Image-Guided Cataract Surgery
RIGS — the Refractive Image Guidance System — brings digitally planned, image-guided precision to cataract surgery. It builds a surgical blueprint unique to your eye and tracks it live through the operating microscope. RIGS is a precision add-on that pairs with either approach: standard manual surgery or laser-assisted ReLACS.
A digital surgical plan, unique to your eye
The Refractive Image Guidance System (RIGS) is an advanced digital planning and intraoperative guidance platform that brings image-guided precision to every phase of cataract surgery — without changing the surgery itself. It is best understood not as a different operation, but as a layer of precision added on top of the operation you and your surgeon already plan.
Before surgery, a high-resolution image of your eye captures the anatomical landmarks that make it unmistakably yours — scleral vessels, iris patterns, the contour of the limbus, and the characteristics of the pupil. Together these create a detailed “fingerprint” that no two eyes share. Your surgeon uses that fingerprint to build a customized surgical plan: precise incision locations calculated to reduce astigmatism, an optimal lens orientation matched to your corneal anatomy, and a step-by-step roadmap tailored to your visual goals.
That digital plan then travels electronically from the clinic to the operating room, eliminating the manual re-entry of measurements that can introduce transcription errors. During surgery, the RIGS platform projects a real-time digital overlay directly into the operating microscope. The overlay tracks your eye continuously and automatically compensates for the natural rotation — called cyclotorsion — that occurs as you move from sitting upright to lying down. Your surgeon sees the planned incision axes, lens-alignment targets, and capsulorhexis guidance superimposed on a live view of your eye, turning a mental surgical plan into a visible, trackable guide.
The result is measurably more accurate incision placement, more precise lens alignment — especially important for toric and other premium lenses — and a consistent, reproducible approach that reduces the variability inherent in traditional manual technique. The cataract is still removed and the new lens still implanted exactly as in any cataract surgery; RIGS simply guides each step with digital precision.
Where this page fits. RIGS is a precision add-on, not a separate operation. For the complete picture of cataract surgery — when it is time, the surgical approaches, lens choices, and what the experience is like — start with our cataract surgery guide. To compare the surgical approaches RIGS can guide, see laser cataract surgery, and to explore the lenses it helps align, see our lens options guide.
How RIGS guides your surgery
RIGS integrates three distinct phases into a single seamless workflow. Each phase builds on the last, so that by the time your surgeon begins operating, every critical decision has been digitally planned and verified.
| 1 | Image — preoperative captureA high-resolution reference image of your eye is captured while you sit upright at the RIGS unit. The system simultaneously measures corneal curvature (keratometry) and pupil dimensions, and maps the unique anatomical landmarks that serve as registration points during surgery. This non-invasive scan takes only a few moments and requires no dilation. |
| 2 | Plan — the digital surgical blueprintUsing the captured measurements and image data, your surgeon creates a fully customized surgical plan. The system calculates the ideal corneal incision placement to reduce astigmatism, determines the optimal axis for toric lens alignment, and maps the capsulotomy and lens-centration targets. Multiple lens-power formulas are available within the platform, letting your surgeon cross-verify the best lens power for your eye. |
| 3 | Guide — the intraoperative overlayIn the operating room, RIGS projects the surgical plan as a real-time digital overlay into the operating microscope. As your eye is tracked continuously, the overlay automatically adjusts for any rotation or movement, keeping incision axes and lens-alignment markers precisely positioned throughout surgery. Your surgeon follows the digital guide to place incisions, centre the capsulorhexis, and align the lens — with image-guided verification rather than manual estimation. |
Why it matters: digital tracking instead of ink
Traditional cataract surgery often relies on hand-drawn ink marks on the cornea to guide incision placement and lens alignment. Those marks are workable in skilled hands, but they are subject to smudging, migration, and parallax error. RIGS replaces ink with a continuously tracked digital overlay — a fundamentally more reproducible approach. Published studies of image-guided alignment report toric lens positioning within roughly one to three degrees of the intended axis, compared with about three to five degrees using manual ink-marking. For a lens whose optics depend on its rotational position, a few degrees can be the difference between a result that is good and one that is excellent.
From your side of the experience, none of this changes how surgery feels. The cataract is removed and the lens implanted in the usual way, in the same surgical visit. What changes is the precision of the planning and the execution behind the scenes. The full surgery-day experience — arrival to going home — is walked through in Your Cataract Surgery Journey.
Why choose image guidance?
RIGS delivers measurable improvements in surgical accuracy and lens performance. These advantages are most meaningful when paired with premium lenses, where even small alignment errors can affect the quality of vision.
Precise lens alignment
Toric and multifocal lenses must sit at exact axis orientations to function as designed. RIGS provides real-time alignment tracking, helping your surgeon place the lens within roughly one to three degrees of the intended axis — more accurate than manual ink-based technique.
Cyclotorsion compensation
When you lie down for surgery, your eyes naturally rotate — an effect called cyclotorsion that can shift the intended axis of a toric lens. RIGS detects and compensates for this rotation automatically, holding the accuracy of the preoperative plan throughout the procedure.
Optimized incision placement
The system calculates and displays the ideal corneal incision location to minimize surgically induced astigmatism. Rather than relying on visual estimation, your surgeon places each incision at a digitally verified position based on your unique corneal topography.
Seamless data transfer
Your measurements, reference image, and surgical plan transfer electronically from the clinic to the operating room. This removes the manual re-entry of patient data between systems — a common source of transcription error that can affect surgical accuracy.
Outcomes tracking
RIGS maintains a record of postoperative results, allowing the surgical team to continuously refine its approach. This feedback loop supports the evidence-based, research-led methodology that underpins care at Uptown Eye Specialists.
RIGS and ReLACS: better together
RIGS and UltraView ReLACS are complementary technologies that address different aspects of cataract surgery. Understanding how they work together helps clarify the range of options available to you — and why one is never simply a substitute for the other.
ReLACS — the laser that cuts
- A femtosecond laser that physically performs key surgical steps
- Creates blade-free corneal incisions to a mapped plan
- Makes a precise, circular capsulotomy — the opening in the lens capsule
- Pre-softens and divides the cataract before removal
- Replaces manual cutting with laser precision
RIGS — the overlay that guides
- A digital planning and guidance overlay, not a cutting instrument
- Projects a real-time visual map of the surgical plan into the microscope
- Tracks the eye and compensates for rotation throughout surgery
- Guides incision placement and lens alignment with digital verification
- Ensures every step — by laser or by hand — follows the digital plan
Which combination is right for you?
Because RIGS guides and ReLACS cuts, they are not rival choices — they solve different parts of the same problem. RIGS can guide a standard manual surgery or a laser-assisted one; ReLACS can be used with or without the RIGS overlay. Each option has genuine clinical merit, and there is no single “best” choice for every patient. Your surgeon will recommend the approach that best fits your visual goals, your lens selection, and your eye’s anatomy during your consultation.
Patients choosing toric or other premium lenses tend to benefit most from RIGS, because precise alignment is essential for those lenses to deliver their full optical performance — and pairing RIGS with ReLACS brings together laser-precise cutting and digitally tracked guidance for the most comprehensive precision available. To understand the laser approach in depth, see laser cataract surgery and the technology behind it on the UltraView ReLACS page, and walk through the whole experience in Your Cataract Surgery Journey.
Is RIGS right for you?
RIGS can be added to any cataract surgery — standard manual or laser-assisted — but its clinical advantages are most significant for patients receiving premium lenses, where alignment precision directly affects the quality of vision. In plain terms: the more your lens plan depends on exact positioning, the more the digital guidance contributes.
These are the situations where the evidence for image guidance is strongest:
- A toric lens to correct astigmatism — where even a few degrees of misalignment reduces how well the correction works.
- A multifocal, EDOF, or trifocal-style lens — where centration and axis alignment shape the quality of vision at multiple distances.
- A Light Adjustable Lens or other premium lens — where precision during the initial placement sets the foundation for later fine-tuning.
- Significant corneal astigmatism — where precise incision placement is part of the correction.
- A preference for added confidence — a digitally verified surgical plan, tracked in real time through the microscope.
- Combining RIGS with UltraView ReLACS — for the most comprehensive image-guided cataract experience.
Important context. Standard cataract surgery without RIGS is safe, well-established, and delivers excellent outcomes for the great majority of patients. RIGS adds a layer of digital precision that is most clinically meaningful when premium lens alignment is involved. Your surgeon will recommend whether RIGS is appropriate based on your specific eye anatomy, your lens selection, and your visual goals — and if a standard approach serves you just as well, you will hear that plainly. Explore the full range in our lens options guide.
How coverage works in Ontario
Standard cataract surgery is an OHIP-insured procedure in Ontario — the consultation, the surgery, a standard monofocal lens, and medical follow-up are all covered by your provincial health insurance, and that pathway is complete, excellent care on its own. RIGS is an optional precision enhancement, like the other optional choices in cataract surgery, and it is discussed transparently in your consultation, where your surgeon can speak to your individual eyes and your specific plan rather than generalities. You will leave that conversation with a clear, written understanding of your plan before anything is decided, with all the time you need to consider it — complete information, zero pressure, always.
Image-guided surgery, guided by experience
A precision technology is only as good as the hands and judgment behind it. Image-guided cataract surgery at Uptown Eye Specialists is performed by the same team that developed our UltraView ReLACS program — the highest published refractive laser-assisted cataract surgery volume in Canada, anchored by a peer-reviewed series of more than 3,000 cases.
That depth matters here. Our surgeons are fellowship-trained, hospital-credentialed ophthalmologists experienced in both traditional manual and image-guided cataract surgery, and the practice carries on-site cornea, retina, and glaucoma expertise — so when an eye’s complexity extends beyond the cataract itself, the expertise is already in the building. RIGS is one more precision instrument in hands that have measured, published, and refined their results for over a decade.
Refractive Laser-Assisted Cataract Surgery versus Conventional Manual Surgery: Comparing Efficacy and Safety
Our group’s peer-reviewed comparison of laser-assisted and conventional manual surgery across more than 3,000 consecutive cases — among the most extensive such series ever published, and the highest published volume in Canada. It is the foundation of the same research-led, outcomes-tracking culture that informs how we plan and verify every image-guided procedure: adopt carefully, measure honestly, and let patients decide with complete information.
For referring optometrists
Community optometrists are the backbone of cataract care, and image-guided cases are co-managed with the same commitment as every cataract referral. No special process is needed to refer for RIGS — whether image guidance has a role is determined at our assessment, alongside the surgical approach and lens plan, so you do not need to decide candidacy before referring. A note is welcome when you suspect a premium-lens or astigmatism conversation, but it is not required.
Our co-management commitment is specific: you receive the consultation findings after assessment, the operative summary after surgery — including the approach used, whether image guidance was applied, the lens implanted, and its parameters — and the post-operative plan, so your patient’s record in your office is as complete as ours. Your patient returns to you for their long-term eye care, and we are always available to discuss a case before you refer. Visit our referring doctors page for referral forms, co-management protocols, and direct contact lines for urgent cases.
Common questions about image-guided cataract surgery
They do different jobs. ReLACS is a femtosecond laser that physically performs surgical steps — creating the corneal incisions, the capsulotomy, and pre-softening the cataract. RIGS is a digital planning and guidance system that projects a real-time surgical overlay into the microscope, ensuring precise incision placement and lens alignment. Put simply: ReLACS replaces manual cutting with laser cutting, while RIGS replaces manual estimation with digital tracking. They are complementary technologies that can be used independently or together, and your surgeon will recommend what suits your eye and your lens plan.
Standard cataract surgery is an OHIP-insured procedure in Ontario — the consultation, the surgery, a standard monofocal lens, and medical follow-up are all covered by your provincial health insurance, and that pathway is complete, excellent care. RIGS is an optional precision enhancement, like the other optional choices in cataract surgery, and it is discussed transparently in your consultation, where your surgeon can speak to your individual eyes and your specific plan rather than generalities. You will leave that conversation with a clear, written understanding of your plan before anything is decided, with all the time you need to consider it — complete information, zero pressure, always.
Not necessarily — each technology adds value on its own. RIGS is especially beneficial if you are receiving a toric or other premium lens, where alignment precision matters most. ReLACS is valued for its laser-guided incisions and reduced tissue trauma. Combining both provides the most comprehensive precision, but more is not automatically better for every eye. Your surgeon will recommend the combination that best serves your specific situation, your lens selection, and your visual goals — and will explain honestly why, either way.
No — RIGS does not change the surgical technique; it enhances it with digital guidance. The cataract is still removed and the new lens still implanted in the same way as any cataract surgery. What changes is the precision of the planning and execution: your surgeon has a continuously tracked digital overlay showing exactly where to place incisions and how to orient the lens, rather than relying on manual ink marks that can shift or smudge. From the patient’s side, the experience of surgery feels essentially the same.
RIGS can benefit any cataract surgery by improving incision-placement accuracy and reducing surgically induced astigmatism. That said, the clinical advantage is most pronounced with toric and premium lenses, where precise alignment directly affects the quality of vision. For a standard monofocal lens without astigmatism correction, the added precision of RIGS is often less impactful — and standard surgery serves those eyes excellently. Your surgeon will advise honestly whether image guidance is clinically meaningful for your specific situation, and will never recommend it simply because it is available.
RIGS itself does not introduce additional surgical risk — it is a guidance overlay, not a cutting instrument. The risks of cataract surgery remain the same whether or not RIGS is used. As with all cataract surgery, those include a small risk of infection, inflammation, bleeding, retinal detachment, and the possibility that your refractive outcome may differ from the target. These complications are uncommon, and your surgeon will discuss the risks that apply to your individual eye in full before you decide anything.
Ready to explore your options?
A comprehensive cataract evaluation will determine whether RIGS, ReLACS, or both align with your visual goals and lens selection. Ask your optometrist about a referral — or contact us to learn more — and you’ll receive complete, balanced information about every available approach, with our honest recommendation for your eyes. We see cataract patients across multiple Ontario locations throughout the Greater Toronto Area.