Abstract: This paper describes the development of the evidence base for the WHO's global initiative for the elimination of avoidable blindness launched in February 1999 (in Johannesberg for English speaking African in April 2000). This programme proposes to eliminate avoidable blindness in the world by the year 2020. If this ambitious aim is to successfully achieved, it must be based on sound research and ongoing evaluation. The initial programme focuses on the main avoidable causes of blindness in the World - Cataract, Trachoma, Onchocerciasis (river blindness) and Childhood Blindness including the correction of refractive errors and the rehabilitation of children with low vision. Cataract blindness can only be treated by surgical means but there is still argument over the most cost effective method to deliver high volume, high quality low cost surgery to the poorest parts of the world where cataract blindness is most common. The Cochrane Eyes and Vision Group is conducting a systematic review on this important question in order to help inform strategy. The WHO has already adopted the SAFE (surgery, antibiotics, face washing and environment) strategy for tackling Trachoma blindness although there are still many questions about each of these in terms of the most cost effective interventions. The Cochrane Eyes and Vision Group have done prepared a review of antibiotic treatment in trachoma with particular interest in the basis for the use of Azythromycin - a powerful but expensive new drug that needs very infrequent dosing. Onchocerciasis in its endemic and hyperendemic areas across sub-Saharan Africa and central America is microfilarial parasitic disease which causes profound visual impairment and chronic skin disease. In affected villages, as many as one in ten are blind, men more than women and the most fertile land is scourged by this pest whose vector breeds in fast flowing rivers. The only available treatment until a few years ago was Diethyl-Carbamazine - a powerful microfilariacide - but which for years, unknown the missionary benefactors distributing it, was actually increasing the likelihood of blindness. Now, Ivermectin is has been made available by its manufacturers, Merck and Co, free of charge for the treatment of Oncho. Trials indicate that it is not only safe but effective. Our systematic review of the few trials bear witness to this but also reveals new important questions about dosage and delivery which will be central to the goal of eliminating this horrific disease in the next 20 years. We will jointly present the work ongoing in our group which we believe is essential to ensure the success of the WHO's ambitious global initiative.