【Hisanori Imai (Retina Specialist)】"A Doctor I Can Trust": The Medical Care You Will Find in Japan
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Hisanori Imai, MD, PhD
Professor and Chair, Depart of Ophthalmology, Kansai Medical University
After graduating from Kobe University School of Medicine in 2001, Dr. Imai served as a postdoctoral research fellow at the Department of Ophthalmology and the Department of Cellular and Molecular Physiology, Penn State College of Medicine in the United States. He built extensive clinical experience as a Lecturer and Inpatient Director at Kobe Kaisei Hospital and Kobe University Hospital before assuming his current position as Professor and Chair of the Department of Ophthalmology at Kansai Medical University in May 2024. Dr. Imai is active in both clinical practice and research, notably developing a surgical technique known as “cystotomy” for refractory macular edema (including diabetic macular edema and macular edema secondary to retinal vein occlusion).
Areas of Expertise: Surgical Retina
【Background】"Because It Helps People": Why I Became a Doctor
Could you tell us briefly about your background?
I was born in the southern part of Osaka Prefecture. Due to my parents' work, we moved frequently: I spent the latter half of elementary school in Fukuoka, middle school in Saitama, and high school in Tokyo. When choosing a university, I decided on the Kansai region, partly because my parents' family home was in Nishinomiya, Hyogo Prefecture. Wanting to enter university directly without taking a gap year, I chose Kobe University as it was a good fit for my academic level at the time.
Because I was naturally adapt at communicating, I made friends easily in each new place and thoroughly enjoyed my time there. I wasn't entirely consumed by studying; instead, I devoted myself to tennis. From middle school all the way through university graduation, I spent nearly every waking moment playing court.
What led you to choose medical school?
In high school, there came a moment when I thought deeply about how I wanted to contribute to society. Medicine seemed like the clearest and most direct choice in terms of helping others. I felt it was a profession where my own hard work could directly bring joy to people. It was simply for that reason.
【Specialty】Choosing Vitreoretinal Surgery: Inspired by Mentors and Personal Aptitude
Why did you decide to enter the field of ophthalmology?
Observing cataract surgery when I was a medical student was the spark that drew me into ophthalmology. I found it truly impressive.
The appeal of ophthalmology lies in how clear and tangible the treatment outcomes are. Cataract treatment is a prime example. When cataracts develop, vision deteriorates, but surgery offers the potential to restore clear sight.
Much of medicine focuses on preventing diseases from worsening or stopping their progression. Relatively few medical interventions can actually return a patient to almost the exact state they were in before falling ill. Orthopedics, for instance, can restore a fractured bone to its former state; similarly, in ophthalmology, cataract surgery is a treatment that can truly "restore." Seeing that ability to bring patients back to where they were is what made me feel, "This is the field for me."
Before observing cataract surgery, I had intended to go into gastrointestinal surgery. In surgery, the more you refine your skills, the greater the likelihood of bringing a good outcome to your patients. As I mentioned earlier, I played tennis for years and lived in the world of individual sports—a world where the results come back entirely to you. Win or lose, it is your own responsibility. That kind of accountability fits my personality well. Furthermore, ophthalmology allows physicians to gain independence early and perform surgery from a young age, which suited my nature perfectly.
Could you tell us why you chose to specialize in vitreoretinal surgery?
One reason was Dr. Yasutomo Tsukahara (former Associate Professor at Kobe University), the surgeon whose cataract procedures originally inspired me to become an ophthalmologist, specialized in vitreoretinal surgery.
In addition, because I had always aimed to be a surgeon, I wanted a field where surgical intervention could help as many patients as possible achieve what we call "optimal visual function." This goes beyond basic visual acuity to encompass field of vision, brightness, color vividness, and freedom from double vision. When considering where I could deliver this through surgery, vitreoretinal surgery became the clear choice.
【Challenge】The First Cystotomy Case for Refractory Macular Edema
Could you share a memorable episode involving a patient?
Even in cases where conventional therapies struggle to produce results, alternative approaches can sometimes offer a new way forward. One example is a surgical technique I introduced for a condition called macular edema, which involves swelling of the retina. Certain cases of macular edema do not respond to standard anti-VEGF injections, nor do they improve with conventional vitrectomy.
Twelve years ago, in 2014, I came up with an idea and developed a technique known as cystotomy for refractory macular edema—specifically for cases secondary to diabetic macular edema or retinal vein occlusion. Just as the technique became ready for clinical application, a suitable patient presented.
After thorough discussions, we performed the very first case at Kobe University. Naturally, I was extremely nervous, and I imagine the patient was as well. Anxious about the postoperative outcome, I performed examinations just a few hours after surgery and again the next day—tests I would not ordinarily conduct until discharge. As we monitored the follow-up, we confirmed that the retinal structure had improved. I vividly remember the shared sense of relief among the patient, the young doctors on our team, and myself. That was our first cystotomy case for refractory macular edema.
To be clear, there were also many patients whom this surgery could not cure. Subsequent research revealed that the procedure is ineffective in roughly one-third of cases. Nevertheless, I feel deeply grateful that this first patient came to us. Had that initial case not succeeded, I might not have continued developing this treatment, as it could have been discouraging. Fortunately, our first few cases yielded positive outcomes, which was immensely significant for us.
In my career, those early cases and procedures were crucial. The feeling of having contributed and given back through that successful experience became the driving force that allowed me to approach subsequent innovations with the exact same dedicated stance.
What do you think led that first patient to place their trust in you?
Ultimately, I believe they were simply in deep distress. The frustration of vision loss is profound, and the patient truly wanted to try whatever option was available.
Of course, personality plays a part as well. My approach resonated with a patient who felt, "If there's a chance, I want to try." At the time, I was still young and lacked the extensive track record that typically inspires confidence. Even so, the patient had the courage to take that leap and, after hearing my explanation, decided to place their trust in me.
【Message to Overseas Patients】Advanced Care You Can Count On: High-Level Medical Options in Japan
What are your thoughts on the quality of ophthalmology in Japan?
I feel that surgical techniques and standard of care in Japan’s vitreoretinal field are held to an exceptionally high level internationally. One of the greatest virtues of Japanese healthcare is that anyone, regardless of background, has the freedom to choose high-level treatment. Whether consulting a renowned specialist or entrusting one's care to advance medical science, patients have that freedom—provided they possess the information and initiative to seek it out.
Globally, medical therapies such as oral medications and intravitreal injections have become standardized. The strength of medical treatment lies in its accessibility: many doctors can administer it, and patients generally receive consistent results regardless of where they are treated. While this global standardization is undeniably positive, it also means that specialized procedures—treatments that can only be performed by specific experts or in limited settings—are often overlooked, even though many such doctors exist here in Japan.
For instance, cystotomy for refractory macular edema has been spreading among physicians within Japan since I first introduced it, yet it remains relatively uncommon abroad. This means that while certain cases can be successfully managed in Japan once patients find the right information, many individuals worldwide are still unaware that such options exist.
If information reaches international audiences and global momentum builds, there will be many opportunities for Japan’s unique strengths to shine. Beyond my own work, if we effectively communicate what individual specialists can offer, I believe Japan’s standing in the international medical community will evolve significantly.
【About the Hospital】A Unified Commitment to International Medical Tourism and High-Standard Care
Is Kansai Medical University actively welcoming international patients?
Yes, the university as a whole is committed to promoting international medical tourism. To accommodate patients traveling from abroad, we are even considering transportation support to and from major hubs like Kansai International Airport and Itami Airport to ensure a seamless experience.
Inquiries are already reaching our Department of Ophthalmology, with many currently seeking cataract surgery in Japan. Going forward, we hope to broaden awareness of cystotomy for refractory macular edema as well. Across fields such as vitreoretinal surgery and cornea care, I am confident that we can provide high-standard medical care that truly satisfies our overseas patients.
Our hospital is directly adjacent to the university campus and is fully equipped with medical interpretation and coordination services. While there is certainly pressure to meet high expectations, nothing would make me happier than having patients travel from overseas specifically saying, "I came because I want Dr. Imai to manage my care."
Kansai Medical University Hospital
2-3-1 Shinmachi, Hirakata, Osaka, Japan
※Approximately 3 minutes walk from Hirakata-shi Station (Keihan Railway)
Clinic Hours: First-time / General Registration: 8:30 AM – 11:30 AM, Automated Kiosk Registration (With Appointment): 8:00 AM – 5:00 PM (Closed: 2nd and 4th Saturdays, Sundays, National Holidays, and Year-End/New Year Holidays [Dec 29 - Jan 3])
