Laser-assisted cataract surgery first began in the United States in 2010. I performed Japan’s first laser cataract surgery at Omiya Nanasato Eye Clinic in 2012 – only two years later.

Today, millions of laser cataract surgeries have been performed in the United States, where the procedure has achieved widespread recognition. In Japan, however, only a small number of facilities offer it and public awareness remains low.

Why has such an outstanding technology not become more widely discussed in Japan?

The answer lies in Japan’s universal health insurance system. Standard cataract surgery using monofocal IOLs and conventional manual techniques is covered by insurance, leaving patients responsible for only a portion of the cost. Premium cataract surgery, however, is generally not covered by insurance and so must be self-funded, slowing its adoption into mainstream practice.

One might deduce that the cost alone is enough to put people off. However, through my own surgical experience, I know that this is only half the story. Patient education – or lack thereof – is a challenge that I have been seeking to address since the early days of my career, driven in part by my own personal experiences.

Back in 2009, my mother, who had always been active, began complaining that her vision had become unclear and stopped going to her local sports club. She was only in her early sixties at this time, and so when she first told me her symptoms I did not immediately suspect cataracts. However, when I examined her eyes, her crystalline lenses were significantly clouded white – a textbook case.

My father, on the other hand, was less concerned about his vision. But, when I asked him about it after examining my mother, he replied, “Now that you mention it, driving has become a little harder lately.” When I examined his eyes, I found that his lenses were even cloudier than my mother’s.

In fact, my father had mild myopia and severe astigmatism. He had apparently assumed that his worsening vision was simply due to aging and astigmatism. As we are all aware, those who already have poor unaided vision because of myopia or astigmatism are often less likely to notice cataracts.

In February of that year, I made the decision to perform cataract surgery on my own parents at my practice, Omiya Nanasato Eye Clinic. I did not hesitate to choose multifocal IOLs – which were still not widely used in Japan at the time – rather than the standard monofocal IOLs commonly implanted in cataract surgery.

Thankfully, the surgeries were both successful.

After surgery, my mother said she could walk more comfortably at night and resumed going to her sports club. My father was delighted that he could now clearly see both distant scenery and the nearby navigation display while driving.

Shortly after, the significance of my actions would become even more apparent.

Over a meal, my extended family, all aged in their sixties, gathered at a Chinese restaurant. With the exception of my parents, every other relative struggled to read the single menu placed at the center of the table without reading glasses. In fact, they were astonished by my parents’ ability to read the small print unaided.

Explaining my parents’ reclaimed vision, I told my gathered relatives that I had recently performed multifocal IOL surgery on them both, correcting not only their cataracts but also their presbyopia and refractive errors. This, I explained, enabled them to see both near and far without reading glasses.

The relatives listened – not with concern, but with great interest. None of them had even heard the term “multifocal intraocular lens” before. When I had finished telling them about the surgery, several said they would like to undergo the procedure themselves in the near future.

This experience led me on a personal mission to help people – like my relatives – gain an understanding of advanced cataract surgery technologies, and the remarkable benefits that can be achieved with such technology.

In Japan, few medical treatments are as misunderstood as cataract surgery. There is an overwhelming amount of misinformation and conjecture surrounding the topic.

At my clinic, we hear the same concerns repeated. Young patients worry that undergoing cataract surgery will require more surgeries later down the line. Others fear that intraocular lenses will wear out and require replacement in 20 years, while even more patients treat cataract surgery as a far-off procedure to be worried about in the distant future – a last resort option when their vision is severely impaired.

Each time I encounter these recurring concerns, I carefully explain the facts to patients who genuinely believe these misconceptions. My clinic employs several highly skilled full-time ophthalmologists, and so we are able to provide accurate explanations to our patients regarding exactly what advanced cataract surgery entails.

Yet, I cannot personally explain these things to people who cannot visit the clinic. That’s why, in 2017, I wrote Life-Changing Cataract Surgery. In this book, which has sold over 37,268 copies, I explain multifocal IOLs and laser cataract surgery in a clear and accessible manner for readers, much as I explained the topic to my own family.

And the message appears to be getting through – since opening my clinic in 2008 I have personally performed almost 10,000 cataract surgeries, including over 5,000 femtosecond laser-assisted cataract surgeries using multifocal intraocular lenses.

At the heart of my procedures is a robust surgical microscope that offers precise control, efficient workflow, and attention to ergonomics: the METIS 900 (Haag-Streit).

Using this equipment, I typically operate with a depth of field setting of three and a red reflex intensity of 67%, optimizing both clarity and surgical precision. I find that its stable, brilliant red reflex, provides the optical clarity and brightness required for my procedures.

Moreover, I can operate effectively at just 20% illumination, which still provides clear visibility while reducing light exposure for patients. Even at low illumination levels, it delivers bright, high-quality video recordings suitable for clinical documentation and presentations. This leads to improved postoperative patient comfort, with some patients able to leave the operating room with less assistance, potentially due to the reduced light intensity during surgery.

Continuing the theme of innovation in intraocular lenses, I plan to enhance my procedures by integrating Haag-Streit’s digital workflow system for toric alignment, which the company plans to launch at ESCRS in September.

I am proud to say that the results of all my premium procedures have been excellent and significantly superior to conventional insurance-covered cataract surgery.

Yet the fact remains: these premium cataract surgeries, performed by my fellow ophthalmologists and me, account for only a tiny fraction of the approximately 1.8 million cataract operations performed annually in Japan.

And so my mission continues. Because, as in the case of my parents, premium cataract surgery really can “change your life.”