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Figure.
Map of Northeastern Miyagi Prefecture
Map of Northeastern Miyagi Prefecture

Miyagi is the nearest prefecture to the epicenter of the Great East Japan Earthquake. Overall, we examined patients during 25 visits to 15 shelters in 11 emergency districts (solid circles) on 15 separate days between April 15 and May 29, 2011.

Table.  
Chief Complaints and Diagnosesa
Chief Complaints and Diagnosesa
1.
Ishigaki  A, Higashi  H, Sakamoto  T, Shibahara  S.  The Great East-Japan Earthquake and devastating tsunami: an update and lessons from the past great earthquakes in Japan since 1923. Tohoku J Exp Med. 2013;229(4):287-299.
PubMedArticle
2.
Shibahara  I, Osawa  S, Kon  H,  et al.  Increase in the number of patients with seizures following the Great East-Japan Earthquake. Epilepsia. 2013;54(4):e49-e52. doi:10.1111/epi.12070.
PubMedArticle
3.
Oshima  CR, Yuki  K, Uchida  A,  et al.  The Vision Van, a mobile eye clinic, aids relief efforts in tsunami-stricken areas. Keio J Med. 2012;61(1):10-14.
PubMedArticle
4.
Tsubota  K, Yoshida  T, Kurosaka  D, Lee  RK, Alfonso  EC, Nakazawa  T.  Miami to Japan eye-care rescue mission: Vision Van helps with relief efforts. Am J Ophthalmol. 2011;152(5):886-887.
PubMedArticle
5.
Aoyagi  T, Yamada  M, Kunishima  H,  et al.  Characteristics of infectious diseases in hospitalized patients during the early phase after the 2011 great East Japan earthquake: pneumonia as a significant reason for hospital care. Chest. 2013;143(2):349-356.
PubMedArticle
6.
Igusa  R, Narumi  S, Murakami  K,  et al.  Escherichia coli pneumonia in combination with fungal sinusitis and meningitis in a tsunami survivor after the Great East Japan Earthquake. Tohoku J Exp Med. 2012;227(3):179-184.
PubMedArticle
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Brief Report
July 2014

Ophthalmologic Examinations in Areas of Miyagi Prefecture Affected by the Great East Japan Earthquake

Author Affiliations
  • 1Department of Ophthalmology, Graduate School of Medicine, Tohoku University, Sendai, Japan
  • 2Miyagi Ophthalmologists Association, Sendai, Japan
JAMA Ophthalmol. 2014;132(7):874-876. doi:10.1001/jamaophthalmol.2014.849
Abstract

Importance  One month after the Great East Japan Earthquake on March 11, 2011, our clinic was granted free use of the Mission Vision Van, a customized bus airlifted to Japan. This mobile eye clinic made it possible for us to provide ophthalmologic examinations anywhere in the disaster zone in Miyagi Prefecture.

Observations  This study included 731 patients who received treatment in the eye care van in Miyagi Prefecture between April 15 and May 29, 2011. We examined and cared for patients during 25 visits to 11 emergency districts during 15 clinic days. Of the 914 diagnoses we identified, 358 were refractive disorders (39.2%), which were the most common ocular diseases we observed; others included 155 (17.0%) cataracts, 106 (11.6%) dry eye, and 73 (8.0%) infectious diseases, such as conjunctivitis. Overall, we provided emergency prescriptions for 871 bottles of eyedrops comprising 222 prescriptions (25.5%) for dry eye, 189 (21.7%) for cataracts, and 107 (12.3%) for glaucoma.

Conclusions and Relevance  A substantial number of patients in the earthquake-damaged areas needed replacements for eyeglasses, contact lenses, and eyedrops. The mobile clinic appears to be a useful way to provide ophthalmologic examinations and support after a disaster.

Japan has a long history of devastating earthquakes and tsunamis.1 On March 11, 2011, the Tohoku area suffered an unprecedented disaster when it was struck by the most powerful earthquake in Japanese history followed by a massively destructive tsunami. The most serious damage was caused by the tsunami along the northeastern coast. The coast of Miyagi Prefecture between the towns of Matsushima and Kesennuma has a population of approximately 320 000 (Figure).2 There were relatively few ophthalmologic institutions in this area before the disaster. Afterward, more than half of these institutions were too damaged to function. Although determined local and Tohoku University ophthalmologists were able to access the stricken areas by car, emergency shelters numbered in the hundreds and were spread across a vast area. The quality and number of examinations possible under the circumstances were therefore limited. However, the Mission Vision Van, a mobile ophthalmologic examination van owned by the Bascom Palmer Eye Institute, Miami, Florida, revolutionized the situation. The van has all the key equipment of a general ophthalmology clinic and is capable of providing examinations similar to those within the clinic. After generously being offered use of the Mission Vision Van at no monetary cost, we obtained the van in Sendai approximately 1 month after the disaster.3,4

Methods

We analyzed clinical data on patients and determined the distributions of age, sex, chief complaints, and diagnoses, as well as the number of eyedrops, eyeglasses, and contact lenses prescribed. We report details on the uses of the mobile clinic and the ophthalmologic examinations performed with it in the disaster-stricken areas of the Miyagi Prefecture. This retrospective study was approved by the institutional review board of the Graduate School of Medicine, Tohoku University (Protocol No. 2013-1-94).

Results

In total, we provided ophthalmologic care to 731 patients (men, 259; women, 472; age range, 0.3-90 years; mean [SD] age, 57.1 [20.7] years) in the stricken areas of Miyagi Prefecture with the Mission Vision Van, starting approximately 1 month after the Great East Japan Earthquake. We examined patients during 25 visits to 15 shelters in 11 emergency districts (Figure) on 15 days between April 15 and May 29, 2011. Forty-three physicians performed examinations and 47 orthoptists and nurses participated. Most patients came to the mobile clinic for replacement of items lost in the disaster: 233 individuals (30.6%) for eyeglasses, 159 (20.9%) for eyedrops, and 103 (13.5%) for contact lenses (CLs) (Table). Of the 914 diagnoses we identified, 358 (39.2%) were refractive disorders, including myopic astigmatism (23.0%), hyperopic astigmatism (2.2%), and presbyopia (14.0%), which were the most common ocular diseases. Other disorders included 155 (17.0%) cataracts, 106 (11.6%) dry eye, and 73 (8.0%) infectious diseases, such as conjunctivitis (Table). Overall, we provided emergency prescriptions for 871 bottles of eyedrops, including 222 prescriptions (25.5%) for dry eye, 189 (21.7%) for cataracts, and 107 (12.3%) for glaucoma.

Discussion

We initially believed that ocular infectious diseases would be aggravated in the stricken areas by the environment of the emergency shelters, but this was a relatively minor concern and there was less need for antibacterial eyedrops than we expected.5,6 Problems related to preexisting ocular conditions were more severe than we expected because of the loss of eyeglasses, CLs, and eyedrops. As a result, we now believe that refractive care and eyedrop replacement are the primary concerns in such situations and recommend that an auto lens edger be considered an essential part of emergency mobile eye clinics.

Conclusions

We found that the mobile clinic was an indispensable way of providing ophthalmologic examinations and support to the stricken areas of Miyagi Prefecture after the Great East Japan Earthquake. Thus, we believe that mobile eye care vans will be of great importance in future natural disasters. On March 17, 2013, the government of Miyagi Prefecture presented the Miyagi Ophthalmologists Association with a dedicated mobile eye care van (the Japanese Vision Van) for use in future disasters.

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Article Information

Submitted for Publication: November 26, 2013; final revision received January 24, 2014; accepted February 2, 2014.

Corresponding Author: Toru Nakazawa, MD, PhD, Department of Ophthalmology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8574, Japan (ntoru@oph.med.tohoku.ac.jp).

Published Online: May 8, 2014. doi:10.1001/jamaophthalmol.2014.849.

Author Contributions: Dr Doi had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: All authors.

Drafting of the manuscript: Kunikata.

Critical revision of the manuscript for important intellectual content: All authors.

Study supervision: All authors.

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank Kazuo Tsubota, MD, PhD (Department of Ophthalmology, Graduate School of Medicine, Keio University) for managing the airlift of the Mission Vision Van to Japan from the United States. We also thank the University of Miami Miller School of Medicine, Volga-Dnepr Airlines, MediProduce Inc, Kazumasa Yamagata, MD, PhD (president of the Miyagi Ophthalmologists Association), the Japanese government for their support of the Mission Vision Van project, and the staff of the Department of Ophthalmology, Graduate School of Medicine, Tohoku University.

References
1.
Ishigaki  A, Higashi  H, Sakamoto  T, Shibahara  S.  The Great East-Japan Earthquake and devastating tsunami: an update and lessons from the past great earthquakes in Japan since 1923. Tohoku J Exp Med. 2013;229(4):287-299.
PubMedArticle
2.
Shibahara  I, Osawa  S, Kon  H,  et al.  Increase in the number of patients with seizures following the Great East-Japan Earthquake. Epilepsia. 2013;54(4):e49-e52. doi:10.1111/epi.12070.
PubMedArticle
3.
Oshima  CR, Yuki  K, Uchida  A,  et al.  The Vision Van, a mobile eye clinic, aids relief efforts in tsunami-stricken areas. Keio J Med. 2012;61(1):10-14.
PubMedArticle
4.
Tsubota  K, Yoshida  T, Kurosaka  D, Lee  RK, Alfonso  EC, Nakazawa  T.  Miami to Japan eye-care rescue mission: Vision Van helps with relief efforts. Am J Ophthalmol. 2011;152(5):886-887.
PubMedArticle
5.
Aoyagi  T, Yamada  M, Kunishima  H,  et al.  Characteristics of infectious diseases in hospitalized patients during the early phase after the 2011 great East Japan earthquake: pneumonia as a significant reason for hospital care. Chest. 2013;143(2):349-356.
PubMedArticle
6.
Igusa  R, Narumi  S, Murakami  K,  et al.  Escherichia coli pneumonia in combination with fungal sinusitis and meningitis in a tsunami survivor after the Great East Japan Earthquake. Tohoku J Exp Med. 2012;227(3):179-184.
PubMedArticle
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