Interview with Athlete Keiji Amakawa

Note: The following is an English language translation of the original Japanese language article and interview.

Glaucoma is the leading cause of vision loss in Japan. Because glaucoma develops few subjective symptoms, some patients find too late that their symptoms have already advanced, and others drop out of treatment because they cannot perceive the therapeutic effects. As a specialized company in the field of ophthalmology, Santen focuses on raising awareness of the importance of early detection, early treatment, and continuation of treatment in glaucoma treatment to prevent vision loss.
Keiji Amakawa, an athlete actively participating in sports for the visually impaired, started to have difficulty seeing due to glaucoma while in the upper grades of elementary school. He lost the vision of his right eye when he was in his first year of university, and after graduation, he lost the sight of his left eye. In this interview, Mr. Amakawa revealed his experience he has had since he was in elementary school, during which he first noticed the symptoms of glaucoma. He also talked about how he became engaged in sports for the visually impaired as well as his observations as a person with visual impairment.
Through his experience, we hope to share the importance of early detection and continuation of treatment of glaucoma.
* This interview was conducted in March 2018.

Athlete Keiji Amakawa (center); Hasegawa (left) and Tsuji (right) of the Glaucoma Team, Ophthalmic Marketing Group, Santen Pharmaceutical

About the Athlete

Keiji Amakawa
Bronze medal winner in men's judo for visually impaired competitors at the Athens 2004 Paralympics
Former member of the Japan National Men's Blind Football team, currently with Hyogo Samurai Stars Blind Football Club
Teacher at a special school for the visually impaired

About Glaucoma

Glaucoma is primarily a disease that damages your eye's optic nerve due to elevated intraocular pressure (IOP), resulting in defects of the visual field (i.e., the range you can see) or partial blindness. Note that people with the normal range of IOP can develop glaucoma, which is called normal tension glaucoma.
One in 20 people aged 40 or over in Japan are said to have glaucoma.

Initial Symptoms and Starting Treatment of Glaucoma

Hasegawa:
Thank you for coming for this interview. Tsuji and I are in charge of the marketing of glaucoma treatments. While many types of glaucoma treatment are currently being developed, glaucoma remains the leading cause of vision loss in Japan. Through our work, we aim to minimize the risk of vision loss resulting from glaucoma through the use of drugs as well as our activities, in other words, to eliminate vision loss due to glaucoma.
The visual field, once lost by glaucoma, never recovers, so it is crucial to detect the disease early and start treatment. However, it is said that the initial stage of glaucoma is often without subjective symptoms, and this may delay the detection of glaucoma.
I hear that your loss of eyesight was due to glaucoma. How did you first notice your symptoms?

Amakawa:
I first had the symptom of cloudy vision when I was in the upper grades of elementary school. The symptom persisted for two to 12 hours a day, so I went to see an ophthalmologist, and was diagnosed with glaucoma and was prescribed eye drops.

Hasegawa:
Did you use the eye drops as prescribed? It is important to use medication according to the designated dose frequency.

Amakawa:
I sometimes forgot to use the eye drops when I was able to see clearly, but when I had cloudy vision, that is, when my eye condition was poor, I never failed to use them.

Hasegawa:
Patients often forget to use eye drops when their condition is good, and we realize this is a problem. To preserve the visual field for a long time, it is vital to start glaucoma treatment early and continue the treatment, whereas people generally do not see ophthalmologists as long as they have no subjective symptoms. Even if they are diagnosed with glaucoma and prescribed ophthalmic solutions, the majority do not use the prescribed drugs regularly every day.

Amakawa:
That's true. I had no sense of fear that this might lead to vision loss in the future, so when my eye condition was good, I didn't bother.

Hasegawa:
An ophthalmologist I know once told me that it was very difficult to encourage patients to proactively receive treatment, and wondered if it was a good idea to tell them firmly that they might lose their vision unless they continued the treatment rigorously.

Amakawa:
I had thought that if I continued to use the drugs even when my eyesight was good, their medicinal effects would wear off. If it had been explained to me about the benefits of maintaining the dosage regimen regardless of my condition and the reason, I would have kept using my eye drops.

Tsuji:
What about the dosage frequency? The prescribed dosage frequency when you started using eye drops must have been three times daily. Is it difficult to apply eye drops regularly if you have to use them frequently?

Amakawa:
Yes. Particularly when I was in elementary school, I was too engrossed in playing indoors and outdoors to remember to apply my drugs. It would be so much better if the drug could have the same efficacy with a reduced frequency.

Mr. Amakawa revealing his experience of receiving glaucoma treatment

Visual Field Defects in Glaucoma

Hasegawa:
When did you first notice the change in your vision?

Amakawa:
I first realized I had partial vision loss when I was in the second year of junior high school on our school trip. I was seated in the middle of the backmost row on the bus, and didn't notice a microphone that other students had passed around to me. Surprised, I had my vision tested alternately with the right eye and then the left, and found I had partial vision loss in the lower right corner near my nose. It was really a shock.

Hasegawa:
I see. Examining your visual field using only one eye at time turned out to be the easiest and surest way to check your vision. I often hear from ophthalmologists that many patients see an ophthalmologist only after their condition has significantly worsened, that they should have noticed their symptoms much earlier. However, most somehow believe that they are okay because they can see with their two eyes.

Amakawa:
Exactly. In my case, when my condition was poor, I had cloudy vision as if I were looking through frosted glass. Had I checked the difference in vision using each eye in turn, when my vision was not cloudy, I would have been able to notice missing areas in my visual field.

Mr. Hasegawa and Ms. Tsuji interviewing Mr. Amakawa about his experience

Hasegawa:
We also need to make more efforts to raise awareness of the significance of receiving testing at an early stage to start treatment early, in order to slow the progression of visual field loss.

Amakawa:
I was a member of the football club at my junior high school. The visual field loss developed not only in my right eye but also in my left eye. I couldn't see the football if it was in the lower part of my visual field, and became unable to handle footballs even though I had previously been able to. When I took part in long-distance running, I used to fall in places where other students never fell. Also, when I was taking exams, I was able to see only four out of five options, so I became increasingly unable to solve problems when my condition was poor. These were tough situations.

Positive Life with Sports for Visually Impaired

Hasegawa:
If it's all right with you, might I ask you how you felt as your visual field gradually diminished, depriving you of your vision?

Amakawa:
They say some people become desperate and turn into a social recluse, but such sentiments never occurred to me. For one thing, my family supported me greatly and helped me to remain positive in life. If I was to lose vision over time, I thought, it would be all the more important for me to value the present. I felt sure that my current efforts would pay off in the future, even if I lost my vision.

Hasegawa:
You are tough. If I were in your situation, I don't know if I could be so positive and determined. I feel truly empowered.

Amakawa:
In fact, devoting myself to playing football for three years while I was in junior high school gave me an additional advantage when I started playing blind football after losing my vision. I also became a member of the judo club in high school, because my visual field became more constricted, making it difficult for me to see things, and this led to my participating in men's judo for the visually impaired at the Paralympics after I completely lost my vision. I also gained many experiences through playing sports for the visually impaired. I had increasing opportunities to be interviewed, and this helped me to speak freely in public.

Tsuji:
Your experience in sports has provided you with various opportunities.

Amakawa:
Everything went for the better. Loss of eyesight created opportunities for me to travel abroad and meet my wife. Another thing I remember is having competed in the All Japan High School Quiz Championship for three years in a row when I was in high school, and when I was in the third year, I was able to participate in a national competition. This experience taught me the benefit of continuing to try. I always like to enjoy life because you only live once, and find enjoyment in every opportunity.

The bronze medal Mr. Amakawa received in men's judo for visually impaired competitors at the Athens 2004 Paralympics

Realizing a Unified, Borderless Society for All

Ms. Tsuji interviewing Mr. Amakawa

Tsuji:
I understand that you go to a lot of places in your daily life. Have you experienced dangerous situations because you cannot see?

Amakawa:
I have fallen onto railway tracks. Many of my friends who have visual impairments have had similar experiences. Steps on the road as well as ditches and gutters are also dangerous. I become very startled if a dog suddenly barks close to my face.

Tsuji:
That's really dangerous. How can we provide support for people with visual impairment in their daily living?

Hasegawa:
They say that all you have to do is to ask casually, and lend them your shoulder, removing all barriers. However, when I actually see people with visual impairment, for example, on a platform of a station, I don't know what to say to them. Do you have any advice?

Amakawa:
Talk to as many people as you like. If a person seems to be in trouble, ask him/her if you could be of any help. If no help is required, that person will say so. Your talking to as many people as you like will spread through the network of people, thereby creating a society that is kind to people in wheelchairs or senior people as well as people with visual impairment.

Expectations for Santen

Hasegawa:
What are your expectations for Santen, or things we can do?

Amakawa:
You mentioned earlier about glaucoma being the leading cause of vision loss. I think delaying the progression to vision loss as much as possible will be very helpful. As for myself, I appreciate using eye drops because they have been useful in preserving my eyesight for a longer time.

Hasegawa:
We realized the significance of providing drugs with higher efficacy, which show maximal effect with minimum dosage frequency, and raising awareness of the importance of early detection, early treatment, and continuation of treatment, for preserving visual fields, thereby contributing to patients by helping them to maintain their vision. As a member of society, we will start by asking what we can do whenever we see someone who needs help.
Thank you for sharing your experience today.

At the reception of Santen Pharmaceutical Corporate Headquarters