OCT 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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22 EW NEWS & OPINION October 2012 Chief medical editor's corner of the world Weekends are overrated by Jena Passut EyeWorld Editor choose the best materials and use the best machines. he 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 develop- ing the prechop technique and instrumenta- tion—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. T David F. Chang, M.D., chief medical editor EyeWorld: Are you using the fem- tosecond laser at Mitsui now or in private practice? Dr. Akahoshi: Femto is good tech- nology, 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 and Dr. Chang visit in Chicago at the 2012 ASCRS•ASOA Symposium & Congress 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 an- other 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. Nowa- days, the femtosecond laser pre- chops, 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 remark- ably 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 frac- ture 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 per- formed 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 doc- tors 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 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 trav- eled 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 hos- pital 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 intraocu- lar lens, the best machine, so the re- sult 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

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