Mr. Junichi Maruyama

Former Ambassador of Japan to Serbia

Aiming to advance policies to combat antimicrobial resistance (AMR), AMR Alliance Japan (Secretariat: Health and Global Policy Institute (HGPI)) has been engaged in joint action with people impacted by AMR and those close to them in Japan and abroad. As part of these activities, starting in 2021, AMR Alliance Japan has been gathering the voices of citizens who have been involved in AMR control.
This installment focuses on Mr. Junichi Maruyama’s experiences with continuous ophthalmologic treatment and AMR. Mr. Maruyama’s current source of concern is having cataract surgery for his left eye, which is his only remaining source of vision. He highlighted how long-term antimicrobial use that results in AMR can impact one’s future treatment options and shared how AMR is an issue that is close at hand in his life.

Contents:

Introduction

(1) Mr. Maruyama’s history of ocular trauma and treatment

(2) Experiencing AMR and changing treatment

(3) Undergoing retinal surgery and treating cataracts

(4) The importance of AMR control and prospects for the future

Introduction

In this report, I would like to share about my experiences as an individual who has faced the issue of AMR as a patient. While “AMR” may sound like a complicated topic to some, it is actually something that can have a direct impact on our daily lives. I would be pleased if this article provides readers with an opportunity to recognize AMR as an immediate issue and to consider the importance of AMR control.

(1) Mr. Maruyama’s history of ocular trauma and treatment

When I was young, I was involved in an accident in which a glass shard entered my right eye, causing partial vision loss. While I underwent surgery immediately, of course, a fragment of the glass was left behind. The body reacts to a piece of glass as a foreign body, which can easily lead to infections. This means that I need continuous monitoring at a health facility. For many years, I have continued treatment using a fluoroquinolone antibiotic eye drop called levofloxacin. I have regular follow-up with my doctor once every three months to monitor my condition.

It seems my case was a very interesting one from a medical perspective, so there were many times when I was examined by several doctors alongside my primary doctor. At times, I felt like I was being observed like a guinea pig, which created a psychological burden. Knowing that healthcare professionals saw me as an opportunity to deepen their medical knowledge while I was in the position of a patient undergoing treatment left me with mixed feelings.

(2) Experiencing AMR and changing treatment

Despite these circumstances, by following my doctor’s instructions and using antimicrobials appropriately, I was fortunately able to avoid any major infections. However, as my treatment went on, I began to feel as if the eye drops were not working as well as they did before. After an examination at a health facility, I learned that at some point, the bacteria in my eye had developed resistance to levofloxacin. From then on, I had to stop using levofloxacin and had to switch to a different fluoroquinolone eye drop called tosufloxacin. Furthermore, my doctor told me to keep my use of the new eye drops to the bare minimum to avoid AMR bacteria from emerging again. However, at the time, I did not grasp the severity of the situation.

(3) Undergoing retinal surgery and treating cataracts

I underwent retinal surgery on my right eye twice in 2024. This time, I told the doctor ahead of time that I had previously experienced AMR, and because he took the appropriate measures, I was able to complete the surgeries without issue. During the surgery on my retina, I had cataract surgery at the same time. Since retinal surgery can make it easier for cataracts to progress, it seems that many patients have both surgeries at once, and it is a common practice.

However, my real challenge now is the situation with my left eye. Only my left eye has retained vision, but I am developing a cataract in it that will eventually require surgery. I cannot move my right eye and am missing half of my field of vision, so I depend on my left eye to live my life. This is why I am left with a lingering fear of having cataract surgery on it. My history with AMR might limit the antimicrobials available for use if I undergo surgery. If I am unable to use enough antimicrobials to prevent an infection, it may impact treatment for my left eye, my only remaining source of sight. These circumstances make me feel concerned. For patients, any situation in which medicines that would normally be available without question can no longer be used poses very serious problems.

*This article is based on a speech from Mr. Maruyama given at the AMR Special Symposium, “Reframing AMR as the Infrastructure Guarding the World: Building Multi-Stakeholder Commitment to the One Health Approach Looking to the G7, UNGA, and Beyond” held on February 28, 2023 and hosted by Health and Global Policy Institute (HGPI) with support from the British Embassy, Tokyo, the Department of Health & Social Care, UK, and the European Bank for Reconstruction and Development (EBRD). An additional interview with Mr. Maruyama was also conducted for this installment.