 Thank you very much. Earlier today, the United Nations Friends of Vision group and the United Nations President, the WHO representative and the ILO joined us to launch the Landsat Global Health Commission and launch the Vision Atlas. This webinar, which is targeting a global Eastern time zone, will give more detailed reports of the work of the Commission. And so on behalf of Professor Matthew Branson and I, co-chairs of the Commission, the multidisciplinary group of 73 commissioners representing experiences across all regions, we welcome you back, including all the new participants just joining us from the regions and from the countries. We particularly welcome the UN offices and its agencies, especially the World Health Organization. We welcome the media, regional and local, prints, broadcasts and internet, especially national government representatives. As I Health moves into development, we also welcome stakeholders in development as we reframe I Health within a development paradigm. Agencies focused on children, the elderly, are vulnerable populations ensuring we leave no one behind. The general health and I Health fraternity who have been and will continue to be part of this journey. Donors, small and large, who have supported global and local I Health over the decades. And in this fast moving innovation phase, tackling head on the global challenges of the pandemic and climate change. I welcome industry, technology and pharmaceutical companies, and in fact, the entire population. The webinar will be such a unique opportunity to share. And I thank you all for attending, for participating, for listening to recordings, thereafter, for continuing advocacy, and for continuing to punish to own I Health within development, even after the seminar. Thank you so much for your time. And for those things, thank you for participating in this webinar. Thank you. Thank you, Hannah. So my name is Zoe Mullen, I'm the editor in chief of the Lancet Global Health, and I'm delighted to be co introducing this webinar this afternoon. I want to thank you for your attention to what I've certainly learned over the past two years is a crucially important cross cutting issue for health and development. Before we hear from the commissioners in more detail. I just wanted to give you a flavor of what a commission is, as we define it. So a commission, a Lancet commission is a scientific review, and it's science led, it's international, it's multidisciplinary, and it focused on policy and particularly policy change. We usually choose a topic that's perhaps understudied, and we aim for transformational change and I think we're hoping this is going to happen with this particular commission. Practically speaking, it's a report of 20,000 words. So it's a, it's a meaty thing we've, we have printed it so print copies will be available. Certainly we've circulated some for the earlier launch, and others will be available but it's also available open access online at the Lancet Global Health website. We also have an executive summary which is only 1000 words long. And so you are welcome to dip into that as well. There's also an audio version of that, which is more accessible we hope. And so these commissions are usually commissioned by the editors themselves but they can be suggested by authors, and in fact that's what Professor Matthew Burton who you're you're here from in just a second suggested to us so we worked with him to come up with the concept for this commission, and then he went away with his team, and did the absolutely enormous work that you will see presented shortly. So it's been a long journey for this really dedicated group of researchers, and I heartily congratulate them on this inspiring, and I hope impactful work. I really hope you enjoy the presentations to come. Thank you. Healthy vision and eyes are something we take for granted. But nearly all of us will experience poor eye health during our lives. Today, 1.1 billion people around the world are living with vision impairment that has not been addressed. And there are hundreds of millions more who need ongoing eye care throughout their lives. Eight out of 10 people in need of eye care live in low and middle income countries. And many of those with vision loss cannot access the eye health services they need. Vision impairment has a huge economic impact. The estimated annual productivity loss is equivalent to 411 billion US dollars. That's nearly twice the GDP of New Zealand. Poor eye health can impede learning, working, caring for others, reduce overall health and well-being, and can lead to lower life expectancy. These challenges have far-reaching effects on the world's development. And as more of us live longer, the problem is only going to get bigger. Fortunately, solutions exist. In fact, up to 90% of vision impairment could be prevented or treated with existing, highly cost-effective interventions. Yet services are under-resourced and least accessible to those that need them most. We need to work together to increase investment in eye care. Governments need to include eye care within their health systems, plans and policies, providing comprehensive services that put people and communities at the centre of care, through health promotion, prevention, treatment and rehabilitation, and by reducing the impact of vision loss by creating inclusive and accessible environments. Collectively, we can help to deliver better eye health for all, while benefiting individuals and nations economically, and advancing sustainable development. Now is the time for action to unlock the power of eye health for all. Hello, my name is Matthew Burton. It is a great pleasure to welcome His Excellency Ambassador Walton Webson, who is the permanent representative to the United Nations for Antigua and Babuda. Ambassador Webson is the co-chair of the United Nations Friends of Vision and has kindly agreed to formally open this webinar with a keynote address. Thank you, Ambassador Webson. Thank you very much, Matthew. Thank you, Hannah, Zoe, colleagues, friends all around the world. It's an extreme honour for me to have been invited to be a commissioner with this very distinguished team of professionals and across all disciplines. Because the team is a multidisciplinary team, it helped to amplify the need for us to move eye health from the silo of simply locking it into a health challenge to recognize that eye health is a broader development challenge. This commissioners report shows the evidence and shows us the urgency that we must take to address the problem of eye health and if we are going to achieve the sustainable development goals. Because I was given this honour as a commissioner, I was able to work with my colleagues and the Friends of Vision, a group that we founded only three years ago, to be able to bring to the attention of the diplomatic community, the politicians and the health leaders around the world, to bring to their attention the urgency for eye health to be inclusive in universal health but also to be inclusive in the development agenda if we are going to attain the objectives of leaving no one behind. We know that poor eye health services, poor eye health conditions and individuals is a major factor in inequality. To that end then, we are working with colleagues from across the spectrum to show that the discipline, all disciplines must come together in addressing the problems from all countries. This report shows the statistics. You will hear more about it. It addresses the urgency. You will read more about that and it shows us the need for us to address eye health as a multidisciplinary approach towards meeting the SDGs, the sustainable development goals, and towards beating back the challenges and problems of inequality. I want to thank Matthew and the team, every member, every commissioner for the outstanding job done and for the work that lies ahead because when we put something like this out, people are looking for solutions and together we all will work with governments across all ministries in addressing the problem and beating the challenge that's before us. I thank you. Hello. My name is Matthew Burton. I'm based at the International Centre for Eye Health in London and with HANA file I co-chaired the commission. I would like to add my welcome to those of HANA, ZOE and AUBRI to mark the launch of the commission and to thank you for joining us. Today we would like to outline some of the findings from the commission which we hope will be useful in advancing understanding and catalyzing action on eye health. The commission report is the work of an interdisciplinary group of 73 academics, national program leaders, and practitioners from 25 countries. A further 75 people have contributed to many original reviews which are being published as subsidiary papers. In addition to the main report and appendices, the commission's subsidiary publications, case studies, and other resources can be accessed through the commission website. You can also access the reports and related materials through the main Lancet commission hub website. The report is structured in six sections. Today we're going to have a series of 14 rapid fire talks by commissioners on a range of topics. Because this is being delivered over several different time zones, these have been pre-recorded. Our key message can be found on the front cover of the report. Investing in universal eye health is a realistic, cost-effective way of unlocking human potential by improving health and well-being, education, work, and the economy. It is essential to achieving the sustainable development goals. The commission seeks to reframe eye health as not only a health matter, but also an enabling cross-cutting issue within the sustainable development framework. We believe the evidence in favor of urgent global action on eye health is compelling. I will now briefly outline who will be speaking today. First, Rupert Born will talk about the global magnitude of vision impairment. Nathan Condon will talk about eye health and the SDGs. Bonnie Sweener will talk about the relationship between eye health and quality of life, general health, and mortality. Patricia Marquez will talk about the economics of eye health. Nuiro Wangi will talk about the last 20 years of eye research. And Esmil Haptamu will talk about the grand challenges in global eye health project. We will then have a series of talks on different aspects of delivering high-quality eye care for all. I will talk on integrated people-centered eye care, Samarana Yasmin on human resources, Andrew Bastoros on technology, Ian Jones on health financing, Ian McCormack on measuring progress, Tulsi Ravala on quality of care, Jackie Ramkey on equity. Hanafa will round things up with a call to action. Finally, Zoe Mullen will moderate a question and answer session. Just to add that you will be able to access these talks and other resources and publications from the commission website. I will now hand over to Rupert Born, who will talk about the latest data on vision impairment. Thank you. Thank you for the opportunity to talk about the magnitude of eye disease section of the Lansing... I coordinate the Vision Loss Expert Group, which is a group of more than 100 ophthalmic epidemiologists worldwide, which for the last 14 years has gathered together data from population-based studies in eye disease into the global vision database. Every five years we model the data to provide global estimates the prevalence of vision impairment and blindness. For example, the 2015 estimates that we used for the WHO's first report on vision. Working closely with the GBD, we have published the 2020 estimates in Lansing Global Health a few weeks ago, and a summary of this data is reproduced in the Lansing Global Commission. None of this will be possible without the generous support of our funders listed here, who are funding our current five-year cycle. To give you a feel of how eye disease fits within the overall burden of disease, here are three countries, each with a box into which you can fit all things that ale and kill people in terms of dallas. The orange-red colours represent the disease burden caused by infectious child and maternal health conditions, while the blue colours are non-communicable diseases. There are countries such as Nigeria on the left, whereas much as 70% of the disease burden is caused by infectious child and maternal health conditions with a relatively small portion due to non-communicable diseases. As countries undergo what's called the epidemiological transition, where the average age of the population increases and more people live into adulthood, the disease burden shifts to non-communicable diseases and disabilities. For example, Germany here on the right, where 95% of the burden is through NCDs. Most causes of eye disease are non-communicable diseases. Therefore, this epidemiological transition is particularly relevant for vision impairment and blindness, as you'll see in the next slides. This graph shows the strong association of vision impairment and blindness with age. The lowest of the curves is for blindness, and you can see how globally the prevalence of blindness begins to increase in the late 60s. The central curve is for mild vision impairment, and the uppermost curves are for moderate and severe vision impairment. You can see that there's an exponential increase with increasing age from the age of 50 years, with 10 to 20% of the world's population in their 70s affected. The prevalence is higher in women. Starting with mild vision impairment, we estimate 257 million people that have had mild vision impairment in 2020. That's a 62% increase in cases since 1990. If you age standardize the prevalence data, essentially removing the change caused by changing age structure over that time, then you can see a decline in the prevalence of mild vision impairment over 30 years. For modern, severe vision impairment, we estimated 295 million people affected, and for blindness, 43 million people are more modest increase in cases, but a much more dramatic reduction in age standardized prevalence over this time. So for blindness and vision impairment at distance, there's been a reduction in prevalence of blindness, which is a really important message to which our blindness intervention efforts will have contributed. But we have a large pool of people still with lesser, but still moderate or severe vision impairment. For all of these, we'd expect there'll be an approximate doubling of people affected over the next 30 years, given the population projections. The age standardized prevalence of blindness has fallen over 30 years, and we see that illustrated in purple for cataract, the leading cause of blindness, glaucoma, age-related macular generation, and uncorrective refractive error, the leading cause of vision impairment, where rates of blindness due to these diseases have fallen by about 30%. However, blindness due to my better retinopathy is notable in that it is increased. These are certainly striking figures for vision loss, yet under the surface, there's a much greater need for eye care services. In the commission, we presented this need in terms of three groups, people with manifest or corrected vision impairment who need ongoing care, those with early stage disease, where they may manifest a vision impairment later in life, and those with symptomatic conditions that typically don't cause vision impairment, but do require services. So why collect data unless you can use it effectively and make it available to as many people who may benefit from it? In the words of Bill Gates, whose foundation has supported some of V-Leg's work, along with other funders listed here, the focus has been on not just publishing this data, but making it actionable data. That's why the Vision Loss Expert Group partnered with the IAPB to create the Vision Atlas, where vision impairment and blindness data from the V-Leg GVD model can be visualized by any internet user. Thank you. It now gives me great pleasure to introduce the brilliant updated Vision Atlas, and I'd encourage you to disseminate this really as widely as possible to make this data truly actionable. Thank you. Welcome to the Vision Atlas, a panoramic view on all things eye health. Produced by the International Agency for the Prevention of Blindness, IAPB, the overarching alliance for the global eye health sector. At IAPB, we know that improving the world's eye health has far-reaching benefits for health, wellbeing, education, work, and ultimately the global economy. The Vision Atlas sets out a wealth of data and easy to understand formats that illustrate the inequalities of who is affected by Vision Loss and the inequity of access to eye care services across the world. The Vision Atlas is powered by the latest evidence from the Vision Loss Expert Group, the Lancet Global Commission on Eye Health, and relevant national bodies. It has been kindly supported by Allagan and ABV Company, Bayat, CBN, Saver Foundation, Sitesabers, and the Fedholos Foundation. Today, 1.1 billion people are living with Vision Loss, limiting their education opportunities, income, and their increasing risk of early death by up to 2.6 times. The Vision Atlas highlights the inequality of Vision Loss across the world, showing that 90% of people with Vision Loss live in low and middle income countries, that 55% are women or girls, and 73% are over the age of 50. Vision Loss costs the global economy $411 billion per year in productivity losses. But it doesn't need to be this way. For 9 out of 10 people with Vision Loss, the Vision Loss could have been prevented or could be treated now, meaning many people's lives could be so much easier if only they could reach the basic health they need. The Vision Atlas brings this data into the light so that the world can do something about it. Improving eye health is a practical, cost-effective way of unlocking human potential and achieving many of the United Nations sustainable development goals. The Vision Atlas enables the eye sector to speak with one voice to governments and policymakers. The simple interactive tools on the Vision Atlas allow you to search and interrogate the database by age, gender, causes of Vision Loss, country and region over the last 30 years. Understanding the causes of Vision Loss in your region enables us to work together on the appropriate eye care services to match the needs of the patients on the ground. The Vision Atlas shows quite simply that the burden of Vision Loss falls on women and girls. This is an invaluable tool to advocate for access to eye care for everyone. The Vision Atlas is accessible, easy to use and provides simple, downloadable content, making it easy to present key data to the right audiences. The data contained in the Vision Atlas is great for adding much needed evidence to media stories and to explain to a wider audience the importance and impact we should be making around the world. We encourage you to explore the Vision Atlas online where you can download relevant and specific resources for your needs. My name is Nathan Condon and I work with Queen's University Belfast, Orbus International, and the Zhongshan Arthamics Center in Guangzhou, China. I'd like to speak to you today about the various ways in which promoting eye health can help us to achieve the sustainable development goals. The sustainable development goals serve as a roadmap for the global community, guiding us to reach a healthier, safer and more equitable world by 2030. That path is signposted to specific and achievable targets. We've been working over the last year on the Lancet Global Eye Health Commission. You can read more about our work at the website of Lancet Global Health. Dr. Justine Zhang has spearheaded specific work looking at eye health in the SDGs, and this has shown that promoting eye health offers an effective fast lane on the path to achieving many of the SDGs. At the heart of the sustainable development goals lie poverty reduction and decent work. Safe, inexpensive and effective eye care, such as glasses and cataract surgery, has been shown by high quality studies to increase productivity on the job and stimulate economic activity, not only among beneficiaries, but also their families in direct service of SDGs 1 and 8. The SDGs recognize the importance of education in the life of a child. It's been shown that providing glasses to children in school improves academic importance, and in fact it has a greater proven impact on parental education, family income, and any other school-based health interventions in achieving this important sustainable development goal. A cornerstone of good health is freedom from injury, and that's recognized in SDG 3 reduced injuries and SDG 11 safe cities. Good vision has been shown to reduce the risk of traffic-related injuries, which are the world's leading cause of death between the ages of five and 29. But vision also reduces falls among the elderly, which is a major factor in the loss of independence and even death. Equity is of bedrock importance to the sustainable development goals, and in fact equity of gender, equity between men and women, is recognized as its own independent SDG number five. Vision screening outreach in schools and communities has been shown to reduce gender inequalities and access to spectacles, cataract surgery, and care for glaucoma and diabetic high disease in direct service of this important gender equity sustainable development goal. Finally, the sustainable development goals really couldn't get off the ground without working together, and in fact partnerships between stakeholders and across borders and disciplines really act as the glue that hold the SDGs together. Importantly, the global community has collaborated in dozens of countries to tackle some of the world's most challenging healthcare problems, including glaucoma and river blindness, or oncosecises. I invite you to visit the website of the Lancet Global Health Journal in order to find out more for yourself about the various ways in which investment in eye health can bring the SDGs into focus. Next, I'd like to introduce my colleague on the Global Eye Health Commission, Dr. Bonnie Lynn Swenor of Johns Hopkins University School of Medicine, who will speak to us about the importance of eye health in promoting various aspects of systemic health. Thank you very much for your attention. Dr. Bonnie Lynn Swenor, Associate Professor at the Johns Hopkins Wilmer Institute and Director of the Johns Hopkins Disability Health Research Center. Today, I'm presenting the summary of the general health, well-being, and mortality sections of the Lancet Global Health Commission on Global Eye Health. Vision loss and eye disease can impact far more than just vision and have implications on health over the life course. The Commission conducted reviews of the literature examining the connections between vision and health and the data revealed that although this connection is complex, two main pathways emerged, which are shown on the slide. First, there are downstream consequences of vision loss, which include reductions in social interaction, restrictions of physical activity, and barriers to healthcare that can lead to negative health outcomes, such as depression, dementia, cardiovascular disease, and cancer. Second, common factors such as smoking, diet, UV light exposure, and changes that come with advanced age can simultaneously lead to negative health outcomes, including mortality. While vision loss does not directly lead to death, the mortality risk is elevated among people with vision impairment. The Commission conducted a meta-analysis of 38 studies representing 30 cohorts from Africa, Asia, Australia, Europe, and North America. This slide is showing a forest plot of these results, which found that the risk of mortality was higher among people with visual acuity worse than 6 over 12, as well as those with acuity worse than 6 over 18 when compared to people with better vision. For people with visual acuity worse than 6 over 60, more severe vision loss. Mortality risk was elevated when compared to people with visual acuity of 6 over 18 or better. However, a significant association between vision loss and mortality was not found when comparing those with acuity worse than 6 over 60 to those with acuity of 6 over 60 or better. This is likely because the comparison group in that last set of analyses includes people with substantial vision loss. While the reasons for this increased risk of mortality remain unclear, these results reinforce the connection between vision and overall health and an emphasis on the public health importance of vision loss. In addition to the impact on health and mortality, vision loss influences quality of life. Assessments of quality of life can provide insight on how vision affects well-being from a person-centered perspective and how the experience of vision loss can be affected by personal, social, and environmental factors. The commission undertook an umbrella review or review of systematic reviews related to vision and quality of life. Out of 69 systematic reviews identified, 60 of these studies examine the relationship between alphalmic interventions and quality of life, which are shown as the outer rings of the circle figure on this slide. Of those studies, 75% showed that these alphalmic interventions, which included cataract surgery and antivascular endothelial growth factor or anti-vegeth treatment had a positive impact on quality of life. And that's indicated by the darker shades in the inner ring of the circle figure. These results underscore the close relationship between vision loss and quality of life and call for an increased investment in eye health, as well as a deeper understanding into the factors that reduce quality of life for people with vision loss. Hi, I'm Patricia, and on behalf of the commission, I'm here today to talk about section four of the commission reports. In section four, we summarize the findings of the systematic review on economics of vision impairment. We present a new axiomative global productivity losses and an analysis of cost-effectiveness ratios for cataract and refractive error services. First, we undertook a systematic review to identify and summarize the costs associated with vision impairment. To do this, we searched the literature from 2000 onwards with no geographic or language restriction, and we identified 138 studies that meet our inclusion criteria. 38 of these studies reported costs for vision impairment and our blindness, and 100 reported data for one of the seven major causes of vision impairment known. Studies were very concentrated in high income countries, and we also found large variation in methodological approach, cost measurement, and management of uncertainty, which made it impossible to combine studies to generate an estimate of the costs of vision impairment globally. We generated regional and global estimates of annual productivity losses using the most recent prevalence, demographic, and economic data. The vision loss expert group provided us data from their latest model. That estimated that in 2020 there were 161 million people in the working age population who were either blind or had moderate or severe vision impairments. Our literature review identified data on the employment of people with vision loss from 15 countries, and we determined that globally the relative reduction in employment of people with vision loss was 30%. We calculated productivity losses as the product of people with blindness and moderate to severe vision impairment of working age. The population employment rate, the relative employment for people with vision loss, and finally the per capita gross domestic product. We estimated that the annual cost of potential productivity losses in 2018 to be 411 billion US dollars per chasing power parity, which represents 0.3% of the combined global gross domestic product, as much as Ireland's GDP in the same year. Half of all productivity losses were concentrated in three regions, East Asia, South Asia, and high income North America. In East Asia and South Asia, this was primarily due to their large number of people with vision loss in the working age population. While in North America, this was driven by the high GDP per capita and a higher relative reduction of employment. Finally, we looked at cost-effectiveness of eye health interventions. We focused on cataract and refractive error, hence these accounts for more than three quarters of blindness and moderate to severe vision impairment globally. From our systematic review, we looked for studies reporting health benefits using disability-adjusted life years, dailies, or quality-adjusted life years, qualities, and what we identified in 11 publications providing 58 cost-effectiveness ratio for estimates for cataract and three publications providing 17 cost-effectiveness ratios estimates for refractive error services. Most cost ratios were in less than 1,000 per dailies or quality gain, indicating that cataract surgery and refractive error services are cost-effective in many settings. This information combined with a well-structured and context-specific decision-making process should encourage countries to prioritize eye care delivery services. We believe that decision-making on eye care financing and provision of services will benefit from improved economic evaluation studies. To address the substantial data gaps we identified in our analysis, we will need to increase the use of standardized methodological approaches following international guidelines for health economic evaluations. Collect more data from diverse settings periodically and in standardized ways. Gain a better understanding of the impact of vision impairment on employment status on absenteeism and prosenteeism to improve productivity analysis estimates. Perform more comprehensive economic analysis including cost-effectiveness studies and cost-effectiveness analysis. Thank you very much for listening. As part of the commission, we explored the extent of eye health research in the two decades leading to 2020. We identified 150,000 published primary research studies. 40% of them were on one of the five leading courses of visual impairment. There was a 50% increase in research output between the two decades and 4% of the studies were trials. Countries such as the United States, the United Kingdom and China had high research output whereas the Caribbean, Latin America, Africa and Southeast Asia had low research output. It is notable that high income countries have 15% of the world's population but contribute 75% of the research output. We also looked at the trials conducted in sub-Saharan Africa during this period and found that half of them had been conducted in only four countries, that is Nigeria, Ghana, South Africa and Ethiopia. These trials focused mainly on trochoma, on Cossackiasis and also glaucoma. Regarding the authorship of the 150,000 studies, we found that one third of all authors are female whereas a quarter of the senior or last authors are female. There was an increase in female authorship from 28% to 37% during this period. With some of the trials from Africa, 8% of all authors were females from the country of study. Another 43% were males from the country of study. Authors from high income countries contributed half of all the authors. The gaps we find are that there is more distribution regarding where research is done, more distribution regarding the choice of research questions and the composition of research students. Based on these findings and the findings of other studies on the commission, the commission recommends that we increase solution-focused research, especially on the five leading causes of visual impairment. This needs to be well-designed research studies, which in turn requires capacity-building for research, especially in low- and middle-income countries. This can be done through effective and equitable partnerships between North-South or South-South partners. We will also need to monitor diversity in teams consistently, as well as emphasize on translating the research evidence into policy and practice. I will now ask Esme to talk about the ground challenges. Hello, I am a smile half-time. I'll talk about the I-Health Grand Challenges that was conducted as part of the commission work. We undertook a ground challenges in global I-Health prioritization exercise to identify the key challenges that need to be addressed to improve I-Health in the context of a growing and aging population. We defined the Grand Challenge as a specific barrier that if removed would help to solve an important health problem and that its intervention would have a high likelihood of feasibility for scale-up and impact. A three-round modified Delfi was employed to nominate and rank challenges. In the first round, parts nominated up to five-ground challenges and the rounds of prioritization led to a finalist. Ranked based on perceived importance, as well as likelihood of reducing disease burden and inequality, immediacy and feasibility. 336 people from 118 countries completed all three-rounders, among these 48% were women and around 31% were from South Saharan Africa. These participants included decision makers, researchers, advocates, program implementers, clinicians and the patient groups. We have identified 60 priority-ground talent in some right under four categories. People were condition-specific, pipe ware on health systems, terrain-business, three ware around access in the QT, two ware on building to minor resource capacity. I really encourage you to look at the commission report for details, but here I will summarize the top five-ground challenges identified at the global level. The first ranked-ground challenge was creating demand and ensuring access to accurate, affordable and good quality refraction services and spectacles. The second most ranked was identifying and implementing strategies to improve cataract services, particularly in terms of quality, productivity, equity and access. The third most ranked was improving child health so integrated, evidence-based, primary and secondary care services, as well as the school I have the programs. The fourth most ranked was developing and implementing services that cloudized marginalized communities or groups, such as women, pro-communities, indigenous people, ethnic minorities, people with disabilities and so on. The fifth most ranked was developing and implementing strategies that can reduce out-of-pocket costs for those unable to afford full-cost services, such as subsidy, tiered pricing and health insurance scans. Universal health coverage will not be realized without universal eye health and universal eye health will not be realized without a health research and the use of the evidence in general. We believe the findings from these ground challenges exercise provide a starting point for immediate action by helping to guide eye health researchers to prioritize and frame their research questions, guide pointers to frame research investments, divide care service providers a clearer and more focused purpose and goal, and facilitate collaboration across various stakeholders to answer the biggest questions. And also this exercise can help for other priority-setting exercises. As next steps, context-specific implementation and health-system research is needed to address most of the ground challenges and particularly to guide effective delivery of services on the leading cause of vision impairment. Health research in low-end medical countries primarily needs to focus on how to effectively expand and scale up coverage, improve quality, and ensure sustainability. Innovative research for specific areas that are without efficacious interventions such as glaucoma remains critical. I will now hand back to Matthew who will talk in more detail about eye health within universal health coverage. Thank you. Thank you, Esmael. In the 2019 World Report on Vision, WHO's leading recommendations were firstly making eye care integral to universal health coverage and secondly, implementing integrated people-centered eye care. In responding to this call, the Commission has sought to unpack these issues in detail and summarize the evidence base. Universal health coverage is central to delivering SDG3, good health and well-being. The Commission argues that UHC is not universal without affordable, accessible, high-quality eye care. Throughout Section 6, we explore turning this aspiration into a reality. We illustrate this with a focus on cataract and refractive error services in particular. We have carried out several new reviews and analyses, which I encourage you to read about. To help conceptualize eye health within UHC, we have adapted the well-known cube diagram to show the proportion of the population covered, essential eye services provided, direct costs covered by pooled funds, and effective quality. The World Report on Vision has placed renewed and very welcome emphasis on people-centered approaches to eye care delivery. Effective services need to be easily accessible to the population, with easy navigation through the system in cases for which more specialized services are required. The Commission examined how eye care can be integrated into different aspects of the health system and other sectors. We developed a framework to illustrate the different connections and components. Integration of eye health with other services in health, the health system, and beyond can take many forms. However, there are a number of key foundations. Firstly, there needs to be policy integration, not only in the health sector, but also in education, employment, and finance. A second foundation is integration of eye health into national health financing mechanisms. Ian Jones will talk about this shortly. There also needs to be health workforce integration with thoughtful workforce planning to meet population eye health needs and the inclusion of eye health training for generalists. Samarana Yasmin will talk more about this in a moment. There are many ways in which eye health service, provision, and delivery can be embedded throughout the health system as a whole. In the Commission, we provide multiple examples and case studies. Connections need to be made at all levels of the system, integrating eye health into community level activities, as well as primary, secondary, and tertiary health care. A crucial component of delivering eye health within UHC is primary eye care. This is needed in all resource settings. The Commission takes a broad view of primary eye care, encompassing activities and interventions within community settings, as well as primary health facilities, such as health education in the community, schools, and workplace, screening for vision impairment, for example, in school programs, protective eyewear to prevent injuries, community-based interventions such as vitamin A distribution, basic diagnostic and treatment services, diabetic retinopathy screening in NCD clinics, and child eye health programs. There is an increasing need for refractive error services, and access in primary care settings is crucial. In many regions, these services are largely provided in the private sector and represents a major opportunity to bring services closer to communities. More consideration needs to be given to developing the right regulatory and market conditions to promote high quality, affordable, and equitable services. Public-private partnerships are promising ways to increase spectacle coverage while ensuring a safety net for those who are unable to afford commercial prices. Weak connections between primary care and specialist services are common. Considerable action is needed in many settings to strengthen referral decisions and pathways. Delivering integrated people-centered eye care is a complex process. It will require breaking down traditional barriers within healthcare. Major investment in training, sharing of tasks, and development of enabling environments. I will now hand over to Samarana Yasmin who will talk to us about the commission section on human resources for eye health. Thank you. Good morning, everyone. The commission reflected on the key issues relating to human resources for eye health and made a number of recommendations to enable countries to realize universal health coverage. As we all know, a critical issue is the shortage of eye health workforce experienced by many countries across all levels of care, especially when it comes to projected eye care needs in coming years. With available data on ophthalmologist and optometrist, we examine the density per million population across world region and share the results of ophthalmologist care. We can see massive differences across regions and also a pattern of higher rates of vision impairment and blindness in regions with low density of ophthalmologist. Beyond the number of personnel, their distribution within the countries is also an issue. With much higher density in urban compared to rural areas. So what can we do to change this? In the commission, we discussed several strategies for countries to realize a competent and well-resourced eye health workforce in place that is integrated into health system and accessible for people in need. To maximize the capacity of eye health workforce, we need to start with strengthening a competency-based model within the training programs. We also need to explore that how we can engage and train general health workers in eye health and encourage task sharing with them. Developing enabling environment, including appropriate equipment, supportive supervision and mentoring is equally important if we want to increase access to eye care. At the same time, we also need to make sure that career development pathways are in place because that's the only way we'll be able to increase motivation and address the issue of low productivity. We know that we cannot achieve success unless we engage with other stakeholders within the sector and outside of the sector. We also cannot underestimate the role of private sector. So if you want to maximize the impact, if you want to increase access, we need to make sure that we engage with private sector. And most importantly, all of this needs to be supported within the local context if we want to ensure integration and continuum of care. As part of the commission, we also assembled some great case studies, including a number which speaks to challenges and innovation in eye health workforce development in settings including Pakistan, India and Pacific Islands. I encourage you to look at these in annex material of the commission. And at the end, I would also like to include that if you want to change the landscape of eye care in coming years, we need to make sure that we join our hands and work together. Thank you. And now I will hand over to Andrew Vistoris who will speak about technology in eye health. Thanks. Technology has transformed the way we live and has advanced healthcare globally. However, the benefits of these advancements have not been equitably received. In this talk, we'll look at three specific aspects of technology in eye health. First, we'll look at teleophthalmology. Teleophthalmology has been used for more than 20 years with ophthalmology lending itself to image-based diagnosis and analysis. Asynchronous teleophthalmology is the practice of acquiring ophthalmic imaging, typically retinal photos, saving them and then sharing them for review at a later date by a specialist or grader. This has been widely used for diabetic retinography screening and more recently for retinography of prematurity. Advantages include reduced travel for patients and more economic human resources for image acquisition, increasing the service coverage. Synchronous live consultation, aids in decision-making, immediate initiation of treatment whilst reducing the burden of patients travelling. This has increased in importance during the global pandemic. AI or artificial intelligence has a lot of interest in terms of eye care, particularly deep learning. This interest is primarily driven from high-income settings facing challenges related to managing high-volume chronic conditions such as DR, AMD and glaucoma. Deep learning is well-suited because their diagnosis and management is largely dependent on retinal images. AI has many potential uses in eye health including point-of-care diagnostics, surgical decision-making, patient management and treatment, all enhancing service delivery and optimizing health systems. Most immediate benefits in public eye health will likely be in diabetic retinography and ROP screening programs. Coupled with teleophthalmology, it enables synchronous image grading and decision support. In 2018, IDXDR was the first AI screening product for DR to obtain FDA approval. To assess the extent of translation-ready AI, this commission conducted a scope and review of publications on AI and eye health between 2015 and 2020. Over 1,200 primary data reports were identified, most 60%, focused on retinal imaging and only 12% of reports addressed conditions that affect the front of the eye. Arguably the greatest potential for AI to contribute to advancing eye health would be to assist in case identification and health system efficiency, helping people with uncorrected refractive error and cataract access services, neither of which are currently well represented in the AI development platforms. A further global review of datasets reviewed huge underrepresentation from LMIC populations, which we term health data poverty. The scarcity of representative datasets limits the extent to which populations can benefit from digital health solutions and AI systems. We recommend visibility, accessibility and use of existing public datasets as improved and investment is made in developing new public datasets to support research, innovation and validation in regions with insufficient health data. And finally, we look at mHealth. According to the GSMA, there are more than 5 billion people today who have a mobile device. That is 2 thirds of all people on the planet. Its applications in healthcare have led to huge growth in mHealth, including within eye health. Although few applications have been tested, validated or achieved widespread uptake. Several vision testing applications have been validated and shown good performance compared with conventional tests in rural settings, including visual acuity in Kenya and contrast sensitivity in Ethiopia. By linking smartphone applications to a wider system, the effectiveness, efficiency and knowledge gains can be considerable. For example, a cluster randomized control trial for school vision screening in Kenya found that teachers can reliably identify pupils with vision impairment initiating an automated referral and nudging for full assessment. This method more than doubled the uptake of secondary eye care services. In conclusion in this section, we define that technological developments offer the potential to revolutionize eye healthcare. However, caution is needed to ensure all populations benefit. Thank you. I would like to hand over to Ian Jones who will outline the commission's reflections on eye health financing. Hello everyone. The commission includes a call to action for the raw and better funding of eye care, particularly in low and middle income countries where the need is greatest. The amount, the source and the allocation of resources determines the scale, scope and depth of coverage of eye care. It also influences the quality of services and care provided. The sustainability of those services and the equity of eye health programs. As part of the commission, we looked at a number of national eye health system assessments, analyzed aid data and considered other sources of eye health funding. Estimating global eye health funding is challenging. National health plans and budgets in many countries often don't include eye care. Estimating external support to eye care is problematic and out-of-pocket payments for eye health are widespread but difficult to estimate. But what we did conclude is that eye health is underfunded. The commission calls for more funding for faster progress to universal eye health as part of wider efforts to deliver UHC. Without a significant step change in funding from all sources, we will be neglecting an important component of UHC and we won't deliver on our promise to lead an old behind. But it's equally important that funds are used wisely supporting the right interventions in the right place, in the right way to maximize impact and tackle inequity. This requires more evidence to inform these decisions and careful design and evaluation of insurance schemes and alternative financing mechanisms. So we learn, adapt as eye health needs change. And in hand with more and better funding for eye health we need to increase our data and evidence around eye health. More evidence is needed on costs, cost-effectiveness, efficiency of different delivery models, affordability for governments and individuals and the financial barriers to access services. This would support evidence-informed decision makers of faster progress to UHC. Everyone in a population will require eye care at some time in their lives. Yet there are often direct and indirect costs to individuals preventing them from accessing essential eye health services. I hope governments and partners will respond to this call for action for more and better eye health funding. With eye health included in national financing of UHC and efforts to improve access for the whole population to the eye care that they need. I'll now hand over to Ian who's going to speak about the commission's work on indicators for eye health. Thank you. Hello, I'm Ian McCormick. I work at the International Centre for Eye Health and I'm going to introduce some of our work on eye health indicators. One of the commission's key messages is that reliable data from both surveys and facilities are key to progress in eye health and that a balanced set of indicators are needed to measure progress and drive change. As part of the commission, we undertook a study to help address this need. We aimed to develop an indicators menu aligned with the dimensions of universal health coverage, access, quality, financial risk protection and equity and gathered a global perspective on eye health indicators by recruiting an expert panel to a prioritization exercise. The panel was made up of 72 experts from 39 countries with representation from all global burden in these super regions. From an initial long list of 200 indicators, we arrived at a final menu representing 22 priority eye health concepts. We identified seven as core indicators, measures which, if collected by all countries, could allow governments and super national organizations to monitor universal access to quality, affordable eye care services. The menu is prefaced with an equity statement. This is intended to be cross cutting to all relevant metrics. Without appropriate disaggregation of indicators, we won't know we're making positive change in the populations most at risk of eye health. The core indicators include to effective service coverage indicators, effective cataract-surgeable coverage, ECSC and effective refractive error coverage, EREC. ECSC and EREC have been identified as candidate WHO universal health coverage, service coverage indicators and in the near future, we hope to see these two eye health indicators integrated into broader universal health coverage monitoring frameworks. To examine effective cataract-surgeable coverage in more depth, we re-analyzed all available rapid assessment of avoidable blindness survey data from the past 20 years. We investigated regional trends in ECSC and differences by gender. The figure on the left shows some inter-regional variation, although data are limited in certain regions. The figure on the right shows that the regional median ECSC was lower among women than men in every region except for Latin America and Caribbean. The indicator menu developed as part of the commission will now be put forward to help inform the development of WHO's indicators for integrated people-centered eye care, while the ECSC analysis will contribute to WHO baseline estimates for monitoring progress towards new national targets for 2030. However, the existence of an indicator framework is insufficient in isolation. Work is needed to strengthen national health information systems and eye health placed within them and to engage with the private sector to support data collection and reporting. I will now hand over to Thilsi Raveela who will outline the commission's reflections of quality of care in eye health. Thank you, Ian. Hello, I am Thilsi Raveela from Aravind Eye Care System in India. I am going to talk a little about the work that the Lancet commission on global eye health has done on the delivery of high quality eye care. While everyone appreciates the importance of quality, there is a growing recognition of its central role in sustaining and enhancing eye care. Unfortunately, high quality service are far from being universal. In the commission we examine the question of quality of eye care from a holistic perspective. We sought to look beyond the narrow confines of outcomes of clinical interventions. Quality is not limited to what we do. It is equally influenced by what we don't do. We use the quality framework referred by WHO which considers seven components effectiveness, safety, people centeredness, timeliness, equity, integration and efficiency. For the purpose of the commission and to align with the SDGs we also added planetary health. We have particularly applied this framework to the delivery of cataract surgical services. This is a very busy slide. We systematically reviewed literature for research on intervention approaches that improves quality of delivery in one or more of these components. We found multiple studies that show how quality across these dimensions can be improved. I encourage you to read this section to find more details in the report, appendix and related papers. As Yen has already touched on the key indicator to eye health service delivery is effective cataract surgical coverage or ECSC. This combines information on both coverage of services in the population and in the community. We find as people with cataract vision impairment or operable cataract and also the outcome in terms of visual equity. Both the threshold of vision impairment defining the population need and the benchmark are for a good outcome can greatly influence using data from RAB service from Vietnam the country with the most longitudinal population based survey data. We call for raising the bar for good outcome to be 612 or better up from the current 618. In addition we also encourage a similar change and alignment in the threshold for a cataract to be considered operable in the next 612. You can see from the Vietnam data that these two thresholds changes can have big impact on countries reported effective cataract surgical coverage. We believe that these changes will be drivers for improvement in both quality and coverage of services in the coming years. The commission also examined the impact of how we deliver eye care services on the health of the planet. Globally health care contributes 5% of greenhouse gas emissions. Eye care is a high volume so will be a significant contributor. We have conducted a systematic review of the environmental impact of eye health services. We found only 8 reports. This clearly is an area that needs urgent attention. However, we think there will be ways that we can make big improvements. For example, on the left you see refuse from 32 cataract operations conducted in India. On the right the refuse from one identical operation conducted in UK which produced 20 times carbon dioxide per procedure than the Indian center. To increase the quality of eye care services the commission calls for four key actions. One, govern for quality. Two, redesign services to maximize quality. Three, transform the workforce and the environment. Four, ignite demand for quality in the population. I will now hand over to Jackie Ramke who is going to summarize the commission's work on equity in eye health. Hi everyone, I'm Jackie and I'm very pleased to be talking with you about equity in eye health which underpinned all aspects of the commission in which we've heard several examples of throughout the webinar. One example is that 9 out of every 10 people with vision loss live in low or middle income countries with a persistent disparity in the prevalence and vision impairment with high income regions having rates less than half of those in regions such as South Asia, South East Asia and Western sub Saharan Africa. The commission also highlighted inequality within regions. This figure shows that in all regions there are more women than men with blindness shown on the x-axis as well as with moderate or severe vision impairment shown on the y-axis. This highlights that in all regions with services to be equitable women should be greater than 50% of service users. Gender is the social access for which we have most data. In order to understand more about other inequalities as Ian already mentioned the core indicators developed as part of the commission have an overarching equity statement the cause for expanding beyond gender to also consider other axes of potential and equity wherever possible including residence, socioeconomic position and disability status. The commission also looked for evidence on what we might do to address inequity in several ways and I will share just a couple of these. The first reflection is that we have not focused research efforts sufficiently on generating good quality evidence on strategies to reduce inequity. For example we conducted an overview of systematic reviews on gender and eye health. Of the 58 reviews we identified the vast majority quantified the prevalence of vision impairment or eye conditions. A much smaller number synthesized evidence on access to cataract services and only one review synthesized evidence on how to reduce inequity. We began to fill this evidence gap by conducting a healthy process drawing on more than 180 stakeholders from all world regions who first nominated and then prioritized strategies to improve access to cataract services in population groups who can be targeted with these strategies. We collated the results globally and for all world regions and believe these results serve as a starting point for the systematic development of evidence to overcome the pervasive inequity in access to cataract services in all countries. The commission also calls for more equity, diversity and inclusion in global eye health leadership recognizing that organizations with more diverse leadership are more likely to promote equity focused agenda. New Era already showed the extent to which women were included in authorship teams and those findings were mirrored when we looked at the inclusion of women in leadership structures of members of the specific bodies. Across each of these women held between one in three and one in four of all board membership positions. This reduced when we focused on chairpersons or editors in chief and reduced further when we were able to assess opportunities for women with intersectional identities such as identifying with an ethnic minority. We hope these baseline findings can propel change across the sector and we will be aiming to contribute to this as part of the active afterlife of the commission. These and other reflections on equity and access including the challenges in high income countries can be found in the commission, its annexes and subsidiary papers. I invite you all to explore these and I thank you for your interest in the commission. I'll now hand back to Hannah. Hannah you're beautiful if you could say that. Thank you so much. It's wonderful. Thanks. Thank you. An hour before this webinar we were opportuned to have a session with the United Nations Friends of Vision group and addresses by the president of the United Nations Assembly, the ILO, the UNICEF and it was all about eye health in position squarely in development. So I am going to make a call to action. The first call to action is that we are at a crucial point. The commission has provided evidence and so we've got to go to the global health drivers, national governments health and especially non-health actors, non-governmental organizations, research institutions and industry. And my very first call to action is on development. In line with the SDGs we have to adopt a development imperative using vision and eye health to unlock the human potential throughout the life course of each individual of the populations because we now accept that vision and eye health is an enabling cross-cutting issue within the sustainable development framework. Adopt a new definition of eye health for each individual across the person's life course to ensure that it's maximized vision that's needed, a high quality of life and a maximal functional capacity for each individual of the populations that are visually sighted visually impaired for a short time or visually disabled. My next call to action is for inclusion. Inclusion is an essential part of all aspects of universal health coverage. Be it in the quality of service with equity, and the quality of the resources that are available to the community. So, for the next few months we will have a few periods of pandemics or emergencies or disasters. What do we do during and after those emergencies. And the last one is on financial risk pooling and innovative financing. And the third call to action is on investment. A lot of people have already spoken about investment and increase in investment. But I want to make a point that it should be a renewed and diversified type of investment from both people. And the third call to action is on investment. A lot of people have already spoken about investment from both public and private sectors. And we urge countries to commit and include vision and eye health in their strategic plans, both development and health in the workforce planning. And any direct and direct financing structures. But I would like to stress investment in innovations thinking outside the box. And I would like to address the questions that have been raised. I would like to address the questions that have been raised in service delivery, new ways of training, new ways of partnerships, investment in innovations in technology. This has already been discussed that really to emphasize technology in health intelligence, vision and climate action. The commission has been about research. The difference this commission has made has been on the evidence based approach to the current identification of gaps and identification of challenges. So my fourth call to action is to the research constituency beyond eye health so that we become advocates for health and equity the way we do research and for whom we do the research and begin to look at research responsive to the development paradigm be it in the questions we ask or the design we make or the fields beyond eye health shaking hands with the research constituency beyond eye health beyond health into development and an increased diversification and commitment of resources that this would require. My last and not the least is a call to action on collaborations. We should believe in an act on the power of collaboration drawing in the actors in development some of whom are shown on this slide because I believe together we have an opportunity to shape and prioritize the global eye health agenda and in so doing unlock human potential for sustainable development and that goes beyond health beyond eye health into all the actors that influence sustainable development goals. I hope we all take the bottom of the call to action and each one commits to answering the call made by the commission. Thank you so much. I have a lot of information to take in so I hope you all enjoyed that. We are running a tiny bit late as you might have noticed but we have been granted some extra time for questions because there have been some coming in. Thank you very much for your questions that you have put to us. Now I am going to try and get to as many as I can in the next perhaps ten minutes but we may not get to them all and we may not get to the questions for whom we don't actually have the panellists available so not everybody who presented a video today is actually available on the call so we may not get to any questions that pertain to those particular videos. So maybe I can kick off we have got a couple of questions about myopia and I wonder if I can call on Nathan to answer some of these questions Kathy has a question about myopia and cell phones and computers and the increased use perhaps during Covid and what effects this might have and Shay also has a question on myopia in sub-Saharan Africa and potential for preventing school dropouts by addressing that. So Nathan do you want to have a go at answering that? Sure Zoe thanks very much for that and thanks also to Shay and to Shay for those good questions. With respect to Covid and smartphones let's dissect those and take them apart for just one second. What do we know about Covid effects on vision and what do we know about smartphones? We know that myopia has been getting more and more common for 20 or 30 years and obviously that process began long before we all were carrying smartphones around so I think there's nothing special about smartphones per se anything that gets us particularly as children to look up close at things whether it's reading books or whether it's looking at a game boy or whatever it is is going to promote myopia over time so smartphones are not special in that way it's anything that we're looking at also. In terms of Covid we know that there have been big changes in how we all live over the last year or so. Epidemiology is like the proverbial battleship, it takes time for us to turn our attention in directions like that so we haven't got the data yet to show that there have been big changes in myopia prevalence due to Covid over the last year however I think we can say with a high degree of confidence having children spend much more time indoors than they were previously not going out to school not having recess almost certainly had a big effect on prevalence of myopia probably even more powerful than the evidence of smartphones and books and near work is the fact that absence of outdoor time is a big risk factor for myopia and the fact that kids have been indoors not going to school for the last year around the world we can be pretty confident that there have been some changes there. The good news is that hopefully as things change and we get the vaccines arriving we get kids back into school a lot of that there's still plenty of time for most of these kids to reverse those changes with respect to Shay's question about myopia in Africa it's fantastic that you get a question about myopia in Africa we tend to associate myopia with Asia in particular what I could say is this we don't know as much about refractive error as we should in Africa there have been very few high quality population studies however we have strong evidence from other settings such as China that kids that have uncorrected myopia are to real scholastic disadvantage we know they don't do as well in school they have significant their academic outcomes take a significant hit so yeah I think that's very likely to contribute to drop out and those other things we're doing a study on that right now in China to see whether giving free glasses will get more children to stay in school and go on to high school in rural areas so I would say two things then with respect to Africa we can say that probably not seeing well harms kids school performance we've got evidence from outside of Africa it's a pretty good assumption to make that probably the same impact is there for kids that have uncorrected myopia in Africa but the other thing I would say is we need to do better we need to do more studies to look at the specific impact of uncorrected myopia in Africa particularly as United Nations UNESCO as a number of global programs are leading to more kids going to school as they should we know and expect that those rates of myopia are going to rise in Africa and we need to understand better and have more specific information from African studies about the impact on dropout and school performance and other things so it's a great question thanks thanks for that comprehensive answer thank you Nathan Brune's got a great question that I wonder whether I might be able to put to Hannah or Esmael he says the data indicates unequivocally that prioritization must be given to strengthening the primary eye care in the universe because more than 80% of eye problems can be managed at this level how can we develop the preparedness of national eye care programs to focus on communities and primary health care and referral services for refractive error services at primary health care facilities like a health care so Hannah Esmael I'll say one or two things that Esmael can take over actually I think this is where the integration and inclusion is extremely important to have eye care not as a silo procedure or as a silo service but integrated into primary health care secondly primary care cannot happen without the contribution of the person, the family and the community so that transfer of ownership and decision on health making is made to the community and the present and they are empowered and given enough knowledge and skills and discussion for them to own and understand what to do not just in the demanding of the quality of the service but also taking up whatever and integrating eye health into families, into communities and into the primary health care facility that community health system if we can get eye health into that I think we would succeed a lot in development and in health Esmael would you want to add more to that Thank you Hannah I think you answered it very well so I just want to say that I think a lot of hard work is needed to create awareness around them to the national policy makers national program to indicate that actually University discovered that we achieved without addressing the issues of the community and primary health care label so that we should be able to integrate like you said primary actually the primary health care system and health people with eye problems to not be kept through the system and reach to the secondary and the territory level that kind of system is integrated and implemented I think that would be really an important one to going forward and lots of programs and research around that how to implement and integrate that are being already being planned for the next few weeks Yeah, thank you Thanks Esmael, thank you So we have a question that had actually been addressed to Andrew but Andrew's not on the course so I wonder whether I might pick on Rupert instead The question from one of our attendees says Progress in eye research can be accelerated by data sharing across nations What's your opinion on such sharing what's the status are you seeing any improvements in this in this respect It's a really interesting question and I think we're all witnessing changes in data sharing and openness of collaborations over the last few years and for example simply the scientific journals many are now open access for example the Lancet commission that we're talking about at the moment is open access and free to anyone who wants to access it Certainly in terms of data sharing we for example with our work there's over 400 studies for which we've had very close collaboration with the principal investigators and they've shared data which wasn't necessarily available in papers that sort of thing is hugely important and you've seen some great examples of studies by the various presenters today which have looked at gender inequity and other big issues which really can only be looked at if you've got this sort of desangregation of data where you can really pull information together and now we're in a position to do that so we're very grateful to study investigators who wish to do that That's great to hear, thank you Rupert There's a tricky question around financing here that I might put to Matthew so we have a difficult financial environment increasing difficulties owing to increased budget needed for non-communicable diseases How can this group best help support securing additional funding from proving vision What do you think, Matthew? Thank you absolutely key question isn't it we've got fantastic aspirations about what we'd like to see happen into the delivery of iCare but at the end of the day it's going to be really dependent on the availability of financial resources so at the heart of the commission I hope people have picked up one of the key things we wanted to achieve was to really provide a toolkit of resources for people to take to the decision makers in their countries and say look at this, look at the potential impact on your progress towards the STGs if you invest a relatively not small amounts of money but relatively modest amounts of money on iCare, we know that these interventions are cost effective, you'll get back more than you put in and so the real key thing is to make those arguments in a really coherent and convincing way and one of the things we know that helps decision makers make decisions is having really good quality or high quality evidence and I've been really heartened today to see the engagement at a very high level in the United Nations from leaders of major organizations with this issue and I think particularly under the leadership of the UN Friends of Vision group that message is really getting through loud and clear and I think one of the things that I'd encourage people who are here on this call webinar to do is to go away and have a look at the commission and say okay in my context which of these bits of data and evidence do I think will carry the argument forward and I think that's the best we can do is to make the cases as brilliant as articulately as we can and I think we're starting to get some traction. That was my take home from today. People are really starting to wake up to this issue particularly around children and the key importance of making sure school-based children are able to see the blackboard of school. Yeah I think that you know the lost productivity data are really strong from the commission on those numbers are really striking so yeah let's hope there's some real fodder for action there. Thanks Matthew. So I think we've probably just got time for one more question now. There's a question around I suppose this is a good place to end is Vision Beyond 2020 so I think one of our viewers has picked on the Vision Beyond 2020 as a sort of another program to go beyond WHO's Vision 2020 program. So that's not quite the same thing is it because the commission is a slightly different beast to Vision 2020 which was a WHO kind of roadmap. So does anyone would like to speak to what's happening, what's next going forward from maybe Hannah you could talk a little bit about what's happening in the next 10 years. My read of the situation is that we had Vision 2020 which was a partnership driven by IAPB and the World Health Organization and now we have the world report on vision the commission emphasizing the evidence for development we have a commitment from the development sector which we didn't have in vision 2020. So I think is these three pillars we can come together to map out it will not be a roll out of comprehensive IK programming but it will be a this is a personal opinion it will be a development focused package that will go out to each country probably driven by WHO that will maybe have the program delivery strategies for each country and I have the main new things that I have will not be an asylum I health will be integrated into all the components that make I health happen I think that's what's going to happen WHO being the health agency of the United Nations and they were present today at the at the launch will pick up work with the research constituency work with the development constituency the ILO UNICEF Papadiatrica the UNFPA for maternal and childcare so already the integration and inclusion of I health in all the development agencies is happening so it's for each one of us to replicate that partnership that has started anywhere we work I don't know if I've answered the question but yeah that was very nice that's what I think will probably happen thank you all right wrap it up there thank you I'm sorry we didn't get to absolutely every question but thank you very much for your attention to everybody I'm just going to hand over now to Matthew to say a few final words thank you very much for chairing that question answer session thank you very much for the people in the virtual room for all those great questions I'm sorry for those that we didn't have time to respond to just two things to flag up firstly resources next slide please next slide please we've mentioned two websites today there's the commission specific website global I health commission and then the Lancet also has a website where it hosts pages for each of its commissions and there's one there specifically for the global I health commission and both have a range of resources they have various publications podcasts on the the Lancet one for example and the subsidiary publications and other materials will be available and continue to be posted in the coming months as they get published on the commission specific website next slide please just a couple of thank yous next slide please the work of the commission has been made possible through the generous support of quite a large number of organizations who you can see on this slide here that have contributed either financially or in kind to making it possible over the last two years and we just like to acknowledge them and thank you and thank you particularly to you who have joined us today and stay with us and we hope that you will really enjoy reading the report and engage with the conversation about the material that's in it and from half of Hannah my fellow commissioners myself I'd like to thank you and say goodbye to you now