Dr. Frantz consults with International Cataract Surgery Expert
A couple of weeks ago, Dr. Frantz had the great honor of visiting Dr. Takayuki Akahoshi in Tokyo, Japan as part of his ongoing effort to stay on the cutting edge of technology. Read about his adventures with Dr. Akahoshi below!
I had heard and read many wonderful things about the Japanese cataract surgeon Dr Takayuki Akahoshi. As the inventor of the cataract Prechop method of surgery, he revolutionized the delivery of cataract surgical care. After reading numerous articles written by and about him, I came across several surgical videos showing his cataract surgical prowess.
The possibility of shortening surgical time, decreasing energy and fluid flow through the eye and ultimately making the surgery safer for patients and the recovery much more rapid than traditional cataract surgery intrigued me.
After searching the internet, I was finally able to contact Dr Akahoshi by email. He graciously invited me to Tokyo to watch his surgery and learn his technique.
A little about Dr Akahoshi, he works at a charity hospital treating indigent patients. Unlike American doctors, he receives a small salary from the hospital. Although he doesn’t gain any extra payment for operating on more patients, he feels that it is his duty as a physician to share his tremendous talent with as many patients as possible. Amazingly, Dr Akahoshi performed more than 8000 cataract surgeries in 2014 and will perform more this year. By US standards, he would be the busiest cataract surgeon in the country. To do this number of cataract surgeries, Dr Akahoshi operates and sees patients 7 days a week! Yes, he works weekends. The rare time he has off is spent traveling to other countries to teach his surgical technique. A great humanitarian, Dr Akahoshi has invented numerous instruments to improve the safety of cataract surgery. He refuses to patent or profit in any way from these inventions, since he feels he owes it to all patients to help them obtain safer and better cataract surgery
We arrived after a long flight to Tokyo on Sunday August 16, 2015. Dr Akahoshi had just returned from the Middle East, where he taught surgery to Drs in Abu Dhabi.
Tuesday was a hot, unseasonably muggy day in Tokyo. We asked our cab driver to take us to the Mitsui Memorial Hospital. Since he spoke no English, we provided him with a map. After being dropped of, we realized the building the driver said was the hospital was NOT a hospital. We asked a local young man, who we later found was an engineer, to help us. We were struck by the incredible friendliness and hospitality of this young man and others along the way. They stopped what they were doing and personally escorted us to the hospital and to the fourth floor Eye Clinic.
Dr Akahoshi was running late but graciously greeted me and my wife Jennifer. He is fluent in English and we made introductions and took pictures. He, as you might imagine given his incredible work schedule, was running late. Shortly, he escorted us to the operating room where we quickly dressed in surgical attire. After introducing us to his surgical team, he began operating.
Modern cataract surgery involves dividing the cataract into smaller pieces for their subsequent removal through a small incision. By creating smaller pieces of cataract, they can subsequently be removed through a smaller incision allowing quicker healing and faster healing. The method and technique of dividing the cataract is of critical importance. Traditional methods of cataract division involve ultrasonic sculpting and mechanical division. The problem with this is that it subjects the eye to ultrasonic energy which can, for harder cataracts, be damaging to the delicate inner structures of the eye. The traditional method takes a longer period of time to perform and results in more fluid running through the eye to keep it pressurized. The increased fluid flow also can be deleterious to the inside of the eye.
Dr Akahoshi’s technique is so elegant because it provides a way to divide the cataract with special instruments to avoid sculpting. The cataract is pre-divided into smaller more manageable pieces so that less energy is used inside the eye. Because the technique takes less than 5 minutes, there is less fluid through the eye with enhanced safety and faster visual rehabilitation. Amazingly, on average this techniques consistently resulted in using 80% less energy and 80% less fluid through the eye!
Bladeless Laser Cataract surgery has as one of its advantages, that it pre-divides the cataract without ultrasonic energy and therefore the cataract can be removed faster with less energy, fluid flow or damage to the inside of the eye. Using Akahoshi’s technique can be beneficial even in Laser Cataract surgery cases. Additionally, Laser Cataract surgery had the advantages of more precision in centering and placing the intraocular lens, ultra-precise incisions for the correction of astigmatism, and more precision in lens implant power determination in combination with the ORA and Verion technologies (two technologies that Dr Akahoshi would like but currently can’t have).
In the 25 plus years I have been performing cataract surgery, I have never seen surgery performed with such grace, accuracy and speed. That afternoon in a little over three hours, Dr Akahoshi operated on 29 eyes. His technique is unique and not well known in the United States. He carefully described the technique in exquisite detail, all the while performing flawless cataract surgery on rock hard, to relatively soft cataracts. His technique requires special instrumentation and requires very particular skills for its safe mastery. Every case was done to perfection.
The results of his gift were amazing to his patients. A safer procedure, faster return of vision, and more rapid return to normal activity.
I spent the rest of the week reviewing his videos and watching him perform over 100 surgeries without single complication. He was kind enough to share all of his surgical “pearls” with me. Jennifer and I also had the honor of going to dinner with him. We enjoyed traditional Japanese food and talked about the differences between medicine practiced in Japan and the United States.
After six days, we left for the long return home. There is a thirteen hour time difference between Tokyo and Fort Myers. However, on returning home, we knew the jetlag was worth it because we would be able to provide higher quality care to the people of Southwest Florida and indeed for the many surgical patients who travel from around the country for me to perform cataract surgery on them.
Ophthalmology, medicine, and the world are lucky to have the incredibly humble and talented Dr Akahoshi. We are eternally grateful to you.