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Squint and cataract are major ocular disorders that majorly affect visual perception and interaction capability. This paper proposes a real-time video-based automated detection system for squint and cataract detection based on computer vision and image processing methods. The proposed system uses a media-pipe face-mesh (a 478-point facial landmark detection model) to extract geometric ocular features for multi-class squint classification. Simultaneously, The presence and severity cataract is estimated through grayscale intensity and histogram-based lens opacity analysis. The system records short video sequences with standard laptop or mobile cameras, which can be deployed at low costs and on a large scale. The experimental performance has shown great accuracy in the detection of squint (98.39%) and classification of cataract (96.90%). Besides automatic ocular analysis, the proposed framework is also made accessible for visual impairment inference which will be integrated with future adaptive user interface and Web accessibility systems for people with visual impairment.

Objective: To develop a low-cost automated cataract severity classification system operating on standard consumer-grade colour photographs of the eye, without specialised ophthalmic hardware. Methods: A hybrid framework was designed that fuses deep features from a Convolutional Neural Network (CNN) with five handcrafted Grey-Level Co-occurrence Matrix (GLCM) and intensity descriptors - mean intensity, uniformity, standard deviation, contrast, and energy - extracted from a Hough-circle-localised pupil Region of Interest (ROI). A multi-class Support Vector Machine (SVM) with Radial Basis Function (RBF) kernel classifies each image into one of four severity grades: normal, immature, mature, or hypermature cataract. Results: The proposed fused system achieved 95.0% accuracy, 93.8% sensitivity, and 96.1% specificity on an ophthalmologist-labelled test set drawn from 300 images (75 per class) collected at an ophthalmology clinic, outperforming texture-only (88.5%) and CNN-only (91.3%) baselines and surpassing recently published deep learning approaches. Conclusion: The CNN-GLCM-SVM fusion framework provides competitive four-class cataract grading without GPU acceleration or specialised c

In lens cataract, the clouding change in lens leads to a decline of transparency of part of the lens. There are three types of senile cataract: cortical cataract, nuclear cataract, and posterior/anterior sub-capsular cataract. The most common senile cataract is cortical cataract. For understanding cortical cataract, the pathology and the causing factors in cortical cataract are analyzed. The clouding change in senile cortical cataract begins from the edge of the lens and develops progressively to lens centre. The pathology of clouding change in cortical cataract is characterized by disruption of some lens fibers, swelling of some other fibers, and deposition of water between fibers. Based on the property of a lens fiber, we propose here a hypothesis on the mechanism of development of senile cortical cataract. I. Cortical cataract is triggered by disruption of a cortical lens fiber as a result of injury. The disrupted fiber will release water and crystallin proteins. II. Neighbor fibers can absorb this water due to high intracellular osmotic pressure (IOP) and become swollen. Swelling makes a fiber be stiff and have increased risk to disrupt when it is curved during the accommodatio

Cataract surgery is one of the most commonly performed surgeries worldwide, yet intraoperative complications such as iris prolapse, posterior capsule rupture (PCR), and vitreous loss remain major causes of adverse outcomes. Automated detection of such events could enable early warning systems and objective training feedback. In this work, we propose CataractCompDetect, a complication detection framework that combines phase-aware localization, SAM 2-based tracking, complication-specific risk scoring, and vision-language reasoning for final classification. To validate CataractCompDetect, we curate CataComp, the first cataract surgery video dataset annotated for intraoperative complications, comprising 53 surgeries, including 23 with clinical complications. On CataComp, CataractCompDetect achieves an average F1 score of 70.63%, with per-complication performance of 81.8% (Iris Prolapse), 60.87% (PCR), and 69.23% (Vitreous Loss). These results highlight the value of combining structured surgical priors with vision-language reasoning for recognizing rare but high-impact intraoperative events. Our dataset and code will be publicly released upon acceptance.

Automated analysis of surgical videos is crucial for improving surgical training, workflow optimization, and postoperative assessment. We introduce a CSMAE, Masked Autoencoder (MAE)-based pretraining approach, specifically developed for Cataract Surgery video analysis, where instead of randomly selecting tokens for masking, they are selected based on the spatiotemporal importance of the token. We created a large dataset of cataract surgery videos to improve the model's learning efficiency and expand its robustness in low-data regimes. Our pre-trained model can be easily adapted for specific downstream tasks via fine-tuning, serving as a robust backbone for further analysis. Through rigorous testing on a downstream step-recognition task on two Cataract Surgery video datasets, D99 and Cataract-101, our approach surpasses current state-of-the-art self-supervised pretraining and adapter-based transfer learning methods by a significant margin. This advancement not only demonstrates the potential of our MAE-based pretraining in the field of surgical video analysis but also sets a new benchmark for future research.

Surgical phase segmentation is central to computer-assisted surgery, yet robust models remain difficult to develop when labeled surgical videos are scarce. We study data-efficient phase segmentation for manual small-incision cataract surgery (SICS) through a controlled comparison of visual representations. To isolate representation quality, we pair each visual encoder with the same temporal model (MS-TCN++) under identical training and evaluation settings on SICS-155 (19 phases). We compare supervised encoders (ResNet-50, I3D) against large self-supervised foundation models (DINOv3, V-JEPA2), and use a cached-feature pipeline that decouples expensive visual encoding from lightweight temporal learning. Foundation-model features improve segmentation performance in this setup, with DINOv3 ViT-7B achieving the best overall results (83.4% accuracy, 87.0 edit score). We further examine cataract-domain transfer using unlabeled videos and lightweight adaptation, and analyze when it helps or hurts. Overall, the study indicates strong transferability of modern vision foundation models to surgical workflow understanding and provides practical guidance for low-label medical video settings. The

Cataract remains a leading cause of visual impairment worldwide, and early detection from retinal imaging is critical for timely intervention. We present a deep learning pipeline for cataract classification using the Ocular Disease Recognition dataset, containing left and right fundus photographs from 5000 patients. We evaluated CNNs, transformers, lightweight architectures, and knowledge-distilled models. The top-performing model, Swin-Base Transformer, achieved 98.58% accuracy and an F1-score of 0.9836. A distilled MobileNetV3, trained with Swin-Base knowledge, reached 98.42% accuracy and a 0.9787 F1-score with greatly reduced computational cost. The proposed dual-eye Siamese variant of the distilled MobileNet, integrating information from both eyes, achieved an accuracy of 98.21%. Explainability analysis using Grad-CAM demonstrated that the CNNs concentrated on medically significant features, such as lens opacity and central blur. These results show that accurate, interpretable cataract detection is achievable even with lightweight models, supporting potential clinical integration in resource-limited settings

Realistic surgical simulation plays a crucial role in training novice surgeons and in the development of autonomous agents. World models can scale such simulation environments to realistic and diverse procedures by predicting future patient states conditioned on current observations and surgical actions. However, current state-of-the-art approaches often fail to satisfy key criteria required for clinical applicability, including visual realism, physically grounded interactions, and the ability to simulate scenarios beyond the training distribution. Hence, we introduce SWoMo, a neuro-symbolic world model for cataract surgery simulation that decouples motion generation from visual realism. The symbolic component, consisting of a rule-based simulator and scene graph representations, models motion dynamics and tool-tissue interactions, while a diffusion model produces realistic visual appearance, including textures and tissue deformations. We propose an inverse pairing strategy that reconstructs real surgical videos in the simulator to obtain paired simulated and real videos, which are then used to train our video diffusion model for the reverse objective of sim-to-real translation. Ou

Active learning (AL) can reduce annotation costs in surgical video analysis while maintaining model performance. However, traditional AL methods, developed for images or short video clips, are suboptimal for surgical step recognition due to inter-step dependencies within long, untrimmed surgical videos. These methods typically select individual frames or clips for labeling, which is ineffective for surgical videos where annotators require the context of the entire video for annotation. To address this, we propose StepAL, an active learning framework designed for full video selection in surgical step recognition. StepAL integrates a step-aware feature representation, which leverages pseudo-labels to capture the distribution of predicted steps within each video, with an entropy-weighted clustering strategy. This combination prioritizes videos that are both uncertain and exhibit diverse step compositions for annotation. Experiments on two cataract surgery datasets (Cataract-1k and Cataract-101) demonstrate that StepAL consistently outperforms existing active learning approaches, achieving higher accuracy in step recognition with fewer labeled videos. StepAL offers an effective approac

The healthcare landscape is evolving, with patients seeking reliable information about their health conditions and available treatment options. Despite the abundance of information sources, the digital age overwhelms individuals with excess, often inaccurate information. Patients primarily trust medical professionals, highlighting the need for expert-endorsed health information. However, increased patient loads on experts has led to reduced communication time, impacting information sharing. To address this gap, we developed CataractBot. CataractBot answers cataract surgery related questions instantly using an LLM to query a curated knowledge base, and provides expert-verified responses asynchronously. It has multimodal and multilingual capabilities. In an in-the-wild deployment study with 49 patients and attendants, 4 doctors, and 2 patient coordinators, CataractBot demonstrated potential, providing anytime accessibility, saving time, accommodating diverse literacy levels, alleviating power differences, and adding a privacy layer between patients and doctors. Users reported that their trust in the system was established through expert verification. Broadly, our results could inform

Cataract surgery is the most common surgical procedure globally, with a disproportionately higher burden in developing countries. While automated surgical video analysis has been explored in general surgery, its application to ophthalmic procedures remains limited. Existing works primarily focus on Phaco cataract surgery, an expensive technique not accessible in regions where cataract treatment is most needed. In contrast, Manual Small-Incision Cataract Surgery (MSICS) is the preferred low-cost, faster alternative in high-volume settings and for challenging cases. However, no dataset exists for MSICS. To address this gap, we introduce Sankara-MSICS, the first comprehensive dataset containing 53 surgical videos annotated for 18 surgical phases and 3,527 frames with 13 surgical tools at the pixel level. We benchmark this dataset on state-of-the-art models and present ToolSeg, a novel framework that enhances tool segmentation by introducing a phase-conditional decoder and a simple yet effective semi-supervised setup leveraging pseudo-labels from foundation models. Our approach significantly improves segmentation performance, achieving a $23.77\%$ to $38.10\%$ increase in mean Dice sco

Real-time prediction of technical errors from cataract surgical videos can be highly beneficial, particularly for telementoring, which involves remote guidance and mentoring through digital platforms. However, the rarity of surgical errors makes their detection and analysis challenging using artificial intelligence. To tackle this issue, we leveraged videos from the EyeSi Surgical cataract surgery simulator to learn to predict errors and transfer the acquired knowledge to real-world surgical contexts. By employing deep learning models, we demonstrated the feasibility of making real-time predictions using simulator data with a very short temporal history, enabling on-the-fly computations. We then transferred these insights to real-world settings through unsupervised domain adaptation, without relying on labeled videos from real surgeries for training, which are limited. This was achieved by aligning video clips from the simulator with real-world footage and pre-training the models using pretext tasks on both simulated and real surgical data. For a 1-second prediction window on the simulator, we achieved an overall AUC of 0.820 for error prediction using 600$\times$600 pixel images,

Understanding the intricate workflows of cataract surgery requires modeling complex interactions between surgical tools, anatomical structures, and procedural techniques. Existing datasets primarily address isolated aspects of surgical analysis, such as tool detection or phase segmentation, but lack comprehensive representations that capture the semantic relationships between entities over time. This paper introduces the Cataract Surgery Scene Graph (CAT-SG) dataset, the first to provide structured annotations of tool-tissue interactions, procedural variations, and temporal dependencies. By incorporating detailed semantic relations, CAT-SG offers a holistic view of surgical workflows, enabling more accurate recognition of surgical phases and techniques. Additionally, we present a novel scene graph generation model, CatSGG, which outperforms current methods in generating structured surgical representations. The CAT-SG dataset is designed to enhance AI-driven surgical training, real-time decision support, and workflow analysis, paving the way for more intelligent, context-aware systems in clinical practice.

Computer-assisted surgery research requires large, deeply annotated video datasets that capture clinical and technical variability. Existing cataract surgery resources lack the diversity and annotation depth required to train generalizable deep-learning models. To address this gap, we present a dataset of 3,000 phacoemulsification cataract surgery videos acquired at two surgical centers from surgeons with varying expertise. The dataset provides four annotation layers: temporal surgical phases, instance segmentation of instruments and anatomical structures, instrument-tissue interaction tracking, and quantitative skill scores based on competency rubrics adapted from ICO-OSCAR and GRASIS. We demonstrate the technical utility of the dataset through benchmarking deep learning models across four tasks: workflow recognition, scene segmentation, instrument-tissue interaction tracking, and automated skill assessment. Furthermore, we establish a domain-adaptation baseline for phase recognition and instance segmentation by training on one surgical center and evaluating on a held-out center. Ultimately, these multi-source acquisitions, multi-layer annotations, and paired skill-kinematic label

To meet the growing demand for systematic surgical training, wet-lab environments have become indispensable platforms for hands-on practice in ophthalmology. Yet, traditional wet-lab training depends heavily on manual performance evaluations, which are labor-intensive, time-consuming, and often subject to variability. Recent advances in computer vision offer promising avenues for automated skill assessment, enhancing both the efficiency and objectivity of surgical education. Despite notable progress in ophthalmic surgical datasets, existing resources predominantly focus on real surgeries or isolated tasks, falling short of supporting comprehensive skill evaluation in controlled wet-lab settings. To address these limitations, we introduce WetCat, the first dataset of wet-lab cataract surgery videos specifically curated for automated skill assessment. WetCat comprises high-resolution recordings of surgeries performed by trainees on artificial eyes, featuring comprehensive phase annotations and semantic segmentations of key anatomical structures. These annotations are meticulously designed to facilitate skill assessment during the critical capsulorhexis and phacoemulsification phases,

Cataracts are the leading cause of vision loss worldwide. Restoration algorithms are developed to improve the readability of cataract fundus images in order to increase the certainty in diagnosis and treatment for cataract patients. Unfortunately, the requirement of annotation limits the application of these algorithms in clinics. This paper proposes a network to annotation-freely restore cataractous fundus images (ArcNet) so as to boost the clinical practicability of restoration. Annotations are unnecessary in ArcNet, where the high-frequency component is extracted from fundus images to replace segmentation in the preservation of retinal structures. The restoration model is learned from the synthesized images and adapted to real cataract images. Extensive experiments are implemented to verify the performance and effectiveness of ArcNet. Favorable performance is achieved using ArcNet against state-of-the-art algorithms, and the diagnosis of ocular fundus diseases in cataract patients is promoted by ArcNet. The capability of properly restoring cataractous images in the absence of annotated data promises the proposed algorithm outstanding clinical practicability.

Cataract is caused due to various factors such as age, trauma, genetics, smoking and substance consumption, and radiation. It is one of the major common ophthalmic diseases worldwide which can potentially affect iris-based biometric systems. India, which hosts the largest biometrics project in the world, has about 8 million people undergoing cataract surgery annually. While existing research shows that cataract does not have a major impact on iris recognition, our observations suggest that the iris segmentation approaches are not well equipped to handle cataract or post cataract surgery cases. Therefore, failure in iris segmentation affects the overall recognition performance. This paper presents an efficient iris segmentation algorithm with variations due to cataract and post cataract surgery. The proposed algorithm, termed as SegDenseNet, is a deep learning algorithm based on DenseNets. The experiments on the IIITD Cataract database show that improving the segmentation enhances the identification by up to 25% across different sensors and matchers.

In recent years, the landscape of computer-assisted interventions and post-operative surgical video analysis has been dramatically reshaped by deep-learning techniques, resulting in significant advancements in surgeons' skills, operation room management, and overall surgical outcomes. However, the progression of deep-learning-powered surgical technologies is profoundly reliant on large-scale datasets and annotations. Particularly, surgical scene understanding and phase recognition stand as pivotal pillars within the realm of computer-assisted surgery and post-operative assessment of cataract surgery videos. In this context, we present the largest cataract surgery video dataset that addresses diverse requisites for constructing computerized surgical workflow analysis and detecting post-operative irregularities in cataract surgery. We validate the quality of annotations by benchmarking the performance of several state-of-the-art neural network architectures for phase recognition and surgical scene segmentation. Besides, we initiate the research on domain adaptation for instrument segmentation in cataract surgery by evaluating cross-domain instrument segmentation performance in catara

Instructional cataract surgery videos are crucial for ophthalmologists and trainees to observe surgical details repeatedly. This paper presents a deep learning model for real-time identification of surgical instruments in these videos, using a custom dataset scraped from open-access sources. Inspired by the architecture of YOLOV9, the model employs a Programmable Gradient Information (PGI) mechanism and a novel Generally-Optimized Efficient Layer Aggregation Network (Go-ELAN) to address the information bottleneck problem, enhancing Minimum Average Precision (mAP) at higher Non-Maximum Suppression Intersection over Union (NMS IoU) scores. The Go-ELAN YOLOV9 model, evaluated against YOLO v5, v7, v8, v9 vanilla, Laptool and DETR, achieves a superior mAP of 73.74 at IoU 0.5 on a dataset of 615 images with 10 instrument classes, demonstrating the effectiveness of the proposed model.