In 1996–1997, following consultations in Geneva, a global plan was initiated ‘to enable all parties and individuals involved in combating blindness to work in a focused and coordinated way’. This plan was encapsulated in a Vision 2020 action plan (World Health Organization 2000). Fifteen years on from the publication of the Vision 2020 action plan optometry, as an evolving profession, must ask: where are we now and what should be our role over the next 15 years? Cataract surgery has proven effective in improving health and quality-of-life outcomes (Brown et al. 2013; Polack et al. 2010). It is highly cost-effective and in relative terms it is getting less expensive as an intervention (Brown et al. 2013). Couching is, however, still widely practised in some areas (Gilbert et al. 2010). Huge hurdles remain in terms of inadequate human resource (Palmer et al. 2014).