A health needs assessment project, based in four districts of the North Western Region, has recently investigated the health and social care needs of older people with vision problems. The research project had two stages. In the first, different perspectives on service needs for this client group were gathered through a process of triangulation, involving a literature review, a local survey, a clinical assessment linked to the local survey, secondary analysis of routinely collected health service data, interviews with service providers and focus groups with actual or potential service users. This provided information on‘need’, clinically defined, subjectively defined (both qualitatively and quantitatively) and defined in terms of demand for services. It also provided a picture, albeit partial, of the present pattern of service provision for older people with vision problems. The second stage explored the implications of the information collected for the commissioning of services for this group. The study findings are presented here. We have used the International Classification of Impairments, Disabilities and Handicaps (ICIDH) (WHO 1980) as a framework both to consider the nature and scale of need and to discuss appropriate interventions in relation to these needs.