Market Scope: Robotic Vitrectomy Debate Still Rages for Retina Surgeons

The future of robotic vitrectomy continues to be top of mind for retina surgeons, with panelists at nearly every major retina meeting in 2021 debating the topic—and without reaching consensus as to when the technology will be ready, or even whether it’s needed, according to Market Scope. 

A panel at the 2021 Euro Retina Ophthalmology Futures Forum—titled “Surgery and Robotics: The Next Frontier?”—was co-chaired by Stano Rizzo, MD, and Borja Corcostegui, MD. Panelists were Steve Charles, MD, Eugene de Juan, MD, Greg Draudt, MD, Paulo Stanga, MD, and Paul Hallen of Alcon.

The trigger for these conversations was a presentation highlighting the robotic vitrectomy system from Netherlands-based Preceyes. The system, which has CE marking and is being evaluated at five surgical sites in Europe, is designed to support retina surgeons in inserting and manipulating instruments in the posterior chamber of the eye. It is guided by positioning commands the surgeon provides through an intuitive motion controller.

At the Futures Forum, Gerrit Naus, CEO of Preceyes, described clinical experience in using the system in epiretinal membrane (ERM) and internal limiting membrane (ILM) peeling, dye staining and removal, and light pipe positioning.

He said a clinical trial conducted at the Glostrup Hospital in the Netherlands showed that the robot improved accuracy in common tasks by increasing reproducibility, broadening access, and improving performance.

Though the Preceyes system is commercially available in Europe, the Euro Retina panel members didn’t appear ready to embrace the technology, saying that further development and careful clinical evaluation are needed to validate the value of robotics over today’s conventional vitrectomy technology, according to Market Scope. 

Dr. De Juan pointed out that today’s robots don’t do the procedure better than today’s surgeons. He said today’s vitrectomy surgery maneuvers have been learned over years of experience.

Mr. Hallen summarized the opinion of the panel in pointing out that, while he wanted to have an open mind, the real question is, 'do we need vitrectomy robots?'

Nearly every panel member expressed concern over the cost of these devices. They pointed out that nearly all retinal practices perform vitrectomy, and few would be able to afford a robotic device. Several panel members spoke of the need for clinical evidence to support claimed advantages of robotic surgery over today’s vitrectomy outcomes.

There was consensus that certain key steps of vitrectomy should be the focus of robot development, rather than trying to create a robot that is designed to perform every step. For example, Dr. de Juan noted that addressing tremor and the ability of the surgeon to hold an instrument in very close proximity to the retina would be most valuable, commenting that it’s nearly impossible for surgeons to accomplish manually.

He described several future procedures—including subretinal administration of gene therapy—that would benefit from being able to place an instrument at a precise location on or beneath the retina. He summarized his thoughts by suggesting that at some point retina specialists might need robots, but right now it’s “a solution looking for an application.”

It seemed clear from the comments made by the panelists that, while robotic vitrectomy shows great potential, its adoption is unlikely to occur in the foreseeable future.

Market Scope’s Q4-2021 Survey of US Retina Specialists asked respondents how long they thought it would take for robotic vitrectomy to become commercialized. Nearly 54 percent said they thought it would take more than 10 years; and over 21 percent thought it would take 7 to 10 years.

Market Scope also wanted to know which parts of the robotic procedure were most likely to be automated. Laser application, trocar, and light source placement were the most frequently chosen procedures. Membrane peeling, vitreous removal, and vitrectomy probe placement were also mentioned.

The potential impact of robotic retinal surgery is among several key trends examined in Market Scope’s “2022 Retinal Surgical Device Market Report.”

Vitrectomy is the most common invasive procedure performed by retina specialists. Market Scope estimates that nearly 1.8 million vitrectomy procedures will be performed globally in 2022. Market Scope projects that revenue for retina surgical products will total $1.15 billion in 2022, growing to $1.5 billion by 2027.

The main product categories in this segment are vitrectomy machines, dedicated machine packs, and vitrectomy accessories. Included in the accessories are cryosurgical consoles and probes, illuminator modules and fibers, scleral buckles, silicone oil, ocular gas, retinal dyes, and dedicated retinal surgical instruments.

Market Scope’s “2022 Retinal Surgical Device Market Report” was published in February.