Awareness and Constraints towards the Implementation of Green Dentistry amongst Dental Students and Private Practitioners of West India.

Background: Dentistry is a resource-intensive discipline of healthcare that has a notable impact on the environment. Sustainability should be the major consideration for healthcare service providers to support climate change policies. Green dentistry is an efficient strategy for practicing eco-friendly dentistry. This study was conducted to assess the awareness, knowledge, and barriers to practicing green dentistry among dental practitioners and dental students. Materials and Methods: A cross-sectional, descriptive-analytical online questionnaire survey with 22 questions was carried out. Results: 51.8% of participants were not aware of the concept of green dentistry. Practitioners of the age group 20-30 years are more willing to transform their dental practice into green practice to reduce the carbon footprint of their clinic (P < 0.05). Chi-square data analysis shows that dental practitioners treating more than 20 patients in a week have a better awareness of the concept of green dentistry (P < 0.05). Conclusion: Within the limitations of this study, dental professionals in the younger age group are eager to transform their dental practices to green practices to lessen their clinics' carbon footprints. Financial constraints limit the implementation of green dentistry into clinical practice.

Design of SmartWalk for Estimating Implication of Pathway With Turn and Task Condition on Postural and Gait Indices: Relevance to Fear of Fall.

Fear of Fall (FoF) is often associated with postural and gait abnormalities leading to decreased mobility in individuals with Parkinson's Disease (PD). The variability in knee flexion (postural index) during heel-strike and toe-off events while walking can be related to one's FoF. Depending on the progression of the disease, gait abnormality can be manifested as start/turn/stop hesitation, etc. adversely affecting one's cadence along with an inability to transfer weight from one leg to the other. Also, task demands can have implications on one's gait and posture. Given that individuals with PD often suffer from FoF and their dynamic balance is affected by task conditions and pathways, in- depth investigation is warranted to understand the implications of task condition and pathways on one's gait and posture. This necessitates use of portable, wearable device that can capture one's gait-related indices and knee flexion in free-living conditions. Here, we have designed a portable, wearable and cost-effective device (SmartWalk) comprising of instrumented Shoes integrated with knee flexion recorder units. Results of our study with age-matched groups of healthy individuals (GrpH) and those with PD (GrpPD) showed the potential of SmartWalk to estimate the implication of task condition, pathways (with and without turn) and pathway segments (straight and turn) on one's knee flexion and gait with relevance to FoF. The knee flexion and gait-related indices were found to strongly corroborate with clinical measure related to FoF, particularly for GrpPD, serving as pre-clinical inputs for clinicians.

Smart Wearable Device for Quantification of Risk of Fall: Exploring Role of Gait Phases and Knee Bending Angle for Parkinson's Patients.

Gait disturbances with falls are common among patients with Parkinson's disease. Falls commonly occur from slips while walking on pathways with turns. Gait phases namely Loading Response and Terminal Stance are linked with forward and backward slips. Also, postural deformities (connected with knee joint angles) are debilitating symptoms of Parkinson's patients and are related with falls. Here, we have focused on exploring the contribution of Loading Response and Terminal Stance to risk of fall along with the relevance of postural deformity (e.g., knee bending) while an individual walked overground on pathways (with 0° and 180° turn) under dual task condition. For this, we have used a wearable device consisting of a pair of Sensored shoes and Knee Bending Angle Recorder Units. The device was used to compute Coefficient of Variation of knee bending angle during different gait phases as an indicator of one's risk of fall that corroborated with clinical measure. Clinical Relevance- A study with age and gender matched healthy and Parkinson's individuals indicated the importance of Loading Response and pathway turn while assessing risk of fall. This can serve as important pre-clinical input while designing intervention paradigms.

Force-based Control for Safe Robot-assisted Retinal Interventions: In Vivo Evaluation in Animal Studies.

In recent years, robotic assistance in vitreoretinal surgery has moved from a benchtop environment to the operating rooms. Emerging robotic systems improve tool manoeuvrability and provide precise tool motions in a constrained intraocular environment and reduce/remove hand tremor. However, often due to their stiff and bulky mechanical structure, they diminish the perception of tool-to-sclera (scleral) forces, on which the surgeon relies, for eyeball manipulation. In this paper we measure these scleral forces and actively control the robot to keep them under a predefined threshold. Scleral forces are measured using a Fiber Bragg Grating (FBG) based force sensing instrument in an in vivo rabbit eye model in manual, cooperative robotic assistance with no scleral force control (NC), adaptive scleral force norm control (ANC) and adaptive scleral force component control (ACC) methods. To the best of our knowledge, this is the first time that the scleral forces are measured in an in vivo eye model during robot assisted vitreoretinal procedures. An experienced retinal surgeon repeated an intraocular tool manipulation (ITM) task 10 times in four in vivo rabbit eyes and a phantom eyeball, for a total of 50 repetitions in each control mode. Statistical analysis shows that the ANC and ACC control schemes restrict the duration of the undesired scleral forces to 4.41% and 14.53% as compared to 43.30% and 35.28% in manual and NC cases, respectively during the in vivo studies. These results show that the active robot control schemes can maintain applied scleral forces below a desired threshold during robot-assisted vitreoretinal surgery. The scleral forces measurements in this study may enable a better understanding of tool-to-sclera interactions during vitreoretinal surgery and the proposed control strategies could be extended to other microsurgery and robot-assisted interventions.

The Implication of Pathway Turn and Task Condition on Gait Quantified Using SmartWalk: Changes With Age and Parkinson's Disease With Relevance to Postural Strategy and Risk of Fall.

One's gait can be affected by aging, pathway with turns, task demands, etc., causing changes in gait-related indices and knee flexion (influencing posture). Walking on pathways with turns threatens stability, affecting one's gait-related indices and posture. The ability to overcome such deficits is compromised with age and neurological disorders, e.g., Parkinson's Disease (PD) leading to falls. Also, task demands imposed by single and dual-task (e.g., counting backward while walking) conditions affect the gait of individuals using different postural strategies varying with age and neurological disorder. Existing research has investigated either the effect of the pathway with turn or task condition on one's gait. However, none (to our knowledge) have explored the differentiated implications of the pathway with turn and task conditions on one's gait-related indices and knee flexion while walking. Our study had two phases with 30 participants. Phase 1 had healthy adults (young and old) and Phase 2 had age and gender-matched healthy elderly and individuals with Parkinson's disease (PD) who walked on pathways having turns under single and dual-task conditions. We analysed gait in terms of (i) gait-related indices (Phases 1 and 2) and (ii) knee flexion (Phase 2). Also, we analysed one's counting performance during dual task. One's gait-related indices and knee flexion were measured using a portable gait quantifier. The aim was to (i)understand whether both pathways with turn and task conditions are equally effective in affecting the gait of (a)individuals of varying ages and (b) gender-matched healthy older adults and individuals with PD, (ii)study variations of knee joint angles while walking on pathways having turns (under different task conditions) in terms of its clinical relevance, and (iii) explore the implication of pathway with turn on counting performance (with relevance to postural strategy) with varying age and PD. Results indicated that for the younger group, the task condition caused statistical variations in gait-related indices. For the older group, both pathways with turn and task conditions had statistical implications on gait-related indices. Additionally, individuals with PD demonstrated a higher variation in knee flexion than their healthy counterparts. Again, pathways with varying turns elicited variations in counting performance indicating different postural strategies being employed by the three groups.

Force and Velocity Based Puncture Detection in Robot Assisted Retinal Vein Cannulation: In-Vivo Study.

OBJECTIVE: Retinal vein cannulation is a technically demanding surgical procedure and its feasibility may rely on using advanced surgical robots equipped with force-sensing microneedles. Reliable detection of the moment of venous puncture is important, to either alert or prevent the clinician from double puncturing the vessel and damaging the retinal surface beneath. This paper reports the first in-vivo retinal vein cannulation trial on rabbit eyes, using sensorized metal needles, and investigates puncture detection. METHODS: We utilized total of four indices including two previously demonstrated ones and two new indices, based on the velocity and force of the needle tip and the correlation between the needle-tissue and tool-sclera interaction forces. We also studied the effect of detection timespan on the performance of detecting actual punctures. RESULTS: The new indices, when used in conjunction with the previous algorithm, improved the detection rate form 75% to 92%, but slightly increased the number of false detections from 37 to 43. Increasing the detection window improved the detection performance, at the cost of adding to the delay. CONCLUSION: The current algorithm can supplement the surgeons' visual feedback and surgical judgment. To achieve automatic puncture detection, more measurements and further analysis are required. Subsequent in-vivo studies in other animals, such as pigs with their more human like eye anatomy, are required, before clinical trials. SIGNIFICANCE: The study provides promising results and the criteria developed may serve as guidelines for further investigation into puncture detection in in-vivo retinal vein cannulation.

MRI-guided lumbar spinal injections with body-mounted robotic system: cadaver studies.

INTRODUCTION: This paper reports the system integration and cadaveric assessment of a body-mounted robotic system for MRI-guided lumbar spine injections. The system is developed to enable MR-guided interventions in closed bore magnet and avoid problems due to patient movement during cannula guidance. MATERIAL AND METHODS: The robot is comprised by a lightweight and compact structure so that it can be mounted directly onto the lower back of a patient using straps. Therefore, it can minimize the influence of patient movement by moving with the patient. The MR-Conditional robot is integrated with an image-guided surgical planning workstation. A dedicated clinical workflow is created for the robot-assisted procedure to improve the conventional freehand MRI-guided procedure. RESULTS: Cadaver studies were performed with both freehand and robot-assisted approaches to validate the feasibility of the clinical workflow and to assess the positioning accuracy of the robotic system. The experiment results demonstrate that the root mean square (RMS) error of the target position to be 2.57 ± 1.09 mm and of the insertion angle to be 2.17 ± 0.89°. CONCLUSION: The robot-assisted approach is able to provide more accurate and reproducible cannula placements than the freehand procedure, as well as to reduce the number of insertion attempts.

Wearable Technology for Evaluation of Risk of Falls.

One's risk of fall can be quantified in terms of variability in one's gait, reflecting a loss of automatic rhythm of one's gait. In gait analysis, variability is commonly understood in terms of the fluctuation in the kinematic, kinetic, spatio-temporal, or physiological information. Here, we have focused on the estimation of knee joint angle (kinematic variable) synchronized with some of the kinetic and spatio-temporal gait parameters while an individual walked overground. Our system consisted of a pair of shoes with instrumented insoles and knee flexion/extension recorder unit having bend sensors. In addition, we have used the Coefficient of Variation for estimating the variability in the knee flexion/extension angle while walking overground as an indicator of the risk of fall. A study with healthy individuals (young and old) walking overground on pathways having 00 and 1800 turning angles indicated the feasibility of our wearable system to compute the variability in knee flexion/extension angle as an indicator of the risk of fall.

An Integrated High-dexterity Cooperative Robotic Assistant for Intraocular Micromanipulation.

Retinal surgeons are required to manipulate multiple surgical instruments in a confined intraocular space, while the instruments are constrained at the small incisions made on the sclera. Furthermore, physiological hand tremor can affect the precision of the instrument motion. The Steady-Hand Eye Robot (SHER), developed in our previous study, enables tremor-free tool manipulation by employing a cooperative control scheme whereby the surgeon and robot can co-manipulate the surgical instruments. Although SHER enables precise and tremor-free manipulation of surgical tools, its straight and rigid structure imposes certain limitations, as it can only approach a target on the retina from one direction. As a result, the instrument could potentially collide with the eye lens when attempting to access the anterior portion of the retina. In addition, it can be difficult to approach a target on the retina from a suitable direction when accessing its anterior portion for procedures such as vein cannulation or membrane peeling. Snake-like robots offer greater dexterity and allow access to a target on the retina from suitable directions, depending on the clinical task at hand. In this study, we present an integrated, high-dexterity, cooperative robotic assistant for intraocular micromanipulation. This robotic assistant comprises an improved integrated robotic intraocular snake (I2RIS) with a user interface (a tactile switch or joystick unit) for the manipulation of the snake-like distal end and the SHER, with a detachable end-effector to which the I2RIS can be attached. The integrated system was evaluated through a set of experiments wherein subjects were requested to touch or insert into randomly-assigned targets. The results indicate that the high-dexterity robotic assistant can touch or insert the tip into the same target from multiple directions, with no significant increase in task completion time for either user interface.

Stochastic Force-based Insertion Depth and Tip Position Estimations of Flexible FBG-Equipped Instruments in Robotic Retinal Surgery.

Vitreoretinal surgery is among the most delicate surgical tasks during which surgeon hand tremor may severely attenuate surgeon performance. Robotic assistance has been demonstrated to be beneficial in diminishing hand tremor. Among the requirements for reliable assistance from the robot is to provide precise measurements of system states e.g. sclera forces, tool tip position and tool insertion depth. Providing this and other sensing information using existing technology would contribute towards development and implementation of autonomous robot-assisted tasks in retinal surgery such as laser ablation, guided suture placement/assisted needle vessel cannulation, among other applications. In the present work, we use a state-estimating Kalman filtering (KF) to improve the tool tip position and insertion depth estimates, which used to be purely obtained by robot forward kinematics (FWK) and direct sensor measurements, respectively. To improve tool tip localization, in addition to robot FWK, we also use sclera force measurements along with beam theory to account for tool deflection. For insertion depth, the robot FWK is combined with sensor measurements for the cases where sensor measurements are not reliable enough. The improved tool tip position and insertion depth measurements are validated using a stereo camera system through preliminary experiments and a case study. The results indicate that the tool tip position and insertion depth measurements are significantly improved by 77% and 94% after applying KF, respectively.

A Case of Anomalous Left Anterior Descending Artery Originating From the Right Sinus of Valsalva.

The anomalous origin of coronary arteries has been extensively documented in the literature. Most of the anomalies are incidentally found either during coronary angiography or imaging studies and are usually benign; however, malignant outcomes have been reported in the literature. Here, we present the case of a 76-year-old male with non-ST segment elevation myocardial infarction who was found to have an asymptomatic anomalous origin left anterior descending artery from the right sinus of Valsalva.

A Fully Actuated Robotic Assistant for MRI-Guided Precision Conformal Ablation of Brain Tumors.

This paper reports the development of a fully actuated robotic assistant for magnetic resonance imaging (MRI)-guided precision conformal ablation of brain tumors using an interstitial high intensity needle-based therapeutic ultrasound (NBTU) ablator probe. The robot is designed with an eight degree-of-freedom (DOF) remote center of motion (RCM) manipulator driven by piezoelectric actuators, five for aligning the ultrasound thermal ablator to the target lesions and three for inserting and orienting the ablator and its cannula to generate a desired ablation profile. The 8-DOF fully actuated robot can be operated in the scanner bore during imaging; thus, alleviating the need of moving the patient in or out of the scanner during the procedure, and therefore potentially reducing the procedure time and streamlining the workflow. The free space positioning accuracy of the system is evaluated with the OptiTrack motion capture system, demonstrating the root mean square (RMS) error of the tip position to be 1.11±0.43mm. The system targeting accuracy in MRI is assessed with phantom studies, indicating the RMS errors of the tip position to be 1.45±0.66mm and orientation to be 1.53±0.69°. The feasibility of the system to perform thermal ablation is validated through a preliminary ex-vivo tissue study with position error less than 4.3mm and orientation error less than 4.3°.

Body-Mounted Robotic System for MRI-Guided Shoulder Arthrography: Cadaver and Clinical Workflow Studies.

This paper presents an intraoperative MRI-guided, patient-mounted robotic system for shoulder arthrography procedures in pediatric patients. The robot is designed to be compact and lightweight and is constructed with nonmagnetic materials for MRI safety. Our goal is to transform the current two-step arthrography procedure (CT/x-ray-guided needle insertion followed by diagnostic MRI) into a streamlined single-step ionizing radiation-free procedure under MRI guidance. The MR-conditional robot was evaluated in a Thiel embalmed cadaver study and healthy volunteer studies. The robot was attached to the shoulder using straps and ten locations in the shoulder joint space were selected as targets. For the first target, contrast agent (saline) was injected to complete the clinical workflow. After each targeting attempt, a confirmation scan was acquired to analyze the needle placement accuracy. During the volunteer studies, a more comfortable and ergonomic shoulder brace was used, and the complete clinical workflow was followed to measure the total procedure time. In the cadaver study, the needle was successfully placed in the shoulder joint space in all the targeting attempts with translational and rotational accuracy of 2.07 ± 1.22 mm and 1.46 ± 1.06 degrees, respectively. The total time for the entire procedure was 94 min and the average time for each targeting attempt was 20 min in the cadaver study, while the average time for the entire workflow for the volunteer studies was 36 min. No image quality degradation due to the presence of the robot was detected. This Thiel-embalmed cadaver study along with the clinical workflow studies on human volunteers demonstrated the feasibility of using an MR-conditional, patient-mounted robotic system for MRI-guided shoulder arthrography procedure. Future work will be focused on moving the technology to clinical practice.

Adaptive Control Improves Sclera Force Safety in Robot-Assisted Eye Surgery: A Clinical Study.

The integration of robotics into retinal microsurgery leads to a reduction in surgeon perception of tool-to-tissue interaction forces. This blunting of human tactile sensory input, which is due to the inflexible mass and large inertia of the robotic arm as compared to the milli-Newton scale of the interaction forces and fragile tissues during ophthalmic surgery, identifies a potential iatrogenic risk during robotic eye surgery. In this paper, we aim to evaluate two variants of an adaptive force control scheme implemented on the Steady-Hand Eye Robot (SHER) that are intended to mitigate the risk of unsafe scleral forces. The present study enrolled ten retina fellows and ophthalmology residents into a simulated procedure, which simply asked the trainees to follow retinal vessels in a model retina surgery environment. For this purpose, we have developed a force-sensing (equipped with Fiber Bragg Grating (FBG)) instrument to attach to the robot. A piezo-actuated linear stage for creating random lateral motions to the eyeball phantom has been provided to simulate disturbances during surgery. The SHER and all of its dependencies were set up in an operating room in the Wilmer Eye Institute at the Johns Hopkins Hospital. The clinicians conducted robot-assisted experiments with the adaptive controls incorporated as well as freehand manipulations. The results indicate that the Adaptive Norm Control (ANC) method, is able to maintain scleral forces at predetermined safe levels better than even freehand manipulations. Novice clinicians in robot training however, subjectively preferred freehand maneuvers over robotic manipulations. Clinician preferences once highly skilled with the robot is not assessed in this study.

Spotlight-based 3D Instrument Guidance for Autonomous Task in Robot-assisted Retinal Surgery.

Retinal surgery is known to be a complicated and challenging task for an ophthalmologist even for retina specialists. Image guided robot-assisted intervention is among the novel and promising solutions that may enhance human capabilities during microsurgery. In this paper, a novel method is proposed for 3D navigation of a microsurgical instrument based on the projection of a spotlight during robot-assisted retinal surgery. To test the feasibility and effectiveness of the proposed method, a vessel tracking task in a phantom with a Remote Center of Motion (RCM) constraint is performed by the Steady-Hand Eye Robot (SHER). The results are compared to manual tracking, cooperative control tracking with the SHER and spotlight-based automatic tracking with SHER. The reported results are that the spotlight-based automatic tracking with SHER can reach an average tracking error of 0.013 mm and keeping distance error of 0.1 mm from the desired range demonstrating a significant improvement compared to manual or cooperative control methods alone.

Automatic Light Pipe Actuating System for Bimanual Robot-Assisted Retinal Surgery.

Retinal surgery is a bimanual operation in which surgeons operate with an instrument in their dominant hand (more capable hand) and simultaneously hold a light pipe (illuminating pipe) with their non-dominant hand (less capable hand) to provide illumination inside the eye. Manually holding and adjusting the light pipe places an additional burden on the surgeon and increases the overall complexity of the procedure. To overcome these challenges, a robot-assisted automatic light pipe actuating system is proposed. A customized light pipe with force-sensing capability is mounted at the end effector of a follower robot and is actuated through a hybrid force-velocity controller to automatically illuminate the target area on the retinal surface by pivoting about the scleral port (incision on the sclera). Static following-accuracy evaluation and dynamic light tracking experiments are carried out. The results show that the proposed system can successfully illuminate the desired area with negligible offset (the average offset is 2.45 mm with standard deviation of 1.33 mm). The average scleral forces are also below a specified threshold (50 mN). The proposed system not only can allow for increased focus on dominant hand instrument control, but also could be extended to three-arm procedures (two surgical instruments held by surgeon plus a robot-holding light pipe) in retinal surgery, potentially improving surgical efficiency and outcome.

A Comparison of Manual and Robot Assisted Retinal Vein Cannulation in Chicken Chorioallantoic Membrane.

Retinal vein occlusion (RVO) is a vision threatening condition occurring in the central or the branch retinal veins. Risk factors include but are not limited to hypercoagulability, thrombus or other cause of low blood flow. Current clinically proven treatment options limit complications of vein occlusion without treating the causative occlusion. In recent years, a more direct approach called Retinal Vein Cannulation (RVC) has been explored both in animal and human eye models. Though RVC has demonstrated potential efficacy, it remains a challenging and risky procedure that demands precise needle manipulation to achieve safely. During RVC, a thin cannula (diameter 70-110 µm) is delicately inserted into a retinal vein. Its intraluminal position is maintained for up to 2 minutes while infusion of a therapeutic drug occurs. Because the tool-tissue interaction forces at the needle tip are well below human tactile perception, a robotic assistant combined with a force sensing microneedle could alleviate the challenges of RVC. In this paper we present a comparative study of manual and robot assisted retinal vein cannulation in chicken chorioallantoic membrane (CAM) using a force sensing microneedle tool. The results indicate that the average puncture force and average force during the infusion period are larger in manual mode than in robot assisted mode. Moreover, retinal vein cannulation was more stable during infusion, in robot assisted mode.

Scleral Force Evaluation During Vitreoretinal Surgery: in an In Vivo Rabbit Eye Model.

During vitreoretinal surgery, the surgeon is required to precisely manipulate multiple tools in a confined intraocular environment, while the tool tip to retina contact forces are at the limit of human sensation limits. During typical vitrectomy procedures, the surgeon inserts various tools through small incisions performed on the sclera of the eye (sclerotomies), and manipulates them to perform surgical tasks. During intraocular procedures, tool-tissue interactions occur at the sclerotomy ports and at the tool-tip when it contacts retina. Measuring such interactions may be valuable for providing force feedback necessary for robotic guidance. In this paper, we measure and analyze force measurements at the sclerotomy ports. To the best of our knowledge, this is the first time that the scleral forces are measured in an in vivo eye model. A force sensing instrument utilizing Fiber Bragg Grating (FBG) strain sensors was used to measure the scleral forces while two retinal surgeons performed intraocular tool manipulation (ITM) task in rabbit eyes as well as a dry phantom. The mean of the measured sclera forces were 129.11 mN and 80.45 mN in in vivo and dry phantom experiments, respectively.

Robotic Retinal Surgery Impacts on Scleral Forces: In Vivo Study.

Purpose: This study aims to map force interaction between instrument and sclera of in vivo rabbits during retinal procedures, and verify if a robotic active force control could prevent unwanted increase of forces on the sclera. Methods: Experiments consisted in the performance of intraocular movements of a force sensing instrument, adjacent to the retinal surface, in radial directions, from the center to the periphery and back, and compared manual manipulations with robotic assistance and also robotic assistance with an active force control. This protocol was approved by the Animal Use and Ethical Committee and experiments were according to ARVO Statement of Animal Use. Results: Mean forces using manual manipulations were 115 ± 51 mN. Using robotic assistance, mean forces were 118 ± 49 mN. Using an active force control method, overall mean forces reduced to 69 ± 15, with a statistical difference compared with other methods (P < 0.001). Comparing intraocular directions, superior sector required higher forces and the force control method reduced differences in forces between users and retained the same force pattern between them. Conclusions: Results validate that the introduction of robotic assistance might increase the dynamic interactions between instrument and sclera, and the addition of an active force control method reduces the forces at levels lower than manual manipulations. Translational Relevance: All marketing benefits from extreme accuracy and stability from robots, however, redundancy of safety mechanisms during intraocular manipulations, especially on force control and surgical awareness, would allow all utility of robotic assistance in ophthalmology.

Hybrid Robot-assisted Frameworks for Endomicroscopy Scanning in Retinal Surgeries.

High-resolution real-time intraocular imaging of retina at the cellular level is very challenging due to the vulnerable and confined space within the eyeball as well as the limited availability of appropriate modalities. A probe-based confocal laser endomicroscopy (pCLE) system, can be a potential imaging modality for improved diagnosis. The ability to visualize the retina at the cellular level could provide information that may predict surgical outcomes. The adoption of intraocular pCLE scanning is currently limited due to the narrow field of view and the micron-scale range of focus. In the absence of motion compensation, physiological tremors of the surgeons' hand and patient movements also contribute to the deterioration of the image quality. Therefore, an image-based hybrid control strategy is proposed to mitigate the above challenges. The proposed hybrid control strategy enables a shared control of the pCLE probe between surgeons and robots to scan the retina precisely, with the absence of hand tremors and with the advantages of an image-based auto-focus algorithm that optimizes the quality of pCLE images. The hybrid control strategy is deployed on two frameworks - cooperative and teleoperated. Better image quality, smoother motion, and reduced workload are all achieved in a statistically significant manner with the hybrid control frameworks.