Age-related macular degeneration (AMD) is the most common cause of blindness in the industrialized world and ranks third as a cause of blindness on a global scale. This ophthalmic disease is a condition affecting elderly people and involves the loss of central vision until complete blindness. Many chronic ophthalmic diseases are currently treated by intravitreal therapy. Intravitreal injections have become one of the most frequently performed surgical procedures to the eye worldwide and are performed by ophthalmologists while regulations vary among countries, even within Europe. In many countries injections in the eye are performed in any designated room without specific requirements (e.g. USA). In Switzerland injections are performed in a sterile operating room (OR) under laminar airflow lowering the risk of complications due to reduced bacterial load in the injection environment. However, the increased safety comes at significant cost. Building expenses for an OR, maintenance and required OR staff is expensive.
This project aims at developing an automated system that injects medication intravitreally (into the vitreous humor of the eye). By providing a robotic injection system with an integrated local sterile environment and consumables to hospitals, we can increase safety for patients, decrease procedure times, allow for integrated data storage and documentation, and reduce costs for medical staff and expensive operating rooms. The intended system allows for a fully automated injection that is initiated via a computer and monitored by a remote ophthalmic surgeon via a visual-auditory communication system. As the injection needle is guided through software, including eye-tracking and iris recognition, the only component that touches the eye is the injection needle. Precision and safety are fundamental to the system design and do not depend on the manual dexterity of medical staff using a handheld system.
What is special about the project?
The decreasing reimbursement of physicians and hospitals in many European countries demands the development of safe, cost and time efficient treatment methods. The development of an automated system for intravitreal injections under sterile conditions, that accounts for patient safety, cost and time efficiency, changes the paradigm of treatment of AMD and other chronic ophthalmic diseases. Our system gives rise to a complete execution of an ophthalmic procedure by a robotic assistive system that is remotely controlled and monitored by an ophthalmic surgeon from outside the operation/injection room. Robot assisted intravitreal injections show great potential to support this routine and highly repetitive task and free high-value physician’s time for other high-value surgery.
Before the development of a robotic system for intravitreal injections was started, an extensive patent search was performed to understand the patent landscape in the field of assistive devices for ophthalmic treatment. The market for such a system was analyzed, which indicates the large and continuously increasing demand for intravitreal injections. During the Gebert Rüf Foundation – supported project, a novel pre-clinical prototype of a medical device capable of injecting into the eye has been developed and tested in close cooperation with ophthalmic surgeons, taking into account the standard of care, patient safety, patient acceptance, clinician acceptance, cost and time efficiency, as well as technological constraints. The system has been designed to allow for the integration of a local sterile environment around the patient’s head. Injection studies have been performed on cadaver pig eyes, which prove the functionality of the system.
Ullrich, F., Michels, S., Lehmann, D., Pieters, R. S., Becker, M., Nelson, B. J., Assistive Device for Efficient Intravitreal Injections. Ophthalmic Surgery, Lasers and Imaging Retina, 47, 8, (August 2016), 752-762;
Ullrich, F., Michels, S., Becker, M., Nelson, B.J., Automated Device for Intravitreal Injections. In German Society for Computer and Robot Assisted Surgery (CURAC) Annual Conference (Bern September 2016), 184-185.
Persons involved in the project
Dr. Franziska Ullrich
, project leader, Multi-Scale Robotics Lab, ETH ZürichRoman Ratnaweera
, Multi-Scale Robotics Lab, ETH ZürichRoland Dreyfus
, Multi-Scale Robotics Lab, ETH Zürich Prof. Bradley J. Nelson
, Multi-Scale Robotics Lab, ETH ZürichProf. Stephan Michels
, Augenklinik Stadtspital Triemli, ZürichProf. Matthias Becker
, Augenklinik Stadtspital Triemli, ZürichProf. Raphael Sznitman
, ARTORG, Universität BernHen-Wei Huang
, Multi-Scale Robotics Lab, ETH Zürich
Last update to this project presentation 18.11.2020