Definitions matter. As we prepared the recent Lancet Global Health Commission on Global Eye Health,¹ we recognised that establishing a clear definition of eye health could help galvanise the eye health community towards its ambitious aims in the coming decade. Here, we provide the context into which this new definition speaks, before elaborating on the main ways in which we believe the definition can help strengthen global eye health.

The United Nations declared this the ‘Decade of Action’ to deliver the Sustainable Development Goals (SDGs) and accelerate sustainable solutions to the world's biggest challenges of peace, planet and prosperity by 2030.² The global eye health movement has responded to this call by demanding a fresh approach to ensuring eye health for everyone, everywhere.

In its inaugural World Report on Vision, the World Health Organization highlighted major challenges to improving eye health.³ These challenges include the large and growing number of people with vision impairment—estimated to be 1.1 billion people in 2020⁴—the lack of data on eye conditions not causing current vision impairment, and the need for a continuum of services to meet the full range of eye health needs of communities.³ The proposed solution outlined in the report and adopted by all 194 national governments of the 75th World Health Assembly in 2020, is to establish eye health as a core element of efforts to achieve Universal Health Coverage (UHC) through implementing Integrated People-centred Eye Care (IPEC) across the spectrum of promotive, preventative, curative and rehabilitative services, both within and beyond health.³

The Lancet Global Health Commission further advanced this shift by calling for eye health to be reframed as a development issue and putting forward new evidence that improved eye health contributes to realising the SDGs, particularly those related to poverty, education, economic growth, equity and sustainable cities.¹ Evidence provided by the Commission contributed to the foundation of the first UN General Assembly resolution on Vision adopted in July 2021 ‘Vision for everyone: Accelerating action towards achieving the Sustainable Development Goals’.⁵ This landmark resolution firmly establishes the strategic role that eye care plays in advancing health, social wellbeing and economic development, as well as asserting the instrumental and intrinsic value of eye health.

Historically, international definitions relating to eye health have focussed on biomedical disease classifications and associated levels of blindness or vision impairment (e.g., International Classification of Diseases). These globally accepted definitions permitted the quantification of the magnitude of avoidable vision loss, which in turn enabled advocacy and interventions to be designed to address this need.

However, good eye health is about more than eye diseases and vision loss. Current definitions fall short of describing all the aspects of eye health that are needed to achieve good quality, people-centred eye care that enables everyone to achieve their full potential.

Correspondingly, eye health services are all types of interventions that improve eye health, encompassing the spectrum of promotion, prevention, treatment and rehabilitation.

This broader definition aligns eye health with the pursuit of Universal Health Coverage and sustainable development. The Lancet Global Health Commission outlined ten recommendations for how to deliver high quality eye health services as part of Universal Health Coverage, leaving no one behind.¹ To further support this aim, below we outline what we consider to be intrinsic principles of the definition of eye health proposed in the Commission, along with some key considerations for how it can help us strengthen global eye health.

First, there is a need to generate and meet demand for the full range of eye health services. We must continue to improve access to high quality services for conditions that cause vision impairment, while also addressing the ocular health needs of the vast number of people with conditions that do not impair vision. We must also elevate vision rehabilitation as an equal pillar of the eye health service continuum aligning improved functional ability alongside preventative and restorative care. This will require integrated partnerships across public, private, philanthropic and community sectors to harness the power of shared goals, resources and expertise to ensure all aspects of eye health are addressed.

Second, we should not consider eye health interventions an end unto themselves, but as a means to better health and wellbeing, and greater inclusion. A focus on these outcomes places equal value on interventions that improve the ability of people to function in society, such as through improving vision, through improving mobility in the physical environment with a white cane, or through reading using braille. Achieving these outcomes will require us to routinely consider the policy, regulatory, physical and social environment within which people live and eye health is situated.

Third, people must be at the centre of eye health services and equal importance should be placed on what they think, feel and do resulting from accessing services. We must engage people and communities in service design, delivery, review and innovation, especially people with lived experience of blindness and vision impairment. Designing services around people rather than specific interventions will lead to services being much better integrated, to be in the settings most relevant to people and communities and for them to meet the needs of both individuals and the group.

Finally, we need better evidence. We must better quantify the full extent of eye health needs in populations with a particular focus on the historically neglected—people with non-vision impairing conditions, with near vision impairment and those with vision-related disability in need of rehabilitation services. We must monitor inequality in eye health across population subgroups by routinely disaggregating data by social axes relevant in the local context, including but not limited to gender, disability, place of residence, ethnicity and socioeconomic status. We must also generate and use evidence that identifies how to implement accessible, high-quality eye health services at scale to meet the needs of the population, with equity and inclusion embedded, and financed in ways that do not create financial hardship, thus aligning with Universal Health Coverage.

It is time to change our view on eye health. We believe this new definition provides a holistic and universal perspective that can help shape our priorities and actions across development and delivery of services, research and advocacy. We challenge all eye health stakeholders to use this definition to help achieve eye health for everyone, everywhere.

定义很重要。在我们准备最近关于全球眼部健康的柳叶刀全球卫生委员会^{1 时，}我们认识到建立明确的眼部健康定义有助于激励眼部健康界在未来十年实现其雄心勃勃的目标。在这里，我们提供了这个新定义所涉及的背景，然后详细说明了我们认为该定义有助于加强全球眼部健康的主要方式。

联合国宣布这是一个“行动十年”，以实现可持续发展目标 (SDG) 并加速到 2030 年解决世界最大和平、地球和繁荣挑战的可持续解决方案。² 全球眼健康运动响应了这一呼吁，通过需要一种新的方法来确保世界各地每个人的眼睛健康。

世界卫生组织在其首份世界视力报告中强调了改善眼部健康的主要挑战。^3个 这些挑战包括在2020年大，越来越多的人视力障碍，估计在1.1十亿人⁴ -the缺乏对眼部健康状况的数据不会导致当前视力障碍的，以及需要服务的连续性，全面满足社区眼部健康需求的范围。³ 报告中概述并在 2020 年第 75 届世界卫生大会的所有 194 个国家政府通过的拟议解决方案是，通过实施以人为本的综合眼保健，将眼健康作为实现全民健康覆盖 (UHC) 的核心要素(IPEC) 涵盖健康内外的一系列促进、预防、治疗和康复服务。³

《柳叶刀》全球卫生委员会呼吁将眼部健康重新定义为发展问题，并提出新证据证明改善眼部健康有助于实现可持续发展目标，特别是与贫困、教育、经济增长、公平和可持续发展相关的可持续发展目标，从而进一步推动了这一转变。城市。¹委员会提供的证据为 2021 年 7 月通过的第一个联合国大会关于愿景的决议奠定了基础“人人享有愿景：加快实现可持续发展目标的行动”。⁵ 这一具有里程碑意义的决议坚定地确立了眼保健在促进健康、社会福祉和经济发展以及维护眼健康的工具性和内在价值方面所发挥的战略作用。

从历史上看，与眼部健康相关的国际定义侧重于生物医学疾病分类和相关的失明或视力障碍水平（例如，国际疾病分类）。这些全球公认的定义允许对可避免的视力丧失的严重程度进行量化，从而使宣传和干预措施得以设计来满足这一需求。

然而，良好的眼睛健康不仅仅是眼部疾病和视力丧失。当前的定义未能描述实现优质、以人为本的眼保健所需的所有眼部健康方面，从而使每个人都能发挥其全部潜力。

相应地，眼健康服务是改善眼健康的所有类型的干预措施，包括促进、预防、治疗和康复的范围。

这一更广泛的定义将眼睛健康与追求全民健康覆盖和可持续发展相结合。《柳叶刀》全球卫生委员会概述了关于如何提供高质量眼保健服务作为全民健康覆盖的一部分的十项建议，不让任何人掉队。¹ 为了进一步支持这一目标，我们在下面概述了我们认为委员会提出的眼健康定义的内在原则，以及它如何帮助我们加强全球眼健康的一些关键考虑因素。

首先，需要产生和满足对全方位眼保健服务的需求。我们必须继续改善导致视力受损的疾病获得高质量服务的机会，同时满足广大视力不受损患者的眼部健康需求。我们还必须将视力康复提升为眼健康服务连续体的平等支柱，将改善的功能能力与预防和恢复性护理相结合。这将需要公共、私营、慈善和社区部门之间的综合伙伴关系，以利用共同目标、资源和专业知识的力量来确保解决眼健康的各个方面。

其次，我们不应将眼保健干预视为目的，而是将其视为改善健康和福祉以及更大程度包容性的手段。对这些结果的关注对提高人们在社会中发挥作用的能力的干预措施具有同等价值，例如通过改善视力，通过使用白手杖改善物理环境中的活动能力，或通过使用盲文阅读。实现这些结果需要我们经常考虑人们生活和眼睛健康所处的政策、监管、物理和社会环境。

第三，人们必须处于眼保健服务的中心，并应同等重视他们因获得服务而产生的想法、感受和行为。我们必须让人们和社区参与服务设计、交付、审查和创新，尤其是有盲人和视力障碍生活经历的人。围绕人而不是具体干预设计服务将导致服务更好地整合，在与人和社区最相关的环境中，并让他们满足个人和群体的需求。

最后，我们需要更好的证据。我们必须更好地量化人群眼部健康需求的全部范围，特别关注历史上被忽视的人群——非视力障碍者、近视力障碍者和需要康复服务的视力相关残疾者。我们必须通过与当地背景相关的社会轴（包括但不限于性别、残疾、居住地、种族和社会经济地位）对数据进行例行分类，来监测不同人口亚群的眼部健康不平等。我们还必须生成和使用证据，确定如何大规模实施可访问的、高质量的眼保健服务，以满足人口的需求，嵌入公平和包容性，并以不造成财务困难的方式提供资金，

是时候改变我们对眼睛健康的看法了。我们相信这个新定义提供了一个整体和普遍的观点，可以帮助我们在服务的开发和交付、研究和宣传方面塑造我们的优先事项和行动。我们挑战所有眼部健康利益相关者使用该定义来帮助实现每个人、任何地方的眼部健康。