Semantic data and knowledge infrastructures must reconcile two fundamentally different forms of representation: natural language, in which most knowledge is created and communicated, and formal semantic models, which enable machine-actionable integration, interoperability, and reasoning. Bridging this gap remains a central challenge, particularly when full semantic formalization is required at the point of data entry. Here, we introduce the Semantic Ladder, an architectural framework that enables the progressive formalization of data and knowledge. Building on the concept of modular semantic units as identifiable carriers of meaning, the framework organizes representations across levels of increasing semantic explicitness, ranging from natural language text snippets to ontology-based and higher-order logical models. Transformations between levels support semantic enrichment, statement structuring, and logical modelling while preserving semantic continuity and traceability. This approach enables the incremental construction of semantic knowledge spaces, reduces the semantic parsing burden, and supports the integration of heterogeneous representations, including natural language, structured semantic models, and vector-based embeddings. The Semantic Ladder thereby provides a foundation for scalable, interoperable, and AI-ready data and knowledge infrastructures.

We present CataractSAM-2, a domain-adapted extension of Meta's Segment Anything Model 2, designed for real-time semantic segmentation of cataract ophthalmic surgery videos with high accuracy. Positioned at the intersection of computer vision and medical robotics, CataractSAM-2 enables precise intraoperative perception crucial for robotic-assisted and computer-guided surgical systems. Furthermore, to alleviate the burden of manual labeling, we introduce an interactive annotation framework that combines sparse prompts with video-based mask propagation. This tool significantly reduces annotation time and facilitates the scalable creation of high-quality ground-truth masks, accelerating dataset development for ocular anterior segment surgeries. We also demonstrate the model's strong zero-shot generalization to glaucoma trabeculectomy procedures, confirming its cross-procedural utility and potential for broader surgical applications. The trained model and annotation toolkit are released as open-source resources, establishing CataractSAM-2 as a foundation for expanding anterior ophthalmic surgical datasets and advancing real-time AI-driven solutions in medical robotics, as well as surgical video understanding.