【Hideki Fukuoka (Cornea Specialist)】Innovating from a Proud Tradition: Bringing Breakthrough Corneal Therapies to the World
<Profile>
Hideki Fukuoka, MD, PhD
Lecturer, Department of Ophthalmology, Kyoto Prefectural University of Medicine
Dr. Hideki Fukuoka graduated from Kyoto Prefectural University of Medicine and received his PhD from the Graduate School of Medical Science at the same institution in 2011. That same year, he was appointed Senior Staff Physician in Ophthalmology at the National Center for Geriatrics and Gerontology. He subsequently conducted advanced research at the Shiley Eye Institute at the University of California, San Diego (UCSD) in the United States. Returning to Kyoto Prefectural University of Medicine, he served as Assistant Professor of Ophthalmology from 2017 before assuming his current position as Lecturer in October 2024.
Areas of Expertise: Cornea
【Background】Becoming a Doctor to Heal Himself: Choosing Ophthalmology for Its Impact on Restoring Vision
Could you tell us about your background?
Before moving to Kyoto for university, I grew up in Setagaya Ward, Tokyo. My father worked at a company and my mother was a homemaker, so I didn't come from a medical background. Interestingly, though, my younger brother also became a doctor and is currently a gastrointestinal surgeon in the United States. I also have an older sister who works in an office.
What motivated you to pursue a career in medicine?
I actually suffered from severe allergic rhinitis, which was at its worst during my high school years. It was so intense that I had to bring a whole box of tissues to school every day and would use it all up. I eventually reached a point where I thought, "I can't live like this—I need to fix this myself," which was my initial drive to enter medical school.
However, once I started university, my symptoms naturally improved. Perhaps my constitution changed with age, or maybe my immune response softened over time. Even though I entered medical school wanting to cure my own condition, I ended up thinking, "Well, I guess I don't need to go into otolaryngology anymore."
Why did you choose ophthalmology in the end?
I was drawn to ophthalmology because many conditions can be cured through surgery. Beyond that, ophthalmic medicine has an extraordinary impact. It is said that roughly 70 to 80 percent of the brain is involved in processing visual information, and people often take seeing for granted. Because of that, losing one's sight causes profound distress. I chose ophthalmology because I felt a powerful drive to restore vision through surgery and truly change patients' lives.
【Specialty】Understanding the Whole Eye to Treat the Cornea
What led you to specialize in the cornea?
The Department of Ophthalmology at Kyoto Prefectural University of Medicine has a long-standing tradition of excellence in corneal research and care. Training here made specializing in the cornea a very natural progression. Our institution is particularly focused on clinical research that directly bridges science and patient care, fostering what is known as a "clinician-scientist" approach.
What are the main challenges currently facing the field of corneal care?
One major challenge is the relative shortage of specialists capable of diagnosing and treating complex corneal diseases. While our institution has the framework and experience to train physicians to a high level, expanding this specialist network across the broader medical community remains an ongoing need.
Why are there few physicians who specialize in corneal care?
I believe it requires a comprehensive understanding of the eye’s natural physiology. The cornea cannot be treated in isolation; one must also understand the function of the eyelids, tear film, and conjunctiva. For instance, the eyelids exist to protect and maintain the cornea, while tears keep it clear and healthy. Without a holistic grasp of how these interconnected elements function together, effective corneal treatment is difficult.
Given these specialized needs, do you receive consultations from physicians across Japan?
Currently, consultations primarily come from our affiliated hospitals, though I do receive inquiries from other colleagues as well. This highlights the need for more structured consultation frameworks, such as telemedicine systems.
At the same time, practical challenges remain, including insurance reimbursement structures and the clear assignment of diagnostic responsibility when consulting with unfamiliar clinicians. Telemedicine works exceptionally well between physicians who already share mutual trust and established rapport. In that regard, I have high expectations for platforms like Vision Forth Inc. (Ophthoagent) to strengthen collaborative networks among trusted specialists.
【Environment】Kyoto's Cultural Heritage and Japan's Technological Edge
What are the core strengths of Kyoto Prefectural University of Medicine as a hospital?
Kyoto itself offers a uniquely welcoming environment for international patients. As one of the world's most renowned travel destinations, the city possesses an exceptional hospitality infrastructure, including diverse accommodations, allowing patients to seamlessly combine medical care with travel.
Furthermore, our university hospital holds a long and distinguished history spanning over 150 years, making it one of the most established medical institutions in Japan. Throughout our history, our core philosophy has always been patient-first care. "First, understand the patient"—this principle serves as both our educational foundation and our daily clinical pillar.
Another major strength is our wide range of diagnostic equipment in ophthalmology. Japan has a strong industrial foundation in precision machinery, which is essential for ophthalmology. We are fully equipped with advanced devices, including Optical Coherence Tomography (OCT) for cross-sectional imaging and specular microscopy for evaluating the cornea. Access to and full utilization of such diverse, cutting-edge equipment makes our treatment environment uniquely attractive from a global perspective.
【Innovative Therapies】Pioneering Cell Therapies: Cultured Human Corneal Endothelial Cell and Oral Mucosa Transplants
You have been involved in the development of groundbreaking therapies. Could you share your thoughts from that time and what led to this journey?
Looking back, it felt almost serendipitous. In 2002, during my first year as a resident, I was assigned my very first patient. Coincidentally, this patient was participating in the First-in-Human (FIH) clinical trial for Cultured Oral Mucosal Epithelial Transplantation—the very first phase of administering a treatment to humans after safety and efficacy had been demonstrated in animal studies. Witnessing an FIH study firsthand left a profound and lasting impression on me, opening my eyes to an entirely new realm of medicine.
At the time, seeing research transition directly into bedside care felt almost natural to me. Because I entered the field right as these innovations were taking shape, I found myself part of that trajectory from the very start. Rather than joining midway, I was immersed in the momentum from day one, and following that path naturally led me to where I am today.
Could you tell us more about the advanced therapies originating from Kyoto Prefectural University of Medicine that you helped develop?
These would be "Cultured Human Corneal Endothelial Cell Transplantation" and "Cultured Oral Mucosal Epithelial Transplantation." Both are treatments that originated in Japan and cannot yet be received overseas. Let me explain these treatment methods for patients.
Cultured Human Corneal Endothelial Cell Transplantation
On the back side of the cornea, there is a layer of cells called "corneal endothelial cells." They play an important role in maintaining the clarity of the cornea. Once corneal endothelial cells decrease, they do not proliferate or regenerate. While these cells can decrease due to surgery or various diseases, if they drop below a certain level, it leads to conditions where the cornea becomes cloudy and vision declines, such as bullous keratopathy (corneal edema).
Conventionally, corneal transplantation was the only treatment available. However, it has now become possible to cultivate donor-provided corneal endothelial cells outside the body and inject them into the patient's eye. This is "Cultured Human Corneal Endothelial Cell Transplantation." Although expensive, its key feature is that it is less invasive to the body compared to conventional corneal transplantation.
[References]
Cultured Oral Mucosal Epithelial Transplantation
The other procedure, "Cultured Oral Mucosal Epithelial Transplantation," is a regenerative medicine for conditions that affect the surface of both eyes, such as Stevens-Johnson syndrome. These are conditions where the conjunctival sac in both eyes is lost due to adhesions, or the cornea becomes cloudy as if it suffered a chemical injury. As an alternative treatment, "Cultured Oral Mucosal Epithelial Transplantation" is a surgery where mucosa from inside the mouth is collected, cultured on an amniotic membrane into a sheet outside the body, and placed onto the eye.
Both of these treatments were born at Kyoto Prefectural University of Medicine and are covered by national health insurance. Within Japan, an environment is established where patients can receive them at authorized medical institutions nationwide.
[References]
【Global Cases】Welcoming Patients Worldwide: Treatment Experiences from Singapore, Chile, and Beyond
Could you share any cases of patients who actually came from overseas?
A patient who came from Singapore this year to receive Cultured Human Corneal Endothelial Cell Transplantation left a particularly strong impression on me. Still young and in pain in both eyes, they walked into our outpatient clinic without an appointment, nearly in tears. They told us, "I need you to perform the surgery, even if it's tomorrow."
Cultured Human Corneal Endothelial Cell Transplantation is not a treatment we perform year-round, but I strongly felt that we had to find a way to help. The surgery was completed safely, and the recovery went smoothly. While visits were required every three months at first, they are expected to shift to once every six months going forward. I was deeply relieved that we were able to deliver the necessary medical care.
Their knowledge and initiative were also deeply impressive. I find it incredible how they read the scientific literature and managed to find their way to us from overseas. There was also another patient who traveled about 28 hours to reach us all the way from Chile, on the other side of the globe.
Have you or Kyoto Prefectural University of Medicine actively shared information for patients internationally?
No, we had not actively shared information for patients. When they reached out to us, it seems they relied entirely on our published papers and a simple contact email address listed on our website. We have shared almost no information for patients regarding "Cultured Human Corneal Endothelial Cell Transplantation" or "Cultured Oral Mucosal Epithelial Transplantation," so there was hardly any information available. If Vision Forth Inc. (Ophthoagent) helps share this information, I expect it will have a massive impact, and I am very much looking forward to it.
Kyoto Prefectural University of Medicine Hospital
465 Kajii-cho, Kawaramachi-dori Hirokoji-agaru, Kamigyo-ku, Kyoto 602-8566, Japan
※10-minute walk from Jingu-Marutamachi Station, 15-minute walk from Demachiyanagi Station on the Keihan Oto Line
※Buses are available from JR Kyoto Station Central Exit ("Kyoto Station-mae"), Hankyu Kyoto Line "Kyoto-Kawaramachi Station", Keihan Main Line "Sanjo Station", and Subway Tozai Line "Sanjo Keihan Station" (Get off at "Furitsu Idai Byoin-mae")
Clinic Hours: Registration: 8:45 AM – 11:00 AM / Follow-up Registration (via Automated Kiosk): 8:00 AM – 11:00 AM (Closed: Saturdays, Sundays, National Holidays, Year-End/New Year Holidays [Dec 29 – Jan 3])
