Pharmaceutical focus Weekends are overrated
Pharmaceutical focus
Weekends are overrated
--------------------------------------------------------------------------------
The busiest cataract surgeon in Japan is also one of the most innovative. Takayuki Akahoshi, M.D., has been the director of ophthalmology at the Mitsui Memorial Hospital in Tokyo for 20 years. Internationally, he is best known for developing the prechop technique and instrumentation—a method that he has traveled worldwide to teach. He is also a pioneer of microcoaxial phaco, which has supplanted biaxial phaco as the most popular method of reducing incision size. When you meet him, he is incredibly humble and unassuming, and certainly does not have the ego that one might expect of such a brilliant surgeon. However, what has always amazed me the most is the grueling schedule that Taka keeps. It wasn't until I recruited him to write a textbook chapter that I learned that Taka literally works 7 days a week. Furthermore, most of us would take 3-4 days to see the number of patients or perform the number of surgeries that he performs in a single day. Most inspiring of all, however, is the fact that Taka works in a charity hospital for a very modest salary, which he supplements by working in a private clinic on his days off. He is the individual physician version of the Aravind economic model—operating on enough private paying patients to subsidize the majority of his time spent caring for the poor. I think you'll enjoy EyeWorld's interview with this amazing individual.
David F. Chang, M.D., chief medical editor
Dr. Akahoshi and Dr. Chang visit in Chicago at the 2012 ASCRS•ASOA Symposium & Congress
Dr. Akahoshi performs live surgery in Bangladesh Source: Takayuki Akahoshi, M.D.
An interview with Takayuki Akahoshi, M.D.
EyeWorld: Tell us about your very busy weekly schedule.
Dr. Akahoshi: My main job is to treat cataract patients. I operate 4 days at Mitsui, and the 3 other days of the week I work in my friend's private clinic. I perform about 8,000 surgeries per year.
The number of surgeries I do at Mitsui is 5,000, and I perform another 3,000 at the private clinic. I operate 6 days a week, and on Saturdays I see patients—nearly 100 patients a day.
EyeWorld: How long have you had this schedule?
Dr. Akahoshi: I've been doing it for 20 years, but 20 years ago there were not as many surgeries. At Mitsui, there were about 350 per year. There I started my phaco surgery—a day surgery in Tokyo. Before that, a patient had to stay 1 week. Twenty years ago it was mostly extracap. Also, 20 years ago, I developed my own phaco prechop technique.
EyeWorld: Are you still doing that technique today?
Dr. Akahoshi: Still doing it. Nowadays, the femtosecond laser prechops, but I developed the manual prechop technique 20 years ago. With this simple procedure to divide the nucleus for phacoemulsification, the surgical time could be remarkably reduced. My average surgical time is less than 4 minutes, and my fastest surgery was 1 minute and 29 seconds. I can perform surgery very efficiently.
The prechop technique is a fracture technique to divide the cataract before phaco. Before this, we would groove the nucleus, but grooving the nucleus takes time so I divide the nucleus with a special instrument that I designed called the Akahoshi Phaco Prechopper. Eight years ago, I developed a microcoaxial procedure so all my surgeries are now performed through a 1.8 mm incision. There's no risk of endophthalmitis, and there is quick rehabilitation of vision. I have more than 1,080 doctors refer their patients to me, which is the reason I operate on so many cases. My policy for surgery is to do the best treatment for the patient. I choose the best materials and use the best machines.
EyeWorld: Are you using the femtosecond laser at Mitsui now or in private practice?
Dr. Akahoshi: Femto is good technology, but efficiency is necessary for me. I must perform nearly 60 cases a day, which I can't do using femtosecond.
EyeWorld: Are you, as Dr. Chang said, the busiest surgeon in Tokyo?
Dr. Akahoshi: Yes, I think so—and the poorest! If I had my own private clinic, I would be a millionaire. My main work, though, is at Mitsui, a charity hospital. Also, I have traveled to 65 countries around the world to teach my phaco prechop technique. I believe it is a very good technique to perform surgery safely and efficiently.
EyeWorld: Can you explain a little bit about how the charity hospital system works in Japan?
Dr. Akahoshi: About 100 years ago, the Mitsui family donated this hospital to poor people in Tokyo. The mission is to do good treatment for poor people. I have been working there for 20 years and I get a fixed salary. It's very cheap. That means I have to work the weekends to get some money to travel abroad and attend meetings. The purpose of the hospital is to give the best treatment to everyone. Our president told me, "I cannot give you a good salary, but I will allow you to travel as much as you like and I will allow you to use any material you think is best for the patient." I use the best intraocular lens, the best machine, so the result is good. The patients are happy, and there are 1,080 doctors who refer their patients to me who are also happy. So it is a good situation. Good results bring a good reputation and repeats of referring patients.
EyeWorld: Pardon me for asking, but if the salary is not good, why do you operate at a charity hospital?
Dr. Akahoshi: I am from a very poor family. My father was a bus driver and my mother was working, so both my parents were working. They didn't have enough money to send me to the university. I graduated from a university supported by the government. I got a scholarship. After 6 years, I graduated from the medical department and then I had to work in the rural area to treat people so I had to do anything, including internal medicine, anesthesia, everything. It was my longstanding dream to be a specialist and treat blind people. I had to work in rural areas for 4 years first. Five years after graduation, I had a chance to study at Tokyo University to be an ophthalmic specialist. I very much appreciate having a chance to operate.
EyeWorld: Why ophthalmology, specifically?
Dr. Akahoshi: When I was in elementary school I went to the hospital and saw a lot of patients suffering from eye disease, and there was a female doctor there working hard to treat those patients. I decided when I grew up I wanted to be a doctor to treat blind people.
EyeWorld: You mentioned that you have been to 65 countries around the world. It sounds like teaching, as well as charity, is a passion of yours. Can you tell us why you feel it's important to teach?
Dr. Akahoshi: The number of surgeries I can perform a day may be 50, not 100, because there are complicated cases. Cataract is the number one cause of blindness in the world, and it is a curable disease. People become blind because they cannot be treated. It's necessary to teach doctors who can treat them. The number of patients I alone can treat may be small, but if I teach doctors, hundreds of doctors can operate the same way I do, and those doctors can treat millions of patients. The prechop is a very good technique, but a little bit tricky. There are some small tips and tricks. When I teach this technique to a doctor, I have a condition—I will teach you, but you should teach another doctor. If you agree, then I will teach you. I hope this method can make cataract surgery much more efficient, and many more patients in the world can be treated and saved from blindness due to cataracts.
EyeWorld: Where do you see your future going? Will you continue at Mitsui?
Dr. Akahoshi: Yes, I believe so, and I want to continue my charity work. I want to develop the quality of the surgery. I have been working 20 years to reduce incision size. Initially my incision size was 3.2 mm, but I developed special instruments and techniques to operate through a 1.8 mm incision. That was published 8 years ago, and since then all of my surgeries have been done through the 1.8 mm incision.
EyeWorld: Socioeconomically speaking, you have operated on top leaders all the way down to the poorest of the poor.
Dr. Akahoshi: The homeless, too. I do exactly the same procedure and implant exactly the same intraocular lens. No difference. Usually it would be hard to operate on more than 50 cases a day, but especially in Tokyo, patients come earlier. In Japan, to get a driver's license, we need a visual acuity of 0.7, so people have to have good vision. The patients come much earlier than before, which means many easy cases to operate on. But in rural areas there are still very dense and complicated cases. I have had a chance to travel to developing countries—Africa, the Middle East, and those countries; the patients never come to the hospital until they are almost blind. In those situations, the surgery is very difficult and complicated, takes time, and is risky. If I have a chance, I tell patients, "If you have any problems with vision, you should come and ask the doctor to see your eyes." If they have any problem with vision, they should be treated as soon as possible.
EyeWorld: How rewarding is it to you as a physician to have people come in, maybe from a rural area, who are nearly blind from a cataract, and you are able to remove that cataract for them and change their lives?
Dr. Akahoshi: All my surgeries are done with topical, so immediately after the surgery, the patients cry, "I can see!" It is impressive—a reason for me to continue and promote this hard work. Having the chance to see people smiling is wonderful. When patients come to the hospital, they are gloomy. After the surgery, those patients smile very big smiles.
EyeWorld: What about your family? Do you see them?
Dr. Akahoshi: I have a wife, Mie, and we travel to almost all the countries together. We share economy class tickets. It's a long flight. We travel together and we have a chance to see the world. She supports me. I finish my work at 11 p.m. at the hospital and then I have to make preparations for presentations. Eight years ago, when I developed the microcoaxial technique, I would get a lot of requests all over the world to show the surgery. No one believed that a 6 mm optic lens could implant through a 1.8 mm small incision, but I developed an injector and technique to implant the lens. I needed to travel all over the world to show the technique. At that time, more than 50% of my days were spent abroad. I was always traveling, traveling, traveling.
EyeWorld: Is there anything else that you think is important to discuss?
Dr. Akahoshi: Most of the time doctors think I operate so much that I should be an extremely rich doctor, but that is not how it is because I work in a charity hospital. I work not for money, but for the people, and I am doing my best to develop new techniques and new instruments.
Contact information
Akahoshi: +81 3 3862 9111, eye@phaco.jp
Weekends are overrated
--------------------------------------------------------------------------------
by Jena Passut EyeWorld Editor
The busiest cataract surgeon in Japan is also one of the most innovative. Takayuki Akahoshi, M.D., has been the director of ophthalmology at the Mitsui Memorial Hospital in Tokyo for 20 years. Internationally, he is best known for developing the prechop technique and instrumentation—a method that he has traveled worldwide to teach. He is also a pioneer of microcoaxial phaco, which has supplanted biaxial phaco as the most popular method of reducing incision size. When you meet him, he is incredibly humble and unassuming, and certainly does not have the ego that one might expect of such a brilliant surgeon. However, what has always amazed me the most is the grueling schedule that Taka keeps. It wasn't until I recruited him to write a textbook chapter that I learned that Taka literally works 7 days a week. Furthermore, most of us would take 3-4 days to see the number of patients or perform the number of surgeries that he performs in a single day. Most inspiring of all, however, is the fact that Taka works in a charity hospital for a very modest salary, which he supplements by working in a private clinic on his days off. He is the individual physician version of the Aravind economic model—operating on enough private paying patients to subsidize the majority of his time spent caring for the poor. I think you'll enjoy EyeWorld's interview with this amazing individual.
David F. Chang, M.D., chief medical editor
Dr. Akahoshi and Dr. Chang visit in Chicago at the 2012 ASCRS•ASOA Symposium & Congress
Dr. Akahoshi performs live surgery in Bangladesh Source: Takayuki Akahoshi, M.D.
An interview with Takayuki Akahoshi, M.D.
EyeWorld: Tell us about your very busy weekly schedule.
Dr. Akahoshi: My main job is to treat cataract patients. I operate 4 days at Mitsui, and the 3 other days of the week I work in my friend's private clinic. I perform about 8,000 surgeries per year.
The number of surgeries I do at Mitsui is 5,000, and I perform another 3,000 at the private clinic. I operate 6 days a week, and on Saturdays I see patients—nearly 100 patients a day.
EyeWorld: How long have you had this schedule?
Dr. Akahoshi: I've been doing it for 20 years, but 20 years ago there were not as many surgeries. At Mitsui, there were about 350 per year. There I started my phaco surgery—a day surgery in Tokyo. Before that, a patient had to stay 1 week. Twenty years ago it was mostly extracap. Also, 20 years ago, I developed my own phaco prechop technique.
EyeWorld: Are you still doing that technique today?
Dr. Akahoshi: Still doing it. Nowadays, the femtosecond laser prechops, but I developed the manual prechop technique 20 years ago. With this simple procedure to divide the nucleus for phacoemulsification, the surgical time could be remarkably reduced. My average surgical time is less than 4 minutes, and my fastest surgery was 1 minute and 29 seconds. I can perform surgery very efficiently.
The prechop technique is a fracture technique to divide the cataract before phaco. Before this, we would groove the nucleus, but grooving the nucleus takes time so I divide the nucleus with a special instrument that I designed called the Akahoshi Phaco Prechopper. Eight years ago, I developed a microcoaxial procedure so all my surgeries are now performed through a 1.8 mm incision. There's no risk of endophthalmitis, and there is quick rehabilitation of vision. I have more than 1,080 doctors refer their patients to me, which is the reason I operate on so many cases. My policy for surgery is to do the best treatment for the patient. I choose the best materials and use the best machines.
EyeWorld: Are you using the femtosecond laser at Mitsui now or in private practice?
Dr. Akahoshi: Femto is good technology, but efficiency is necessary for me. I must perform nearly 60 cases a day, which I can't do using femtosecond.
EyeWorld: Are you, as Dr. Chang said, the busiest surgeon in Tokyo?
Dr. Akahoshi: Yes, I think so—and the poorest! If I had my own private clinic, I would be a millionaire. My main work, though, is at Mitsui, a charity hospital. Also, I have traveled to 65 countries around the world to teach my phaco prechop technique. I believe it is a very good technique to perform surgery safely and efficiently.
EyeWorld: Can you explain a little bit about how the charity hospital system works in Japan?
Dr. Akahoshi: About 100 years ago, the Mitsui family donated this hospital to poor people in Tokyo. The mission is to do good treatment for poor people. I have been working there for 20 years and I get a fixed salary. It's very cheap. That means I have to work the weekends to get some money to travel abroad and attend meetings. The purpose of the hospital is to give the best treatment to everyone. Our president told me, "I cannot give you a good salary, but I will allow you to travel as much as you like and I will allow you to use any material you think is best for the patient." I use the best intraocular lens, the best machine, so the result is good. The patients are happy, and there are 1,080 doctors who refer their patients to me who are also happy. So it is a good situation. Good results bring a good reputation and repeats of referring patients.
EyeWorld: Pardon me for asking, but if the salary is not good, why do you operate at a charity hospital?
Dr. Akahoshi: I am from a very poor family. My father was a bus driver and my mother was working, so both my parents were working. They didn't have enough money to send me to the university. I graduated from a university supported by the government. I got a scholarship. After 6 years, I graduated from the medical department and then I had to work in the rural area to treat people so I had to do anything, including internal medicine, anesthesia, everything. It was my longstanding dream to be a specialist and treat blind people. I had to work in rural areas for 4 years first. Five years after graduation, I had a chance to study at Tokyo University to be an ophthalmic specialist. I very much appreciate having a chance to operate.
EyeWorld: Why ophthalmology, specifically?
Dr. Akahoshi: When I was in elementary school I went to the hospital and saw a lot of patients suffering from eye disease, and there was a female doctor there working hard to treat those patients. I decided when I grew up I wanted to be a doctor to treat blind people.
EyeWorld: You mentioned that you have been to 65 countries around the world. It sounds like teaching, as well as charity, is a passion of yours. Can you tell us why you feel it's important to teach?
Dr. Akahoshi: The number of surgeries I can perform a day may be 50, not 100, because there are complicated cases. Cataract is the number one cause of blindness in the world, and it is a curable disease. People become blind because they cannot be treated. It's necessary to teach doctors who can treat them. The number of patients I alone can treat may be small, but if I teach doctors, hundreds of doctors can operate the same way I do, and those doctors can treat millions of patients. The prechop is a very good technique, but a little bit tricky. There are some small tips and tricks. When I teach this technique to a doctor, I have a condition—I will teach you, but you should teach another doctor. If you agree, then I will teach you. I hope this method can make cataract surgery much more efficient, and many more patients in the world can be treated and saved from blindness due to cataracts.
EyeWorld: Where do you see your future going? Will you continue at Mitsui?
Dr. Akahoshi: Yes, I believe so, and I want to continue my charity work. I want to develop the quality of the surgery. I have been working 20 years to reduce incision size. Initially my incision size was 3.2 mm, but I developed special instruments and techniques to operate through a 1.8 mm incision. That was published 8 years ago, and since then all of my surgeries have been done through the 1.8 mm incision.
EyeWorld: Socioeconomically speaking, you have operated on top leaders all the way down to the poorest of the poor.
Dr. Akahoshi: The homeless, too. I do exactly the same procedure and implant exactly the same intraocular lens. No difference. Usually it would be hard to operate on more than 50 cases a day, but especially in Tokyo, patients come earlier. In Japan, to get a driver's license, we need a visual acuity of 0.7, so people have to have good vision. The patients come much earlier than before, which means many easy cases to operate on. But in rural areas there are still very dense and complicated cases. I have had a chance to travel to developing countries—Africa, the Middle East, and those countries; the patients never come to the hospital until they are almost blind. In those situations, the surgery is very difficult and complicated, takes time, and is risky. If I have a chance, I tell patients, "If you have any problems with vision, you should come and ask the doctor to see your eyes." If they have any problem with vision, they should be treated as soon as possible.
EyeWorld: How rewarding is it to you as a physician to have people come in, maybe from a rural area, who are nearly blind from a cataract, and you are able to remove that cataract for them and change their lives?
Dr. Akahoshi: All my surgeries are done with topical, so immediately after the surgery, the patients cry, "I can see!" It is impressive—a reason for me to continue and promote this hard work. Having the chance to see people smiling is wonderful. When patients come to the hospital, they are gloomy. After the surgery, those patients smile very big smiles.
EyeWorld: What about your family? Do you see them?
Dr. Akahoshi: I have a wife, Mie, and we travel to almost all the countries together. We share economy class tickets. It's a long flight. We travel together and we have a chance to see the world. She supports me. I finish my work at 11 p.m. at the hospital and then I have to make preparations for presentations. Eight years ago, when I developed the microcoaxial technique, I would get a lot of requests all over the world to show the surgery. No one believed that a 6 mm optic lens could implant through a 1.8 mm small incision, but I developed an injector and technique to implant the lens. I needed to travel all over the world to show the technique. At that time, more than 50% of my days were spent abroad. I was always traveling, traveling, traveling.
EyeWorld: Is there anything else that you think is important to discuss?
Dr. Akahoshi: Most of the time doctors think I operate so much that I should be an extremely rich doctor, but that is not how it is because I work in a charity hospital. I work not for money, but for the people, and I am doing my best to develop new techniques and new instruments.
Contact information
Akahoshi: +81 3 3862 9111, eye@phaco.jp
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