon, with the phaco probe	Laser pre-cuts it, then the surgeon still uses the phaco probe
Removing the cataract	Surgeon, with the phaco probe	Surgeon, with the phaco probe
Cleaning the lens bag	Surgeon	Surgeon
Placing the new lens	Surgeon	Surgeon
Handling any problem during surgery	Surgeon	Surgeon

The most important and most skilful parts of the operation are done by the surgeon’s hands in both methods.

Why “robotic” is a misleading word.

A robot is a machine that moves instruments and carries out a task on its own. The femto laser does not hold any instrument, does not remove the cataract, and does not put in the lens. It is an image-guided laser, closer to the laser used in LASIK than to a robot.

The word “robotic” is chosen because it sounds modern and error-free. It makes patients feel that standard surgery is outdated or risky. Neither is true.

Two things to keep in mind:

• “No human error” is not possible. The surgeon plans the laser, does most of the surgery, and handles any problem. The surgeon’s skill and experience still matter most.
• Phaco is not “manual” in the old sense either. The phaco machine itself is a highly precise, computer-controlled machine. Calling one “robotic” and the other “normal” is marketing, not medicine.

Fully robotic eye surgery is being researched around the world, but it is not what clinics are offering when they advertise “robotic cataract surgery” today.

Is laser-assisted surgery better?

The laser does some things very well. The round opening in the capsule is perfectly sized and centred, and less ultrasound energy is needed to remove the cataract.

But when doctors have compared laser-assisted surgery with good standard phaco in large numbers of patients, the results have been clear:

• Final vision is about the same.
• Safety is about the same. Serious complications are rare with both.
• Glasses after surgery are about the same. How well you see without glasses depends mostly on the lens you choose and accurate measurements before surgery, not on the laser.

The laser also has its own small downsides:

• The suction ring often leaves a red patch on the white of the eye for a week or two (harmless, but alarming for some people)
• The pupil can get smaller after the laser, which can make the next steps harder
• The surgery takes a little longer, because you move from one machine to another
• It does not suit every eye, for example very small pupils, deep-set eyes or some corneal scars

Then why is it so expensive?

Mostly because of the machine, not because of extra benefit to you.

• A femtosecond laser costs a hospital several crores of rupees to buy, plus yearly maintenance.
• Each surgery uses a single-use disposable part for docking, which adds cost per eye.
• The hospital has to recover this money, so it is passed on in the package price.

You may be paying a lot more per eye for a few steps that a skilled surgeon already does very well by hand. Often the “robotic” package is also bundled with a premium lens, so it becomes hard to see what you are really paying for.

Who might reasonably choose it, and who doesn’t need it.

It may be worth discussing if:

• Your surgeon has a specific reason for your eye, such as a weak cornea lining (for example Fuchs’ dystrophy), where using less ultrasound may help, or a very hard cataract
• You have mild astigmatism and your surgeon plans to treat it with laser cuts (though a toric lens is usually more reliable for more astigmatism)
• You understand the extra cost, and the results are likely to be similar, and you still prefer it

You do not need it if:

• You have a routine cataract and an experienced phaco surgeon
• You are being told it is the only “safe” option
• The cost would be a strain. Good standard phaco gives excellent results for the vast majority of people.

Questions to ask your eye doctor.

• Is this “robotic” surgery actually a femtosecond laser? Which steps will the laser do, and which will you do?
• Will you still use phaco to remove my cataract?
• Is there a specific reason the laser would help my eye?
• What would my expected vision be with standard phaco, and with the laser?
• What exactly is the extra cost of the laser alone, separate from the lens?
• How many cataract surgeries have you done, and what are your own results?
• Which lens are you planning for me, and why?

Frequently asked questions.

The bottom line.

There is no robot doing your cataract surgery. A femtosecond laser can do a few early steps very precisely, but your surgeon still removes the cataract with phaco and places the new lens by hand. For most people the final vision and safety are about the same as with good standard phaco, while the cost is much higher. The things that matter most are an experienced surgeon, careful measurements, and the right lens for your eyes and lifestyle. Choose your surgeon, not a label.

Not sure which cataract surgery or lens is right for you? Get a full cataract evaluation at EYON Eye & Laser Institute, Riverdale, Kharadi, Pune. We will measure your eyes carefully, explain your options honestly, and give you a clear, itemised quote. Call 090909 93399 to book, or book a consultation online.

This article is for general information and does not replace advice from your eye doctor. Your surgery is planned only after a full eye examination, and results vary from person to person.

Dr. Bhalekar performs cataract surgery at EYON Eye and Laser Institute and Vision Care Center Super Speciality Eye Hospital, Shirur.

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