REVIEWThe Vision Van, a Mobile Eye Clinic, Aids Relief Efforts
in Tsunami-stricken Areas
Catherine Ross Oshima, Kenya Yuki, Atsuro Uchida, Murat Dogru, Takashi Koto, Yoko Ozawaand Kazuo Tsubota

Department of Ophthalmology, School of Medicine, Keio University, Tokyo, Japan(Received for publication on December 22, 2011)(Revised for publication on January 12, 2012)(Accepted for publication on January 12, 2012)

In the wake of the devastating earthquake and tsunami of March 11, our group at Keio University
worked diligently to bring the Vision Van, a mobile eye clinic, from Miami, Florida, to disaster areas
where medicines, eyeglasses, and indeed all other ophthalmological supplies and services, were nonexistent, thereby assisting many tsunami survivors suffering from eye problems. This act was encouraging
not only to the patients and those working in the disaster-hit areas but also to ophthalmologists whowanted to use their medical specialty to assist those in need. (Keio J Med 61 (1) : 10–14, March 2012)

Keywords: disasters, Japan, mobile health units, ophthalmology, relief work

The earthquake of March 11, 2011, hit the northeastern Pacific coast of Tohoku, Japan, triggering powerful
tsunami waves that destroyed almost all coastal villages.
Tragically, 15,842 people perished, nearly 5,900 were injured and 3,485 remained missing as of December 14.1
Unlike the Hanshin earthquake of 1995, after which rescue missions were immediately underway and many wererescued from damaged buildings, following the March2011 earthquake and tsunami, initial rescue attempts
were delayed due to disabled communication networks
and destroyed transportation systems. Rescue attempts
were further complicated because the affected areas were
far from metropolitan areas and it was not simply one citythat was affected but almost all coastal villages and cities
were destroyed. In addition to the challenges of the breakdown of communication networks, the lack of gasoline
and supplies and the continuous aftershocks hampered
rescue teams. The affected area was great, with no large
cities nearby (Fig. 1). Sendai, the largest city in Miyagi
Prefecture, itself was affected, and Morioka, the largest
city in Iwate Prefecture, is far from the coastline and theroads were unusable.
A rapid rescue response is crucial, as was noted forthe 2010 Haiti Earthquake.2 However, after the March 11

earthquake, the tsunami was so powerful that municipal
functions, including communications, were destroyed.
Given the magnitude of the Great East Japan Earthquake,
ophthalmic care was considered a relatively minor matter. Yet, the quality of life for survivors who lost theireyeglasses or required eye drops for eye care is an important issue. Many eyeglass shops and about 30 eye clinics
were destroyed, as well as hospitals with ophthalmology
departments. Miyagi and Iwate Prefectures in the northeastern part of Japan were the most affected regions in
the tsunami zone. Several new public hospitals such as
Rikuzentakata Hospital, Yamada Hospital, Shizugawa
Hospital, Onagawa Hospital and Otsuchi Hospital in
Iwate and Miyagi Prefectures were completely destroyed.
Therefore, no eye care was provided in the tsunami-affected areas for the first 7–10 days.
Two weeks after the earthquake, we visited northeastern Japan to assess the situation and find ways to help thesurvivors with their ocular needs. At that time, we hadlimited means of providing assistance because a thorougheye exam requires bulky instrumentation. This was when
we decided to bring the Vision Van, a mobile eye clinic,
to Japan. Use of the Vision Van had been reported in theU.S. media when it was used after Hurricane Katrina in

Reprint requests to: Kazuo Tsubota, MD, Department of Ophthalmology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku,
Tokyo 160-8582, Japan, E-mail: tsubota@z3.keio.jp
Copyright © 2012 by The Keio Journal of Medicine
10Keio J Med 2012; 61 (1): 10–1411Fig. 1 Map of Japan with enlarged inset showing the affected Tohoku Region of northern Japan.

2005 to aid casualties with ocular problems.3 The Vision
Van is equipped with a slit lamp, funduscope, tonometer,
and autorefractor as well as a satellite Internet connection and ample storage. We immediately contacted theBascom Palmer Eye Institute to request the use of their
Vision Van, and they were more than pleased to accommodate us. The next challenge was how to transport thislarge van, truly a bus, weighing nearly 26,000 pounds
and 40 feet long from Miami to Japan. Various possibilities were explored with commercial airlines and the U.S.
Air Force. Finally, the Japanese Cabinet obtained an offer of free transport from Volga-Dnepr Airlines to use
their Antonov AN-124, the world’s largest cargo airplane.
Staff around the world worked quickly to prepare the paperwork and the Vision Van arrived at the newly opened
Sendai Airport on April 14 (Figs. 2, 3). The following
day, the van was in use (Fig. 4) and began its rotation ofproviding eye care to coastal cities in Miyagi and Iwate
Prefectures, starting in the afternoon at Onagawa Evacuation Center. Even with short notice of the availability ofeye care to the evacuees, 61 patients were treated that dayalone (Fig. 5).
The Vision Van is equipped with all necessary equipment and ophthalmic supplies (Fig. 6); therefore, volunteer ophthalmologists can simply go to the care site andbegin treating patients. The Vision Van rotated from thenorthern part of Iwate to Miyagi, visiting several towns

on a weekly rotation, with Sundays off. We were able toprovide eye care to these remote areas through the teamwork of Iwate and Tohoku Universities and the Japanese
Ophthalmological Society.
On the Vision Van’s first day of service in Japan, a42-year-old woman was seen for blurred vision in theright eye. She was found to have diabetic retinopathy
bleeding and was referred to Tohoku University Hospital for further treatment. Unfortunately, emergency foodsupplies that have a high glycemic index, such as riceballs and bread, contribute to many complications forpatients suffering from diabetes. Without an appropriate
eye exam, proper treatment such as photocoagulation orvitrectomy cannot be provided. Additionally, eye care topreserve vision and prevent further vision loss is crucial
for those with chronic eye disorders such as diabetic retinopathy, glaucoma and age-related macular degeneration.
Some patients were found to have elevated intraocularpressure, and appropriate eye drops were provided via
the Vision Van. During the nearly 3 months of the Vision
Van’s rotation in Iwate and Miyagi Prefectures, 3389 patients were seen, averaging 55 patients per day. Overall,
the major problems experienced by evacuees were lost or
broken eyeglasses and the need for treatment for preexisting conditions, including cataract, conjunctivitis/allergy,
contact lens replacement, glaucoma, dry eye/eye strain,diabetic retinopathy, and branch and central retinal vein

12Oshima CR, et al: Relief Efforts in Tohoku via Mobile Eye Clinic

Fig. 2 The Vision Van is transported by Antonov AN-124 to Sendai − US and Russian collaboration makes it a true international rescue mission. Vision Van unloaded from the AN-124.

Fig. 3 Left to right: Kazuo Tsubota, Volga-Dnepr Airlines captain, Dr. Richard Lee (who traveledon the Antonov AN-124 from Miami to train volunteers how to use the Vision Van), and a VolgaDnepr staff member.

Keio J Med 2012; 61 (1): 10–14

Fig. 4 Vision Van on the first day of the rescue mission en route to Onagawa Evacuation Center.

Fig. 5 Patients waiting for a consultation with the ophthalmologist at Onagawa
Evacuation Center.

13

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Oshima CR, et al: Relief Efforts in Tohoku via Mobile Eye Clinicof the Vision Van with its tropical designs on the exterior− especially a van all the way from Miami, Florida − wasuplifting and gave a positive feeling to those who saw it.
Currently, discussions are underway for Japan to secure
its own mobile eye-care van, as well as other vans that
could be designed to address other medical needs. Evena ship offering medical services is being considered by
the Japanese government. Future earthquakes, or otherdisasters such as typhoons, are inevitable, and emergency
medical care should be prepared in advance. Mobile clinics such as the Vision Van provide valuable care to individuals displaced in the event of disasters, but they canalso be used to provide services to those living in remotelocations.
Acknowledgments
We thank the University of Miami Miller School ofMedicine, Volga-Dnepr Airlines, MediProduce, Inc. andthe Japanese government for their support of the Mission
Vision Van project, and we are deeply indebted to all thehealthcare professionals who volunteered their time andskills to see patients displaced by the tsunami.
References

Fig. 6 Inside view of the slit lamp on the Vision Van.

occlusions.
Although transporting the large, heavy Vision Van wasdifficult and expensive, through the goodwill and collaboration of many people, it was possible. The appearance

1. National Police Agency of Japan: Damage Situation and Police
Countermeasures Associated with the 2011 Tohoku District/Pacific Ocean Earthquake. Dec. 14, 2011. (Accessed Dec. 15, 2011
http://www.npa.go.jp/archive/keibi/biki/index.htm).
2. Ginzburg EW, O’Neill W, Goldschmidt-Clermont PJ, et al: Rapid
medical relief–Project Medishare and the Haitian earthquake. NEngl J Med 2010; 362 Mar 11: e31. [Medline] [CrossRef]
3. Bascom Palmer’s Vision Van offered services to battered Louisiana. Ocular Surgery News, October 15, 2005 (Accessed Dec. 14,
2011 http://www.osnsupersite.com/view.aspx?rid=12678).