A new generation of handheld devices is making cataract surgery viable where phaco machines can’t go.
Cataract may be an old adversary, but in many parts of the world, it still wins far too often. A new generation of technical wizardry and innovation, however, may be about to change that.
Modern phacoemulsification has transformed cataract surgery into a high-precision art, but it still remains out of reach for millions—blocked not by medicine, but by machinery, infrastructure and economics.
Elsa, a 41-year-old mother of four, was one of them. Blind for years, she arrived at a regional hospital near the Tanzania-Mozambique border with her baby, whom she had never seen, on her hip. The day after her cataract surgery, she was walking unaided, smiling, helping other patients and reclaiming her life.
“She had her confidence back,” said Dr. Susan MacDonald, co-founder of Eye Corps, the outreach organization that helped guide Elsa’s care. “It’s not just her life that changed—it’s the lives of her children.”
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Stories like Elsa’s give a glimpse not only into a critical gap in eye care delivery, but also the growing push to close it. And at the center of this push lies an emerging generation of portable, console-free devices and surgical innovations designed to bring cataract surgery to places where traditional surgery can’t go.
The infrastructure gap
In many parts of the world, the tools of modern cataract surgery simply don’t fit the environment.
“We lose our electricity,” said Dr. MacDonald of EyeCorps’ work in Tanzania. “We always have a backup generator.”
Electricity is just one among many resources that become scarce when eye care moves beyond major population centers. Engineers are scant. Consumables can be costly or impossible to restock. The list goes on.
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Dr. MacDonald’s team now travels with more than a dozen microscopes and slit lamps, each selected for portability and durability. “If something breaks, we need to ask: Can we repair it? Do we have the parts? The tools?”
In this landscape, every piece of equipment must earn its place through performance, portability, repairability and cost-effectiveness. High-tech phaco systems, with their consoles, foot pedals and single-use packs, often don’t make the cut.
This can lead to a compounding cycle where cataracts that aren’t treated early progress into more challenging surgeries, which require more sophisticated and unwieldy equipment to remove.
“These cataracts are ten times worse than anything I see in the U.S.,” said Dr. MacDonald.
When the environment limits what technology can be used, surgeons must adapt, rethinking both logistics and the very tools of surgery itself.
Rethinking the toolkit
If phacoemulsification is the gold standard, manual small-incision cataract surgeries (MSICS), like those that Dr. MacDonald performs in Tanzania, are the workhorse—quietly restoring sight where phaco machines can’t tread.
But a new category of devices is beginning to take shape in the space between: compact, handheld lens extraction systems that trade complexity for adaptability.
Rather than hauling in an entire operating theater, these emerging tools offer the promise of safe, efficient cataract removal in clinics, mobile units and regional hospitals, even in places where electricity is intermittent and supply chains unpredictable.
“Cataract surgery, unplugged,” as Dr. MacDonald puts it.
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For outreach teams working in mobile units or regional hospitals, having options matters. “Keeping it simple has allowed us to get excellent results and train surgeons who can then perform surgery on their own, in their own communities,” she said.
Sometimes, the right tool is the one that can travel.
Portable innovation in progress
While the category of console-free extractors is still emerging, a handful of portable devices are beginning to push cataract surgery beyond the OR. Among these is the ZEISS MICOR 700 (Carl Zeiss Meditec, Jena, Germany), which reimagines traditional lens extraction. Instead of relying on standard phacoemulsification, it uses a handheld lens removal system powered by sonic mechanical oscillation, eliminating cavitation and heat within the eye. The system also trades the foot pedal for fingertip control and uses a gravity-fed irrigation system with 25 to 50cc of BSS per case.
“I love the concept,” said Dr. Guillermo Amescua, who uses the device in dual-room workflows. Dr. Amescua is a professor of Clinical Ophthalmology and medical director of the Ocular Surface Program at the University of Miami Miller School of Medicine’s Bascom Palmer Eye Institute (Florida, USA). “You open the pack, everything’s sterile and it’s good to go. There’s less plastic than a typical phaco pack and the setup is fast.”
Two recent studies highlight its feasibility. In one, 665 cases showed a 0.45% capsular tear rate across a range of nuclear densities.1 Another found that surgical time improved with experience, and visual outcomes were comparable to standard phaco.2 While not suited for mature or leathery nuclei, handheld extractors may be ideal for pediatric cases, refractive lens exchange or settings where phaco is logistically impractical.
Other contenders are also appearing, each addressing a different facet of access. The CataRhex 3 surgical platform from Oertli (Berneck, Switzerland) is a highly portable phaco option that also has ab interno MIGS capabilities, delivering two-in-one functionality to remote settings. And while the Zepto system by Mynosys (California, USA) isn’t a full cataract removal device, it targets anterior capsulotomy with independence from femtosecond lasers.
For patients like Elsa, whose access to conventional phaco was limited by geography and circumstance, portable systems—whether phaco-based or manual—may provide a practical route to restored vision.
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Where handheld solutions shine…and stall
Not every surgery needs a symphony of machines. In some places, a reliable instrument, a steady hand and a bit of shade from the midday sun are what’s available—and what must suffice.
That’s where handheld, console-free devices may prove most valuable. Rural hospitals with patchy power, in-office procedures in emerging markets and mission-based outreach programs all stand to benefit from a simplified, power-light tool. A device that fits in a carry-on and runs on gravity-fed fluidics may not replace phaco, but in the right context, it might make cataract surgery—and sight restoration—possible.
For Dr. Ronald Yeoh (Medical Director, Founding Partner & Senior Consultant Ophthalmic Surgeon, Eye & Retina Surgeons, Singapore), however, these machines aren’t a panacea. “Handheld phaco devices would be challenged to do the harder, more mature cataracts,” he said, noting that both portable phaco systems and MSICS will likely remain the go-to solutions in outreach and mission work.
Beyond that, safe surgery requires structure. “You cannot perform cataract surgery safely without some OR infrastructure wherever you happen to be,” noted Dr. Yeoh, who recently completed an outreach camp in Bhutan. “The biggest challenge is logistics”, he said, including transporting supplies to ensuring the right IOL inventory makes it up the mountain.
Dr. MacDonald, who has tested handheld systems in Tanzania, sees promise but warns of a common pitfall. Education might be the key. “The technology is there, but without a structured program to teach it, adoption will stall,” she said. “We need to invest in training the trainers. That’s what creates sustainability.”
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Despite their promise, handheld cataract tools remain largely on the sidelines of surgical practice—even in the places where they could do the most good. It’s not because they lack potential, but because the system around them isn’t built for them.
Part of the answer lies in access. Some devices remain available only in select markets, and global expansion has been cautious. “It’s [MICOR 700] only in the U.S. right now,” noted Dr. Amescua. “They’re slowly training more reps and surgeons, but it takes time.”
As Dr. Yeoh notes, portable devices like MICOR 700 may have difficulties with complex cataracts. But for cases where this complexity is the result of years of waiting, early intervention holds the key.
Cost is another obstacle. Even simplified tools must prove affordable at scale in regions where the average income may not cover a single intraocular lens. For smaller companies, the financial risk of developing outreach-focused technology can be hard to justify.
There’s also inertia. Surgeons trained on phaco may see little incentive to switch, especially in the absence of strong data, reimbursement pathways or institutional support. And in low-resource settings, cost and training remain formidable hurdles.
“Technology alone isn’t enough,” said Dr. MacDonald. “We need structured programs that teach it, maintain it and adapt it to local needs.”
The device may be ready. The system around it often isn’t. But it can be built.
What the future needs
The next chapter in portable cataract care won’t be written by technology alone. It will require partnerships between industry and NGOs, between engineers and outreach teams, between innovation and context.
Trials in low- and middle-income countries, not just academic centers, will be essential to proving real-world value. Hybrid models that combine reusable and disposable components could help reduce costs, and collaborations between industry, nonprofits and governments may unlock new funding pathways.
Dr. MacDonald’s wish list is simple: “Equipment and education,” she said without hesitation. “And investment in local leadership. These countries aren’t just recipients—they’re emerging ophthalmic markets. Any company that sees that now will be a leader in the future.”
For Dr. MacDonald, every tool and partnership matters when the outcome is a mother like Elsa, seeing her youngest child for the first time and regaining the independence to guide others the very next day.
Phaco will remain the gold standard, but in places where the power cuts out and the sterilizer sits idle, a pocket-sized alternative could change the surgical map. For handheld solutions to succeed, they must do more than travel well. They must be teachable, sustainable and trusted, wherever the surgery takes place.
Editor’s Note: This content is intended exclusively for healthcare professionals. It is not intended for the general public. Products or therapies discussed may not be registered or approved in all jurisdictions, including Singapore.
References
- Ianchulev T, Yeu E, Hu EH, et al. First in-human clinical performance of a new non-cavitating handheld lensectomy system in 665 consecutive cataract surgeries. J Cataract Refract Surg. 2024;50(7):693–697.
- Beniz LA, Chatzea MS, Zarei-Ghanavati S, et al. Finger-controlled nonultrasonic lens extractor. J Cataract Refract Surg. 2025;51(1):60–65.