In planning for eye care services in Pakistan in 1997, the following factors were taken into account: * Blindness prevalence rate of around 2% * More than 70% of the communities live in the rural districts while almost the same proportion of ophthalmic services are based in urban areas * Presence of a reasonable public health care delivery infrastructure in Pakistan * Potential in district eye units but significant gaps in equipment, physical space, appropriate clinical skills and management systems * The need for cost-effective and sustainable ways to reach the remotest communities. Strengthening cataract services was prioritised as a first step to addressing the problem. All ophthalmologists from the public sector district hospital were trained in extra capsular cataract extraction and intraocular lens (ECCE+IOL) implantation and provided with operating microscopes and instruments. It soon became apparent that, for real impact, a more comprehensive approach was required. A comprehensive district eye care programme was designed in partnership with the government in 2001. Twenty-two districts were chosen for the delivery of the programme, 19 districts have so far been included.