Globally there are 32.4 million people who are blind, and a further 190.6 million people who are visually impaired to the point that their ability to function is negatively impacted. A large proportion of the world’s blind and visually impaired live in low and middle income countries. The cost of expanding and sustaining primary and secondary health services to treat avoidable blindness and vision impairment is substantial. In 2011 PwC and Three Rivers estimated the need for additional expenditure of US$394.2 billion over 10 years if the goal of eliminating avoidable blindness is to be achieved by 2020, noting that $266.0 billion, over two thirds of this is required in the developed world rather than in poorer countries, where $128.2 billion is allocated. Excluding high income countries, the additional investment required to eliminate avoidable blindness and visual impairment was estimated to be US$128.2 billion. The US$394.2 figure represents an increase in global eye health expenditure of around 7% over that period, with two thirds of the expenditure being directed to high income economies.