AI-related innovations for laser cataract technology mark a milestone in history of device

(Image Credit: AdobeStock/Mongkolchon)

The integration of artificial intelligence (AI) in laser cataract technology is transforming the future of cataract surgery and driving increased precision and improved outcomes. Among the leading innovations in this space is the ALLY Adaptive Cataract Treatment System (LENSAR), a device that leverages AI to optimize surgical procedures through advanced imaging, automation, and analysis. In my experience, ALLY is making tremendous strides with its AI-driven technology in three distinct ways.

1. Adaptive Intelligence

ALLY includes Adaptive Intelligence technology to guide and optimize cataract surgery steps and reduce overall energy delivery to the eye.1,2 The laser system automates key steps of the cataract surgery procedure, including corneal incisions, capsulotomy centration, and astigmatism management guided by iris registration with cyclorotation adjustment, helping take the guesswork out of surgical planning and execution. I can customize the size, shape, and position of the capsulotomy based on the IOL selected, ensuring symmetric overlap of the IOL, minimizing the risk of postoperative lens tilt or decentration, and maintaining lens stability as the capsule contracts over time. Further, I have increased confidence in my arcuate incisions because ALLY adapts planning based on my personal nomogram for surgically induced astigmatism (SIA). The system also automatically accounts for SIA if I need to move the location of an incision for ergonomic or anatomical reasons.

From my perspective, one key benefit is the ALLY’s highly detailed Cataract Density Imaging, which incorporates big data to automatically analyze and categorize the cataract density. It then recommends a customized fragmentation pattern by using AI to identify the location of the nucleus and lens layers (more on this topic in point No. 3).

The combination of these Adaptive Intelligence features help me create a personalized treatment plan that accounts for a patient’s unique anatomy and my personal preferences.

ALLY also automatically applies energy settings according to my surgical preference, and the dual-pulse laser optimizes tissue cutting based on the targeted tissue (ie, cornea or lens).

2. Wireless Integration and AI-Driven Registration

Unlike other devices, ALLY integrates wirelessly with almost any preoperative diagnostic device. The laser uses AI to assess and validate preoperative data, making recommendations that can be easily accepted by the surgeon. By automating imaging and analysis, the system ensures more consistent and reliable results and reduces the margin for error. I appreciate how ALLY matches preoperative imaging with intraoperative data, ensuring the laser is docked on the eye correctly.

Another essential feature of ALLY is its AI-driven iris registration, which identifies the correct axis of astigmatism. Whether I’m making incisions on the cornea or placing a toric IOL, the AI-driven registration process ensures that each step is executed with pinpoint accuracy. ALLY centers the capsulotomy on the optical axis to align the lens perfectly within the capsule. In my experience, this leads to better postoperative stability and reduces lens tilt.

3. Customized Nuclear Fragmentation

ALLY uses Scheimpflug imaging to capture detailed images of the eye, allowing more precise analysis of the central nucleus. The data is used to create a customized fragmentation pattern tailored to the specific density and location of the cataract. The result is more precise cataract disassembly with reduced energy in the eye, preserving surrounding tissue.^1,2

Conclusion

AI is being harnessed to enhance surgical precision, improve patient outcomes, and automate key steps to streamline both routine and complex cataract surgery. Optimized astigmatism management software and customized nuclear fragmentation are just the beginning. As AI continues to evolve, systems like ALLY will likely play an increasingly central role in the future of cataract surgery.

Robert J. Weinstock, MD

E: rjweinstock@yahoo.com

Weinstock is a board certified ophthalmologist and fellowship trained cataract and refractive surgeon at the Eye Institute of West Florida. Weinstock is a consultant to LENSAR.