climate in conflict rising to the challenges of a disrupted world. I'm Liz Hume, I'm the Executive Director of the Alliance for Peacebuilding, and we are so grateful that you're here with us today. I first want to start off and say thank you to our partner, the U.S. Institute of Peace, Lise Grand, and her amazing staff who worked so closely with us to make this all happen. I first want to also talk about the title, PeaceCon, COVID Climate and Conflict Rising to the Challenges of a Disrupted World. I want people to know that when we think about this conference and start working on it, this is always the hardest thing to do is to come up with this title. I want to give a big shout out to Alan Fitz, one of our board members at the Alliance for Peacebuilding. This title seems so obvious, but it wasn't. We do it almost a year in advance and we have to think about where we're going and I think the disrupted world captures what we're going to be talking about a lot over the next few days. I want to acknowledge that unfortunately we were so hopeful this year that we would be able to get together in some form in person. It is weird to look out into this great hall at USIP and not see our colleagues, our friends, the peacebuilding community. I want to acknowledge how much we miss that, but I also know that we've learned so much about how important it is to have this connection also through these electronic platforms and how next year we're hopeful when everyone can have a vaccine and testing that we can be together again, but know that we've learned how important this hybrid model is as well to make sure that we can connect globally. But this year we're celebrating PeaceCon at 10. So a lot of people have asked me what that at 10 means. It's 10 years of this conference and this partnership with USIP. For those of you who don't know the history of AFP, it started about two decades ago with a small group of practitioners who came together to develop a community of practice for peacebuilding and conflict prevention. The first conference I'm told was just a small retreat. Fast forward two decades later, AFP is a robust network of 160 organizational members working in 181 countries globally. Now when we say the word peacebuilding, people in other development sectors, policymakers, lawmakers globally, don't look at us and say, what exactly is that? And I know right now everyone's going through their mind a conversation they had where they've had to explain what peacebuilding is. But today peacebuilding can be found in US laws including the Women Peace Law, the Global Fragility Act, the UN Sustaining Peace Agenda, the World Bank's Fragility Strategy. Rob Jenkins will be here this afternoon to talk about USAID's new bureau, the Conflict Prevention and Stabilization Bureau at USAID. We've come a long way. However, we have a long way to go. We have a lot of work to do. We've hit a 30-year high in global violent conflict. We have a global violent conflict problem. COVID is stabilization in reverse. Climate change is compounding conflict, but we don't have to accept that conflict is inevitable. Violent conflict is inevitable. And this robust, committed, and growing community proves that. I'm excited for my new role as executive director and I'm so grateful for the board at the Alliance for Peacebuilding who has the trust in me and for all of you that have worked so hard with us to develop our new strategy moving forward, our field-building strategy. You'll hear a lot about it throughout the next couple days. We're going to be continuing to develop an evidence base, advocating for game-changing policies and laws and making sure that they're implemented successfully, accelerating collective action, and tomorrow's plenary in the morning. We're going to be working on a social activation, a social media activation. So moving forward, I also want to thank the AFP team. They've been working so hard. Nick, Maurice, Megan, Shazia, Sarev, and Jessica. And Jessica, I just want to give a big shout out to her, a senior director at the Alliance for Peacebuilding. Her tremendous work, as always, is someone who I really want to point out. Throughout the conference, you'll be seeing all of the AFP staff. Please reach out to them, get to know them. They're really good people and they're dedicated and passionate about this work. I also want to thank all of you who are attending and participating and have given so graciously of your time. I am so excited for this agenda to be learning and listening and participating and collaborating with all of you. Please take advantage of all the sessions that are here. Please also participate in the chat, whether it's today or the next two or three days. Make sure to engage. This is how we build the field. I also want to thank all of our sponsors. We couldn't do this without you. You're incredible and we are grateful for that. As we go through the next three days, please make sure to hashtag, rise to build peace. Tag things that you like, tag things that you don't like. We make mistakes and also the peacebuilding field, we have to acknowledge our failures. Again, I just want to thank our incredible board at the Alliance for Peacebuilding, which is a true partner. We're so lucky. On that note, I want to introduce Julia Roy, AFP's board chair. She's been part of the peacebuilding community from the beginning. She was the longtime president of Partners Global and now the founder of the Horizons project. So thank you. Thank you so much, Liz. And on behalf of the board of the Alliance for Peacebuilding, it is my pleasure to welcome you to PeaceCon at 10. It is wonderful to be here in person here at USIP. We miss all of you in person, but like Liz said, what a joy it is to have so many of you be able to participate in the conference virtually. And our hope is, is that we can be together again sometime over this next year and continue these hybrid convenings so that the breadth of our peacebuilding field can continue to convene and be participating in these conversations. So also, I of course have to give a special thanks to USIP for their ongoing partnership for so many years and a very special congratulations to Liz on assuming this new role as executive director. The board spent a lot of time thinking about this new strategy of field building together with many of our members over this last year and Liz assuming the role that she is right now is really indicative of the commitment that we have to the facilitative leadership that Liz really embodies. Many of you have worked closely with her. You know her well. She knows so many of our members and our partners all around the world and we're committed to the Alliance for Peacebuilding being a space where we are expanding the field, learning, really committed to more collective action. We know that this is needed now more than ever because it is true. The Alliance for Peacebuilding has been my professional home for almost 20 years. Not one of the founders in that first gathering, that retreat. But the reason that I've chosen the Alliance for Peacebuilding to dedicate my energies to, both as a member and as a board member, is because of the breadth and depth of issues that we work on at the Alliance for Peacebuilding and all of those are represented at this conference. You will find something to inspire you, you will find something to learn more about, you will meet new people and as Liz really encouraged you, participate actively and be present. And she mentioned the title and how long we spend thinking about the title of this conference. The word that most resonated with me and got me most excited about the conference this year is the word disruption and I know that we think a lot about disruption out there in the world but our field is also going through moments of disruption and I think it's something that we also need to wrestle with during the conference. There are movements to decolonize aid and what that's going to look like with regards to the power imbalances within our field and the way that aid is administered, the systems that we all work within because we are a part of those systems that we no need to change. We're going to be wrestling with what happened in Afghanistan over these last years and how many of us worked in that country and were a part of a system that resulted in what we're dealing with now and we're dealing with diversity within our own leadership, within our own ranks and organizations like WCAPS, Women of Color, coming together, advancing peace and security and conflict with their chapters all over the world, looking seriously at diversity, equity and inclusion within the field, within leadership positions that all of us need to be committed to and taking seriously. So as these moments of disruption feel uncomfortable, they also are moments of opportunities for change and we know this as peace builders. We're good at this. People who work on conflict transformation can hold tensions and can work for positive change because the world does need our expertise right now. There's violent conflict, there's people who are traumatized in all areas of the world that need to be finding trauma-informed ways of coming together to work on common problems and so what I would ask of you during this conference is to take full advantage, be present, connect with your colleagues but also be self-reflective, be self-reflective of the ways that our own field of peace building is going to be disrupted going forward and that we can take joy but we can also accompany each other in this moment and so I also would like to say a special thanks to the entire AFP team, to all of you who have been working very hard on your presentations. We know that this is a big collective effort and AFP really is all of you and if you're not already a member of the Alliance for Peace Building please sign up and join us on a regular basis because this is the biggest event we have of the year but there's so many other exciting things that happen throughout the year that we really would like you to continue to be involved with so thank you very much to USIP, to AFP and enjoy the conference. The United States Institute of Peace is delighted to join our partners at the Alliance for Peace Building and welcoming you to the 10th annual peace con. I considered a privilege to share the stage this morning with Liz Hume, the Executive Director of the Alliance for Peace Building and with the Chairperson of their board Julia Roy. My name is Liz Grande and I'm the President of USIP. Our conference this year comes at a time when global realities are hitting hard. The world is two years into a global pandemic. There have been 10 coup or coup attempts during that time and we are on the brink of an armed confrontation between two nuclear powers. The list goes on. New pressures, new technologies, new forms of exclusion and discrimination, continuing injustice and greater inequality are driving conflict and they're making it harder to mitigate violence and much harder to resolve conflicts when they arise. Many of us who work in peace building continue to use the peace building tools and mechanisms which we've established after decades of trial and error. These tools including mediation, negotiation, dialogue, reconciliation, nonviolent action, strategic religious engagement, security sector reform, conflict analysis and systems thinking are being used to great effect across the globe. But one of the questions facing all of us as peace builders is whether we need to do more to create new tools and mechanisms in light of the pressures we're collectively facing. I think many of us feel that we probably do need to develop these tools and to do so as quickly as possible. During the next three days we'll be able to dive deeply into what's driving conflict and think together about how we can more effectively use the tools we do have to prevent and resolve conflicts and to think collectively together about what new tools we need to develop. In addition to the many important conversations we'll be having, PeaceCon is a platform for us to honor the people around the world who every day and in every way build peace in the communities where they live and work. I hope everyone joins us this year in most particularly highlighting and appreciating the role that Afghan women have played during 44 years of near continuous conflict in their country for decades. Afghan women have acted as their country's foremost peace builders, representing the aspirations of their communities during the Doha peace talks, helping to resolve familiar and tribal conflicts and mobilizing to address the drivers of conflict and discrimination. For this year's keynote address we are privileged to welcome Amina Muhammad, the Deputy Secretary General of the United Nations. In her role at the very top of the world's preeminent institution dedicated to global peace, Amina leads UN and global efforts to address the forces that are creating and driving conflict. She has fought for decades to increase access to education, improve clinics and healthcare across the world, fight poverty and reform public sectors so they provide the services people need the most. Prior to her appointment Amina served as the Minister of Environment and the Federal Republic of Nigeria where she steered the country's efforts on climate action and efforts to protect the natural environment. As special advisor to former Secretary General of the United Nations Ban Ki-moon, Amina was responsible for helping to plan, facilitate and shepherd the process of reaching global agreement on the 2030 agenda for sustainable development and helping to create the sustainable development goals. Amina's contributions to the great global processes that are helping to create peace and her leadership of those processes is truly inspirational. Dear friends, I'm pleased to send my greetings to the Alliance for Peacebuilding and the United States Institute for Peace. COVID-19, climate change and deepening inequalities are fueling grievances, driving instability and exacerbating the risk of violent conflict. Prolonged conflict in turn is among the biggest obstacles to achieving progress towards the 2030 agenda for sustainable development. I see three priorities for action. First we must scale up risk informed development investments to address the structural drivers of conflicts. This requires closer collaboration between those working on development, climate, humanitarian and peace to deliver transformative prevention focused and conflict sensitive responses. Our common agenda offers a blueprint for greater strategic foresight, risk preparedness and anticipatory decision making anchored in the sustainable development goals as our ultimate prevention tool. Second, we need to address inequalities, build resilience to climate change and to ensure no one is left behind. In particular, marginalize communities in hard to reach areas. In the Sahel, the Horn of Africa and elsewhere, societies already straining under conflict and COVID-19 are among those hardest hit by climate change. They face even more severe and frequent impacts in the future. The commitment by developed countries to collectively double their adaptation finance by 2025 must be delivered in full and on time to reach developing countries and communities who need it most. Third, addressing inequalities means tackling gender inequalities. We must make women's leadership meaningful participation and equality an absolute priority. When women are at the table, peace has a chance. We must also include young people more systematically in political, social and economic life. Dear friends, together and only together can we build a more resilient, sustainable, just, prosperous and peaceful world. Thank you. Good morning. On behalf of the US Institute of Peace and the Alliance for Peacebuilding, let me express our deep appreciation to the Deputy Secretary General of the United Nations, Amina Muhammad, for those really important and insightful remarks. I'm Joe Hewitt, Vice President for Policy Learning and Strategy here at the US Institute of Peace. Thank you all for joining us today for this opening panel on climate change and peacebuilding. This is a particularly important panel to USIP as we have just launched our new climate, environment and conflict program in the last few months. We are aggressively moving in this direction because we realize that climate change and environmental degradation are increasingly a factor in conflicts around the world. We know that climate change is jeopardizing human security. There's no single statistic that can help us capture the breadth and depth of this challenge, but consider this. In 2070, in just 50 years, an estimated 30% of the global population will live in areas that experience an average annual temperature that's found in only 1% of the Earth's surface today. The challenges we face necessitate a global transition to green energy, but that transition also has the potential to fuel conflict, geopolitical competition for mineral control, mining operations in fragile states that disregard human rights and result in pollution of land and water, decarbonization of economies that leads to destabilization of national governments, localized disputes around land rights and benefits sharing in the implementation of green technologies and social unrest as societies adapt to new economic realities. These issues increasingly require a better understanding as we integrate them into our peace building work. We think that working on environmental issues can be a powerful entry point to peace, but we must be tireless about applying lessons from current experience to guide our future work if we're to expect environmental peace building to be a fruitful driver of positive change. We look forward to learning a lot from today's speakers. So with that, it's now time to hand things over to the moderator for today's opening panel, Andrew Revkin. Andrew Revkin is one of America's most honored and experienced environmental journalists. He has written on climate change and its impacts for over 30 years, primarily for the New York Times, but also in several books. He is currently the founding director of the Initiative on Communication and Sustainability at Columbia University's Earth Institute. It is truly my great pleasure to hand things over to Mr. Revkin, who will introduce our panel. Andy, over to you. It's an honor to be part of this discussion today. I apologize for if there's any audio or internet issues for me. I'm in rural Maine helping take care of my mother-in-law, not in my normal office in Hudson Valley. This is an incredibly important discussion. I hope those in the audience will submit questions. You'll see a Q&A box on the screen, and we'll try to get to as many as possible toward the end, and I can follow up as much as I can in the projects I do online in the coming days and weeks and months. This issue of clarifying what can happen to foster resilience, to foster equity, to reduce potential for conflict where climate and people are changing is one of the most important challenges we face. Obviously, the statistic that one statistic that Joe just included, I think really spells out where we're going in terms of the changing climate, but what I learned as a journalist, I've been writing about climate change for 30, well, since 1988, since before there was an IPCC and the UNFCCC, is that the social climate is still the most powerful determinant of bad or good outcomes. Climate is changing, coastlines will be changing for centuries to come, but how we respond, what we can do in society is a key. Carbon dioxide and other greenhouse gases are also easy to look at, they're easy to measure, they're not easy to look at, they're easy to measure. Cyclones are events, so what do we pay attention to in the media and in politics, events, disasters, we don't do a very good job of paying attention to these underlying conditions that don't come with a sudden dramatic violence through this span where you just heard that statistic at the beginning, we're now at a 30-year high global violent conflict right now. Gillian Caldwell, she's the Climate Change Coordinator and Deputy Assistant Administrator at the U.S. Agency for International Development, responsible for planning, directing, and supervising all climate and energy work at the agency. That is a huge challenge and opportunity, and we'll talk about that, her long career at the intersection of human rights and environmental action, particularly her focus on communication, the role of video and film, makes her a very special guest today. Communication matters enormously. What we see is what we pay attention to, what we don't see is what we miss. Ambassador Fred Nogoga, who is the Head of Conflict Prevention and Early Warning Division at the Peace and Security Department of the African Union is here, a long and storied career right in the middle of on-the-ground situations where things go one way or the other, and we have great regrets or lots of congratulations. Patrick Yusef, Regional Director for Africa, the International Committee of the Red Cross. I'm in touch quite a bit with the Red Cross these days, sadly, in the journalism that I do. Again, we're in a chronic state of emergency in so many parts of the world. He's worked on the ground in Sudan and Chad, Yemen, Iraq, so many places. We're going to start right away with a set of initiating questions. I'll start with Polly and then Gillian and then Ambassador Nogoga and Patrick. I'm not seeing you on screen, but I'm assuming you're all visible to the audience. Polly, what I try to do when I talk to people in my webcast to start with a very simple question, how did you become who you are so far? That can take a little time, and I want to think we have a good sense of what drives you and how you get to where you are. But what I really want to get from each of you today is some input on this question. When you think about these words, climate, conflict, and peace, the core questions on the table here today. What keeps you up at night? What's the core one or two things that give you a sense of opportunity or sense of frustration? Okay. I guess I'll jump right in. Thank you, Andrew. I just want to thank USIP and AFP and Liz in particular for your energetic leadership on this topic and everybody involved in putting together this amazing event. It's an honor and privilege to be here. I think to answer your question, Andy, jumping right in, I'm going to speak from what we see in our work on the ground in Nigeria with our partner, the Neem Foundation. Is it climate change is significantly compounding conflict dynamics? As research has demonstrated, it is a threat multiplier exacerbating existing vulnerabilities. The greatest worry is knowing that the climate security risks will continue to intensify, that the fragile regions in particular are going to experience the most severe consequences of climate change and often with the least capacity to cope, and that people affected by conflict are among the most vulnerable to climate crisis and also often among the most neglected by climate action. The concern is if we don't take concrete action to work differently to mitigate these compound conflict conflict conflict climate dynamics, mostly over resource issues, that the consequences in human terms will be catastrophic and much worse than we're already seeing. But on the other hand, to your point, I mean, along with the threat, there is an opportunity and I think that was highlighted in some of the comments in the introduction as well to work differently, to work collectively in a more integrated way, recognizing the need not only for effective national policies and international support for those policies and programs, but also the critical importance of taking sort of an integrated and inclusive approach that includes supporting local actors working with community organizations develop very context specific conflict sensitive solutions and approaches to mitigate climatic pressures. The evidence is clear that if climate security adaptation and resilience solutions don't include local voice and experience, they certainly increase the risk of inadvertently exacerbating or creating new conflict dynamics. And I mean, certainly the examples of the impact are not hard to find in migration from climate is well documented and certainly in Africa, which is particularly susceptible to the negative effects with many African economies being primarily agricultural. So maybe I can talk more later specifically about our project there, but I'll stop there. No, that's a great start at a great case study. Nigeria has so much opportunity there's for becoming a dominant player and in the globe, you know, it's an enormous country. I just want to dig in on one thing that I studied or reported on there, which is the importance of getting girls through school and the impediments of getting through girls through school as a pathway to stable populations to more functional, you know, equitable society. And this gets to where the systems here get really complicated because the disruption and violence in Nigeria that's keeping impeding full access to education, then is leading to sustained high fertility rates, limited women's power to shaped families. Is that a bigger problem or a bigger opportunity? What does that feel like? That keeps me up at night. You're asking me.  I mean, we see this, you know, we focus very much on the pastoralist population and the project we're working on is early warning, early response systems. We're bringing, you know, pastoralists and herders and trying to bring them together.  I mean, there's been a very conscious effort of bringing women into these early warning, early response platforms and there's a lot of, you know, resistance as you can imagine culturally to that, but that, you know, slowly that has changed and women are actually actively they're being trained as community dialogue facilitators and playing a really active role.  So I mean, it's to your point. We'll circle back to a couple of those things in the solution section.  So I imagine there's more than one thing that keeps you up late at night, but maybe we could focus on the opportunities you see that are so far unrealized, but what are the things that drive you as you look at energy, climate and development at the same time? What does that feel like? Well, first, thanks so much to the US Institute of Peace and Andy to you for the introduction. Andy and I first met, I think, 15 years ago when I was leading a campaign to pass a law in the US that would put a cap and a price on carbon emissions. And some of you may recall the Waxman-Markey bill, which passed in the House and got stalled in the Senate, much like President Biden's Build Back Better legislation today. And there's so many important climate related investments in that bill. And of course, that's a key sticking point for Senators Manchin and others that are holding it up. So, you know, things change and they stay the same. And as far as change is concerned, you know, what's keeping me up at night is that it's coming faster and more furious than even the world's most experienced scientists in the IPCC projected. So, you know, there's this concern that climate change is driving transformation in, you know, extremely negative ways more swiftly than human and natural communities can adapt to. And of course, it has, you know, these really compounding impacts in terms of exacerbating climate and, you know, creating instability in the governments and the underlying physical infrastructure required to, you know, to respond to climate. I think you asked me about opportunities rather than threats. And of course, try to keep my eyes focused on those because it's just too depressing to spend all your time thinking about what's wrong with the world. And the truth is that, you know, we have, there's so many opportunities if you think about the risk that climate compounds resource scarcity, which can precipitate conflict. You can look at the opportunity, such as the systems we've invested in with NASA and others, the technologies that give us advanced warning regarding drought and other impending natural disasters so that we can be proactive in preparing for, you know, both for the potential physical impacts, but in promoting the kind of cooperation and collaboration that's necessary to ensure effective sharing of scarce resources. So, I mean, looking at, looking at it from a positive perspective, this can, this can move peace building forward in anticipatory ways more, more swiftly than it would otherwise if we're proactive enough. And it pays to be proactive. I mean, there's plenty of evidence to suggest that, you know, we've got at least three trillion dollars in costs ahead of us on mitigation and adaptation, but we're going to have a whole lot more money to spend if we aren't proactive in addressing the underlying infrastructure and the changes in human community and how we're organized to adapt to this. So, you know, and of course, there's the opportunity of, of transforming our entire energy system and creating a just transition rather than finding ourselves in a world full of geopolitical tensions and, and, and, and fights over resource scarcity. So I just hope we can keep our eyes on the prize here. We can't, it's, you know, even I think COVID's another analogy, it's not about going back to the way life was. It's about recognizing the world's fundamentally changed forever. It's continuing to change. And if we adapt in intelligent ways that are, you know, frankly grounded in some, some love and justice will be much better off than we were to begin with. You know, I hadn't thought about this till just now as we were speaking, but I've had recent conversations on my webcast through the Columbia Climate School with DN Criswell, the FEMA director. For those who don't know, that's the emergency management agency. And even the name of that agency is an acridistic because it's about managing an emergency, meaning the emergency is already happening. And the disastrous and conflict community, everyone in this call today is about mitigation of risk before the worst happens. And they're doing their best there. There are some interesting project projects underway at FEMA to try to tip the balance even in funding within the agency toward and commit with the forest service, for example, which also has a huge billion plus firefighting budget and sort of a hundred million dollar mitigation of fire risk budget. And what you're all are focusing on as well. What can we do within our structures to do the same thing? So maybe we'll follow up and have, I could try to schedule some kind of a brainstorm between the disaster community and the peace building community. Very interesting. One thing I wanted to ask you briefly before we get to Patrick and the ambassador is about some of the real dynamic tension between energy access and climate stability. USAID, State Department generally, you know, you are still trying to develop, let's say, clean cooking and arena.  And yet sometimes that can be a fossil fuel and many countries from Africa, that's COP26 talks, were starting to worry that cut off to finance by rich countries for fossil fuel development may impede their energy rights even as we're talking about climate. So does that intersection of climate and energy priorities come, is there a tangle there or is that more of an opportunity to? Well, I mean, there is some tension, but I think it's overstated. Of course, as you mentioned, energy poverty is greatest, greater on the African continent than anywhere on the world. More people in Africa are functioning without electricity than anywhere else. And of course, you know, electricity is critical to all sorts of health and education and economically related outcomes. So it's really a challenge. Power Africa is the US government's response to that. It was launched under Obama and it's an inter-interagency initiative housed within USAID. And the focus is on tackling energy poverty. But over time, they've begun to really evolve their metrics of success to include decarbonization, which hopefully will come into a front and center consideration alongside energy poverty. And in many places, I just read a Bloomberg study indicating that in many places it's cheaper these days to go with renewable energy than it is to go with fossil fuels. The US government has just released guidance which prohibits funding of coal and which allows funding for fossil fuels only in very limited circumstances where there is no other viable alternative or whether there's significant national security interests at stake in places like Ukraine would be one such example when you look at some of the dependency on Russian oil for a country like Germany. But in any case, I don't think it's as big a challenge as some people would like to suggest. And I think if we're creative in looking at how we can leapfrog over fossil fuel infrastructure and invest in decentralized grids, we'll be much better off. Yeah. And one thing people miss, including the media, is that the Electrify Africa Act passed in the most divided Congress in history under Obama, that's signed. If you shape priorities around things that really matter, development, electricity, Africa, even our pretty broken system, the United States can do some remarkable things. So thank you. And now on to the Ambassador. Ambassador Fred Nogoga, Head of Conflict Prevention and Early Warning African Union. You again have been on the ground in so many situations in regions where climate is the source of vulnerability even now. What keeps you up late at night? I have a feeling you focus your full of solutions, even as you recognize the problems. Well, thank you so much, first of all, for inviting me and for having me. I thought it was important for me to be here because this is a topic that is on top of our agenda continentally. What keeps me up at night? What keeps me up at night is the droughts, the high temperatures, the displaced people as a result of climate change. I think, you know, we are the least, you know, the African continent is the least in terms of, you know, the greenhouse emission, yet we suffer the most consequences as we speak. So we recognize that this is for us a priority. We have had about eight sessions of the AUP and Security Council agenda, eight sessions focusing squarely on climate change and its impact on our continent. And we are working very closely, for example, to integrate climate change within our early warning system, therefore helping some of our member states also to be able to establish their own early warning systems about climate change, but also our regional economic communities. We have been actually, the AUP has decided to appoint a special envoy, which will actually be focusing on climate peace and security, and also establishing a climate peace and security fund. So these are some of the things that we've been working on, but we are constantly dealing with these conflicts. Many don't know, but actually the Darfur conflict was the first conflict actually, which was a result of climate change. It's often forgotten, but we're having many more. For example, today as I speak with you, the drought in Somalia is causing so many displacements, and the displacements are actually putting pressure on the host communities. And as a result, the communities are fighting I heard Paulie talking about the pastoralists and herders conflict. It is everywhere. We see it not only in Nigeria, but we're seeing it in the Central Africa, the public. We're seeing it in many, many countries. So these are some of the challenges that we're faced with. We're trying to our level best to address them. But one thing that is for sure, as Gillian said, if we don't come together and work together, you know, we will impact all of us and unstable Africa will not serve the world well. It will create all sorts of other issues which will affect everybody. So I think that the more we keep this on the agenda, the more we have constructive conversations, the more people are less selfish and really, you know, honestly address the issues. I think we will do well. We have in November this year, I think in the COP 97, which is going to be in Egypt 27, sorry, 27, I think I was going to get wrong, it's going to be in Egypt. And so they're going to be discussing some of these issues. And I think it will also be a great opportunity to highlight some of the challenges, but also the opportunities as Gillian and Paulie and yourself, Andrew has mentioned. Thank you. That's a brilliant intervention. There's so much to do. And this is a good time to get to this question of what does the developed world, I want to turn off that phone. Sorry. Again, I'm in verbal Maine at my mother-in-law's house. It'll stop in a second. What does the developed world owe Africa? It's not just what's under the climate treaty. You know, we can't get into the whole history of colonization and life, but if the world wants to have more forecasting capacity, for weather disruptions, whether from climate change or natural variability, there needs to be more data and more analysis in Africa, meaning and also more on the ground capacity in Africa. What are universities like Columbia where I work? And what are governments not doing sufficiently to build Africa's capacity than just to monitor and analyze and then convey those risks? There are data gaps that are profound still, just simple questions of how many areas are being monitored. What's that feel like? I mean, for the African Union, it's not just about how much money you're going to get under the details of the climate agreement. What are the capacities that need to be built? Thank you so much. With COVID, one thing that we realized was that the importance of investing in education and research on the continent, because the entire world was able to produce vaccines, but we were not able to produce vaccines because we were lacking when it comes to research. So this is something that we want to be investing in and where we will need actually support from the world in general. And I think that the more we invest in research, the more also we will be able to invest in the infrastructure that can withstand some of these shocks. I think it's critical. I would like to also highlight something else, which is the continent is facing. So some of these challenges are actually also creating a gap in those who govern and those who are being governed. And as a result, again, it's causing quite a lot of instability on our continent. So I think that the world owes us not only to do what is responsible in terms of limiting their gas emissions, but I think that they also, you know, we all need to invest in not only in the early warning mechanism, but also in the prevention. And when it happens, how to respond to these questions working together. Well, hopefully we can all work on building better systems so that there are great templates. FuseNet, the famine early warning system, demonstrates that we have this potential to bring together expertise, connections to communities and do better. Patrick Youssef at the Red Cross, you know, if anyone is in a state of constant response in an emergency, it's you. But every once in a while, you must have the ability to step back and say, where do we go from here? So again, late at night or early in the morning, what gets you where you just teamed up as an opportunity or key problem. Andy, thank you so much first and foremost to you, but also to the organizers, to USIP, but also to the Alliance for Peace Building. And I think if we really think about the impact of what one can achieve, it's exactly with these alliances, with having different experts around the table, it's having different voices, those who can oppose and not only drive the line of what has been chartered by others. I think what keeps me, but also many managers and field operators with the Red Cross is the following questions. Are we doing the right thing? Are we, as humanitarians, doing enough? And I guess what keeps me up all the time and not always at night, is this sense of injustice that we felt when we started speaking about COVID vaccines on the continent as a regional director for Africa and faced with thousands, hundreds of voices coming from the field about this lack of fairness, about the sustainability of the world's promises and the lack of concrete actions when tackling climate issues. And here, if I may just, again, pitch from what we hear on the ground, through our work as the Red Cross and Red Crescent movement, the biggest network of volunteers of those people exactly living the dual hardship from wars and violence, I think what we see is very clear. People affected by wars and violence are on the front lines of the climate crisis. If we have to get out of such panels, but also worldwide discussions around the duality of armed conflicts and climate, we really need to put that in huge figures and big bold characters.  And I think the reasons are obvious, which I hear when I was recently in the Sahel or in Somalia, but also in less visible contexts, to be honest, like the Central African Republic or Mozambique, which as you know, is currently bracing for the next tropical storm while having to deal with half a million displaced people in the region of Pemba. And again, the consta, the evaluation is the same. It's the same, by the way, that obstructs the path to peace and prolonged wars. And many have been mentioned by Joe Hewitt in his introductory remarks, weakened institutions, essential services, disruptions, poor economies, lack of social cohesion. And clearly, while there are very few cases where there was direct correlation between the climate or an environmental degradation and an armed conflict, as per the Geneva conventions, I think climate change is inseparably linked to some of the most pressing security challenges of our time. And these grandad made reference to these two, which I found spot on. And I think the data to conclude supports our observations about this double vulnerability. So 60% of the 25 countries affected or the most vulnerable are at least ready to adapt to climate change are affected by wars. And I can provide you with a long list. So for now, I think the gist of it is the following. Climate action and finance to support this action are particularly weak in places of conflict because of the challenges I mentioned, because of the hesitancy of those who really can make the difference on the ground in implementing long-term plan in such environments. So as you can imagine, there's an amalgam of 100 and thousands of things to worry about. On top of which comes this life-threatening menace on people's lives, that is climate hazards and climate adaptation, which is lacking, unfortunately, in today's humanitarian landscape.  Thank you. This is really helpful as well. There's some questions that are coming in, but this is the key moment for you in the audience to offer your questions and observations in the Q&A box you should see wherever you're watching. There's a couple that have come in, but I want to now start more of a conversation here. And a point that came up that resonates throughout what you've all been saying is, in one way or the other, you've all recognized that if you work on basic components of a system, a social system, that boost resilience, boost equity, reduce vulnerability particularly, you have that creates sort of an insulator effect when there's a shock, whether it's Mozambique's next cyclone or the like. And we kind of know this, the peace-building community knows this better than anyone, I think. But is it starting to percolate into our broader national and international funding and prioritization? I'm going to frame this around something that was said in 2017 when the Trump administration was settling in. There was a conference in Europe on security. And I wrote a story about this. And there was a European official, the high representative for foreign affairs and security. She said, she was talking to the Trump administration, you need the European Union because we invest in basic social development in places like sub-Saharan Africa.  In other words, national security, wherever you are, Germany, the United States, is abetted by cutting vulnerabilities in places in the world that can be unstable. And I just want to get a sense if you feel that's really, is that important? And is it happening? Maybe back to Gillian briefly and then around the circle here. Is the world really getting this? Well, the military establishment sure is. I mean, the Pentagon has been out in front on climate change as a major national security threat. And there have been a number of both public and classified briefings on point. So there's no doubt in their mind and their experts on this front, no doubt in mind either. I think we've still been slow to come to the table. And I think national security arguments, one that resonates on either side of the aisle and can be important. I mean, what you were just saying, Andy, and what our colleague from the African Union Commission was talking about, it really relates to capacity and preparedness. And interestingly, we just commissioned a study on what the U.S. government and USAID in particular could do to accelerate development in Africa. And they honed in after speaking to hundreds of people across the continent on two things, digital skills, acceleration, and climate analytics and planning. And we just launched, interestingly, before we had the results of that study, but hopefully we're on point, an initiative with the African Union Commission called CACHI, which is a Comprehensive Africa Climate Change Initiative. So the focus here is on strengthening the country level and regional data capability to create an Africa-wide platform to make sense of the mitigation and adaptation challenges Africa's confronting. And if you look at the funding, which, of course, has been too slow to come as the keynote speaker remarked, but will be flowing hopefully in the direction it ought to from developing countries to developing countries. The question is, what's the readiness? What's the preparedness to absorb that? What are the data? What's the arguments for the use of that money? So I think that's an incredibly important initiative to make sure we're investing in the right places and that Africa's well-positioned to argue for and absorb the funding it so desperately needs. Just briefly, there was a question that came in that got to this. Let me see if I have it right here. And this is a question from the audience. I wonder about the trickle down effects of these programs, Power Africa and certain World Bank distributed funds for certain states in Nigeria have never been heard of. The people are not feeling the impact. I worry a lot about these on-the-ground realities. How can we address this? Which kind of gets to your point about, it's not just money, it's like how do you make sure it gets to where it's needed and all that. Maybe I'll just jump in here on Nigeria, because I think it is just such a bit of a working, but it is such a stark case in point about the impact of climate change, because it's on so many multiple dimensions. It is the most populous country with 200 people. Economy closely tied to gas and oil, directly linked to social inequity and awful environmental disasters and one of the highest rates of energy, poverty as well. But it is unquestionably tops national security and recognizes such issue for Nigeria. And it's not just the north again, it's all across the country and people being pushed. It's the cascade of effects, people pushed into cities, urban areas, not having capacity and adequate infrastructure and the erosion of social societal customs and family structures. And I think it's certainly again in the past year list area, the ramifications are very direct in terms of national security, because it's well documented that this former herder conflict has enhanced increased vulnerability recruitment by extremist groups, including Boko Haram. So I think it's kind of in the forefront. And I know the Nigerian government I think has passed some I think like 10 or 11 pieces of national legislation related to climate. Some of them I think have been some missteps and had some negative repercussions. But it's no question that it's a huge issue. And I think back to the Ambassador Nogoga's excellent points and Patrick's on the capacity of figuring out where the gaps are, how do things trickle down to the local level? Because it really has to be at a assistance. It's a systemic issue and it has to be approached from a systemic perspective, i.e. from all different angles. So that's just my two cents there. With the Ambassador, would you like to offer any ideas on those questions? Again, it's kind of like how do you work on the chickens and the eggs all at the same time? If I can come in just I think at the time we committed with UNEP to look at what are the natural resources in dispute? Just to kind of get a sense of what we're faced with. And it was interesting. The first natural resource that is a cause of conflict was land. Second was actually minerals. Third was oil. Fourth was water. And the fifth was fisheries. And all these five natural resources, when you look at them, they're all affected by climate change. So like I said, as the colleague just mentioned, we need to invest not only in early warning, we need to invest in the prevention, how to prevent crisis escalating. We need to invest in the response when the crisis do occur. And most importantly, how do we stabilize the communities that have been affected by some of these changes? And this is something that we tend to often overlook. And I think that I was just thinking a while back, we're seeing some countries actually where the water levels are rising. In my own country, Burundi, the other time the water levels of Lake Taganika just rose and a whole section of the city people had to be evacuated. So these are some of the things that really you started earlier, what keeps up at night. We think about all these things and we look at the resources that we have, our ability to analyze and to respond. And it gives you a headache. It gives you anxiety about how we're going to be able to deal with all of this. Thank you. And there's a question that came in that gets at your point about Burundi and that lake. It's the challenge of turning global data projections into local meaningful forecasts and like, is there an information gap in how climate change will impact localized conflict? So conflict, as you said, is related to resources, clashes of cultures, stresses. And I guess this gets to one or the other. To me, it comes down to some of the basics for us to access education, making sure that American universities have partner universities and developing countries, making sure that extension services are a real thing using data. There are some really cool examples of using communication technology, SMS and radio, old fashioned, to make sure regional rural areas that don't have the internet necessarily have information. But again, where's the headline in that? If you're a funding funder, if you're at the UNDP, how can you do that? It's an interesting question. Oh, sure. Patrick, please. I mean, it's so difficult to answer this question, although in a way, what should reassure us is that we don't need to start from zero. In a way, we've been also adapting in the humanitarian sector our work to really focus on building social cohesion in the communities where such a feature has been either dismantled or totally erased, which explains why, as the ambassador has just mentioned, inter-communal violence, which doesn't amount to a war or an armed conflict, is on the rise everywhere in sub-Saharan Africa, by the way, leading to more death and injuries, more than the war with a group like the Islamic State in the Western Africa province around the Lake Chad, or with Jnim and many opposing factions in the Sahel region. So in a way, I think that building resilience is part of focusing or zooming in on what matters for people affected by wars and putting people at the center. I think it's very critical to build on what we have already done. If I'm just giving an anecdotal example of a delegation today, if one of our embassies delegations in the field that has built its operational planning for the year to come purely on substitution, and substitution, meaning providing food, water, basically making sure that they fill the gap of what governments and institutions should have been doing on their collective behalf, either because they're not present on the ground, governments, that is, or simply don't have the control to do it. So I think we have a lot of features to build on, and I think it's critical to rebalance humanitarian efforts and focus more on preventive responses to strengthen people's resilience and adaptive capacities. And in a way, short-termism is deadly in this role. So short-term fixes are clearly not sufficient. And I think beyond, because we're all super important, I mean super brilliant in providing the problem analysis, but if we link it to humanitarian consequences, then we consider that bullets alone are not drivers of environmental degradations in theaters of war. I think this convergence mostly threatens people's lives and health and worsens food and economic and water insecurity. And in fragile countries, which are in danger, they're becoming stuck in these cycles of conflict. I beg anyone on this panel, but also in the audience, to tell me how can we resolve the situation of 7.1 million today in Somalia when we have no access to them, and they're all hit hard by the worst drought in the last decade. So I think conflicts themselves can certainly man damage the natural environment, but also reduce further people's resilience. So moving from an emergency purely emergency mindset to building resilience and focusing on empowering those economic communities that is excellency, the Ambassador mentioned, the fishermen, the farmers, but also the herders, would also not only build their own resilience, but allow for better protection spaces for people that are affected by those transhumans traveling, stepping into farmers' areas and creating these difficult relations that unfortunately is so difficult to gain. And on the practical side, I want just to propose what we have done in the ICRC and the Red Cross movement, we've been really working to galvanize to first to look at ourselves and try with a climate charter, climate and environmental charter for humanitarian organizations to lead by example. This charter has now been signed by over 200 humanitarian organizations, but also gaining more support from states like Switzerland, United States, and Norway. We just launched Climate Fund, which will help us as an organization minimize our emissions by 140,000, but also cut on our expenses from 30 to 50 million Swiss francs in the next couple of years. So thinking about ourselves, but also collaborating with other partners in my opinion would be one of the winning recipes. So we don't reinvent the wheel for something that we have, you know, lived throughout our ICRC, but also humanitarian careers. And all of those connected to this call are certainly examples and testimonies of that hard work that has occupied us. Thank you. Wonderful. I, you know, there's a, it's like a burst of like a heavy downpour of really great questions that just come in, and we only have 12 minutes left. So I want to be sure that those in the audience know what I will do. I put it personally to running at least one of my sustainable webcasts to sort of fill in the gaps as we go forward to do another follow-up. These conversations are never the end of something. They're always the beginning of something. I'm just going to kind of try to bundle these a little bit, if that's okay. And then have you all weigh in, just raise your hand or shout out. Cities, of course, whether in Africa, in South Asia, are a key part of the future. And I wrote a 2007 story in the time zone that showed how cities can greatly insulate or reduce climate vulnerability, because long, it's too complicated to get into details. But what should be done at the global level to prepare cities in vulnerable regions and or make them more able to do what someone here said earlier to receive, to be a receiving city. This is a term of art these days, receiving cities. Anyone want to jump in there right away? If not, we'll go into the next one. This is a very particular question about for the AU and for the ambassador, I think. How can the AU or other African organizations vote cooperation over complex geopolitical issues like GERD? This is the grand Ethiopian Renaissance dam. What do we need to do with data, resources or capacities to in situations like this? And if you're not dug in on that, don't worry about it. You can go on. Maybe you might be frozen. I just heard a question very well. I think my connection was a bit problematic. Can you question, please? Yes. Your connection is a little slow, and that's another issue we can talk about in the future webcast on digital connectivity. How can the African Union or other organizations promote cooperation over complex geopolitical issues like the grand Ethiopian Renaissance dam? And maybe we'll circle back to that if time allows. Here's a sort of an overarching question. It actually gets to one that was asked of Patrick. So these two together, someone said, what's the example of how you build social cohesion? And there's another question. Although conflict is related to resources, isn't separation consciousness or the lack of recognition of the interdependence of everyone's well-being an issue too? So basically, social cohesion. What does that look like? Or are there great examples of how it can be built in situations where things would go badly otherwise? Maybe. Patrick, do you want to go? No, please, Paulie. I'll follow. Quickly. Going back to Patrick's point, too, about we're not starting from zero. There are a lot of things, processes that have been used over time. And I just point to these early warning, early response systems where, in the instances in our project in Nigeria, just are bringing people together who may not normally interact in communities and sometimes are, in fact, antagonistic. And it's a process of people getting to know each other, developing trust. They may not agree, but having platforms or neutral forums where people can come together and discuss things actually does build social cohesion. We've seen in post-genocide situations, post-Rawanda, post-Bosnia, what is possible and also how challenging it is. But I think there are very good examples of approaches and tools that have been used over many years, relatively simple. But it is a challenge of bringing people together and developing relationships and means of communication, which are not otherwise possible. And I will hand it over to Patrick. Thanks, Paulie. And again, excellent question. Paulie just spoke about diversifying also our partners, thinking about complementarity, about multi-stakeholders, about multi-sectoral engagement. But if you think about those spaces that are tainted by wars and violence since years, since now three decades in Somalia, 10 years in the Sahel, over 15 years in the Lake Chad region, one has to stop and reflect about and see exactly that in protracted crises, we do have a quite a difficult challenge to adapt to the responses we offer to people. Hence the question of bringing some social cohesion back to the communities mostly affected. And I believe, and I'm just inspired by what we do as ICRC, I think it goes through four main areas. One is to be able to provide humanitarian responses that brings people's dignities back to the fore rather than create dependence on humanitarian assistance. And here, again, we are so privileged to be working with Red Cross and Red Crescent volunteers across the globe. That just provides us an essence of whether people dignity have been indeed restored by providing them with the food, with the water, etc. The challenges we see today, for example, as in Ethiopia and the Tigray region, three years of bad harvest will certainly amount to a crisis even if it's not a catastrophe already. And I think that's the first element. The second element is secretly building resilience as opposed to providing 100 kilos of rice for a family that has been displaced for 10 years. To listen to them and architect together the humanitarian response that gives them the opportunity again to sustain their livelihoods and redress by themselves. The third, I think, and that relates to the common elements that international humanitarian law and the Geneva Convention say about the rights of people to live in such spaces and brings environmental degradation to the fore. And I think this is a very important point, because this does not de-responsibilize states that are enduring armed conflicts from these responsibilities. One of the ministers told me, without naming the state, that what do you expect that to do? All things is going to the war efforts. And this is God's will on us. But again, comparing to other contexts, that argument doesn't fly that high. So building resilience is certainly third. And fourth is the protection of people from these vulnerabilities, those in places of detention that no one's talked about, those in IDP camps, those migrants stranded in Agades Niger before heading to the Mediterranean. And fourth, I think, is to focus on the most vulnerable of the most vulnerable, meaning those widows, women-headed households, children, migrants, indeed, who live these double vulnerabilities in a totally different way, who don't have livelihoods, who have left their homes because of the reason. But again, I'm saying that it's easier said than done. Hence the complementarity, the need to have states also driving, but also regional organizations to drive these changes. And us humanitarians will only be contributors to local efforts, rather than driving these responses, which in a way, and I worked in Iraq for five, six years, these are not sustainable. We need the local buy-in, and then we can push and debate and negotiate on that behalf. But I loved what I heard last time at COP26. We need African voices, for example, for Africa, that would only be the only recipe for rescue, because the realities are there, and they know how to live these realities. And that brings me back to this notion of injustice that I mentioned in the beginning, which should hurt us all. And therefore, I think that's the way forward that I can see in front of us.  Can I jump in on that, Andy? Are we going to take another? Absolutely. So close to the end. Yes, go for it. I'm just reflecting on a lot of what Patrick was saying and thinking of all the experiences we've had in recent history, or are having, COVID and climate, are two that I think arguably have touched every single human on planet Earth in one way or another. So on some level, it's a deeply common and challenging experience we're sharing. On another level, as Patrick alluded to, both of these challenges have deepened already existing inequities. So we're not having the same experience of these crises. We're having very different experiences, whether we have access to the vaccine or can live safely or are on high enough ground and so forth. And that's why I think as we think about building community and about our response, we really have to be so grounded in equity as a central principle in ensuring that we empower and enable people who are the most marginalized and discriminated against to not just survive, but to thrive and to lead when it comes to action. And it's just the poorest and most marginalized people that are getting hit first and worst here once again. And can I just jump in quickly?  I mean, absolutely, these similarities. But I think the experience of the, we've all gone through with COVID. I mean, it not only highlights all these challenges that are very similar, but also, you know, it's instructive and the climate rich is another systemic risk and challenge, right? That it calls for all the same things, extensive cooperation across sectors, et cetera, partnerships, cooperation, et cetera, and having local voices and equity. I mean, it's sort of, so I think it's a very instructive in terms of the challenges and what needs to happen in terms of this issue we're talking about here. Well, we're pretty much at the end of the allotted time, which for me again, means this is not even chapter one. This is the introduction to some conversations that really should drive forward. I'm committed to helping do that with US guests or others who can come in on my sustained work, broadcasts, and what I write. The one thing that I'd like to end these sessions on is a call to all of us to think about what can we do or our institutions do together that we just simply can't do as well individually. You know, what are the key gaps here? Who's not in conversation? Who can reach out to those most vulnerable? Who's working with them face to face in a way that can then connect with resources and create actionable pathways? So we'll revisit those questions. Normally, we would talk about them here more. So thank you all for being part of this discussion of this critical juncture between climate change, climate vulnerability, and societal change. What can we do in the social climate to help us navigate the change to a physical climate? That's kind of what I've devoted 33 of my 65 years to and we'll keep going on. And I know you all will be too. Thank you for being here today. I'm sure the audience shares my appreciation and the organizers. I've been asked to give a few housekeeping updates for the remainder of the day. Those registered for the full conference will continue through today on AFP's conference website with a jam-packed agenda of interactive workshops and panel conversations, exploring how we can all come together and rise to build peace amid climate change, the COVID-19 pandemic, and a high and global violent conflict and headlines every day saying there's more nigh if we don't get to work harder. For those of you not registered for the full conference, it's not too late to register. Explanation point, seriously. Just head over to the events.bizaboo.com slash peace con at peace con at 10 website. Bizzaboo is B-I-Z-Z-A-B-O dot com events.bizzaboo.com peace con at 10. Again, all of welcome back to you today for the closing of day one. The fireside chat at four featuring Robert Jenkins, USAID Assistant Administrator for the Bureau of Conflict Prevention and Stabilization, and do something every day to connect with somebody that relates to either local vulnerability in your own neighborhood or vulnerability across the world and keep at it. This is a long journey, but it's a helpful one, and thank you.


All right. Sorry I'm late. It's a boring lecture anyway, so you only have to listen to half of this whole thing. You're going to sell us on this lecture tomorrow. I haven't looked at these slides for two years. So we're talking about sort of the basics of the BCSE, right, the anatomy, physiology, all the good stuff. Let's see. Anatomy of the lens. There's no blood supply or innervation. So it depends on aqueous for nutrient delivery and waste removal. We know what it does, it reflects light. Some interesting concepts, I guess you look at it with aging. In terms of changes, sometimes there's a myopic shift, sometimes there's a hyperopic shift. We know it's always increasing in curvature, but the very changes in index of refraction can alter the actual refractive effect of that. Size at birth versus size at adults. So those are sort of important anatomic considerations. If you're a cataract surgeon, just remembering that in adult size, it's usually about five millimeters thick at most. So you've got about five millimeters of depth before you're puncturing or posturing a capsule with whatever instrument you're using. All right. The capsule, elastic membrane type 4 collagen, just remember it's thin as posteriorly. Two to four microns, pretty impressive how strong it is despite its thin nature there. You can see it's thickest equatorial and centrally about 14 microns. Zonules, microfiberals, composed of elastic tissue. They originate from the non-pigmented epithelium of the ciliary body. They insert it in a continuous fashion in the equatorial region. You can see they insert just a little bit more central anteriorly versus posteriorly. And with age, of course, the fibers regress. The equatorial fibers will regress, leading mostly just anterior and posterior fibers. The lens epithelium is a single layer. Of course, there's active replication in the anterior equatorial region, as we all know. The newly formed cells, as we know, they migrate equatorially and posteriorly, forming new lens fibers, losing their organelles through that process. And of course, because they have no organelles, they depend on glycolysis. Which, you know, if you remember that from your chemistry, biochemistry class. Let's see. So, let's highlight here. Of course, no cells are lost from the lens. The oldest form the nucleus. So you'll see that fetal or embryonic suture pattern. The newest form the outermost aspect of the cortex. We've seen the lens sutures on those who've looked on Slitlamp exam, the interdigitations there, the apical and basal cells. We see optical zones when you look at a lens. So you might notice that there's sort of this delineation of an endonucleus, the central lens component, versus the epinucleus or cortical material. When you look at cataracts, sort of a similar finding, except it's not a clear lens, obviously. It's clouded to some degree. There's no morphologic distinction between the cortex and nucleus. Though, you know, we have these surgical delineations that we talk about or discuss when you actually look at it from a pathology assessment. Histologically, there's really no differentiation. The lens up to the other cells, those lens cells look the same. Let's see. Crystalline proteins that make up a lot of what is left over once the lens has eliminated its organelles. You can see some fascinating concepts about it, and maybe you should read about this sometime. It's not super exciting. As that, I know as you age, you start to lose some of the... Let's see. It says here, maybe it's the next slide here. Never mind. Memorandum structural proteins inside of skeletal proteins. Anything a highlight that I could take off of here while you're reading it? Here it is. Yeah, the increase of water and soluble proteins with age. This is actually important to understand as we get older. Protein aggregates into large particles that become water and soluble. That's going to result in opacity, reduced clarity, or cataract. They scatter light. Of course, a certain amount of this process appears to be normal with maturation of lens cells. The scene in clear lenses with the excess of it results in the cataract formation that we see with age. There's a reasonably good correlation between the amount of insoluble protein and brunescence of a cataract. Loss of the reduced form of glutathione as you get oxidative stress with these disulfide bonds. Pigment formation, cross-linging, et cetera. It results in cataracts. Let's see. Carbohydrate metabolism. We talked about it requiring glycolysis because it is essentially anaerobic. There's no blood supply. For those of you who remember what ATP is, there's only two produced with glycolysis versus 38-nicarabs cycle. Very inefficient. Let's see. This isn't working. The lens can remain transparent without oxygen in experimental models, but it cannot remain transparent without glucose, even with oxygen present. Glucose is a very important component to the transparency and functionality of the lens in terms of producing the energy that it needs, the ATP that it needs. We're all familiar. I think this is going to go over diabetic. Here we go. What happens with a diabetic? Aldous reductase, a key enzyme in the pathway of processing glucose. There's always a small amount of glucose that goes through this enzyme, but if we get a high amount of sorbitol in the setting of high glucose, glucose is poorly permeable so it will result in the imbibing of water into the lens which can cause the classic myopic shift that you'll see in diabetics we're poorly controlled. Although I've seen several with hyperopic shifts, so it doesn't always end up myopic, but that's sort of the classic. If you see it on the OCAPs, that's probably the answer that would be that question. So again, osmotic pressure drawing that water in is that sorbitol builds up. So there are different protective mechanisms that you can read about more in terms of preventing oxidation and all of these different systems that are used to help with that vitamin C part of that. So vitamin C deficient patient, greater risk of cataract formation. Also the level of oxygen with hyperbaric therapy or vitrectomy, so the mechanism between one of the mechanisms that are thought to be behind the vitrectomy induced cataract is this oxidative stress. We remove the vitreous, causes increased oxygen tension around the lens and increases the rate of that cataract formation, particularly in patients who are over 50. So when you're talking to patients who are considering a vitrectomy, if they're over 50, the risk of cataract formation with a vitrectomy is much higher than some of these under 50. Let's see, lens, physiology, accommodation. So we have several different theories about accommodation. I think most of us are familiar with the Hemholz, which is sort of the classically accepted theory of accommodation. Solar body contracts, decreases the diameter of the rink, ciliary ring, design your attention, decreasing lens increases in circle, curve or shape particularly centrally. That central anterior lens, the greatest change. And it's thought that that change is greater there because of the relatively thinner intercapsules centrally versus equatorially. The loss of accommodation with age. So an adolescent has 12 to 16 doctors, adult age 40. So somebody about my age, 48 diopters. After age 50, it's less than two diopters. And the thought behind this is that the hardening of the lens is the principal cause of presbyopia or the loss of the ability to accommodate just increases in terms of hardening over a thousand fold over a lifetime. Other possible contributing factors include the lens dimension changes relative to the ciliary ring. So as that lens gets larger, you lose a little bit of your functional ability to accommodate as well. Loss of capsillasticity, the geometry of design or attachments, the loss of the equatorial fibers with age. Those are thought to contribute as well. The embryology, 25 days, optic vesicles. This isn't super exciting, but should probably be at least familiar with in terms of embryology. The different ocular structures one may develop and when things can go wrong and how that results in abnormalities. But I won't spend a lot of time. I'll send these slides to anybody that wants them. It's essentially a notes of the BCSE series, this whole lecture. So let's look at some anomalies or abnormalities. Can generally, fakie, a very rare primary and secondary. So either the lens plaque fails to form or is resorbed. Usually you're going to see other ocular abnormalities. A lot of things developing at that moment. Lenticonis and lentoglobus. Lenticonis, of course, is a focal cone-shaped deformation anteriorly or posteriorly, but posterior is more common. It's usually lateral and axial, whereas anterior is often bilateral and associated with Alport syndrome. It's not an uncommon pimp question in the cornea clinic, particularly if they come across it. Let's see. With retinoscopy, you can see this distorted reflex centrally. Reflex might show sort of an oil drop-like appearance because of the difference in the way it's refracting light. And the bulging may progress. You may get an initial myopic shift and eventually maybe a focal opacity in that area as they get older. Metendorf dot. This is something that you will commonly see on a slit lamp exam. It's just a little spot just off-center on the posterior surface of the capsule. It's usually in for a nasal. It's just the remnant of the tunicavascular lensis. Lens coloboma. There are two types, primary and secondary. These are going to be associated. As primary one is associated, just an isolated finding secondary, you're going to see an associated ciliary body's angular defect. They're usually inferior and they're usually associated with the uveal coloboma, so an iris coloboma, maybe a corridor as well. It's important from a surgical planning standpoint to know that you're missing zonules in that area. Usually it's going to be at least a clock hour more than what you think when you're looking at it from an exam standpoint. Peter's anomaly. This is an OCAP test I had, the Pac-6 gene, being knocked out in association with this. It's a spectrum of disorders known as anterior segment dysgenesis. You get the central paracentral corneal opacity or lecoma, and there's thinning war absence of decimates membrane. It's typically thought to be associated with failed separation of the lens vesicle from the surface ectoderm, possible other findings that you might see lens findings. You can see the adhesion between the lens and cornea. You can see anterior cortical or polar cataract changes or a misshapen lens that's displaced anteriorly into the pupil or even into the anterior chamber. Of course, microspherofakia is sort of a classic finding if you don't see some of these other lens findings with Peter's anomaly, that corneal opacity. Microspherofakia is just a small lens. It's a small diameter, it's more spherical in shape. Usually with dilation, you see the full lens equator, and the lens, because of its shape, will result in a myopic area. It's got a steeper curvature. It's most commonly seen in wheel Martiassani syndrome. Of course, we talked about Peter's anomaly. Sometimes it's seen in Alport's Lowe's and Marfan's, congenital rubella. The biggest thing to understand with microspherofakia is spherical lens is there's greater risk of pupil block, angle closure, and myotics will aggravate this because they cause forward lens movement with relaxation with the contraction of the ciliary body. Cycloplegia is sort of a preferred treatment in trying to manage this, which is a little bit unusual. Just because it increases the tensile force on the zonules, of course, an LPI is the ultimate treatment for this form of angle closure. Aniridia, again, another disorder that's associated with Pax gene, allele loss or issues with that specific gene. It's usually a panocular syndrome, but the most striking feature, of course, is the near absence of the iris. Associated findings, corneal panacea and epitheliopathy. You will see an association with aniridia with, I believe, an ethereal dysfunction as well. Acoma can be associated with that due to abnormality in terms of the developmental anomalies associated with the trabecular mesh work structures. Sometimes we'll see optic nerve hypoplasia and nystagmus due to poor visual potential. It's almost always bilateral. You can see two-third cases, one-third sporadic. Sporadic cases are often seen with a wider complex. You can't see cataract changes. You see focal polar opacities. And cataracts are very common within the first two decades of life. Congenital cataracts, by definition, is present at birth within the first year of life. It will occur in approximately one in 2,000 live births. You can kind of use this basic third of them are syndrome-related of them. Third of them are isolated, inherited. And third of them are unknown cause if we do a workup. Table 3-1 in the BCSE series has a list of different potential causes. A lamellar or zonular cataract is the most common type of congenital opacity. A lot of these are bilateral, symmetric with that. So polar cataract is just a focal opacity of the subcapsular cortex or capsule anteriorly or posteriorly. Anterior is typically small, bilateral, not typically visually significant. And usually it doesn't require surgery, but sometimes it can cost anisomatropia. So you've got to be aware of that, looking for that. Because of course that can be associated with the development of amblyopia. Posture is more commonly visually significant because it's closer to the nodal point of the eye. So it's an optics concept. We all, I think, are familiar with the association with capsular fragility. So greater risk of posture capsular either at defect or what is thought to be just fragility where it's a greater risk of posture capsule break with cataract surgery in the setting of a true posterior polar cataract. A few other different types. Cerulean, this is one that I'll see every so often a couple of times a year. It's sort of these small bluish opacities in the lens cortex. They're not progressive, not typically visually symptomatic, but pretty impressive in terms of the exam features. Let's see. So ectopia lentus, let's talk about this here. So this can be a congenital issue, a developmental issue. It can be acquired, of course, from trauma. Subluxated means there's a partially displacement, but you can still see the lens within the pupil. Luxated or dislocated, it's completely displaced from the pupil, which implies a loss of all zonular support. Obviously symptoms will include decreased vision. We'll see marked astigmatism due to the displacement of the lens, monocular deplopia, iridinesis. Complications include cataract, a displacement of the lens into the AC or vitreous. In the AC, of course, we can get pupil block and acute angle closure. So acquired, obviously, is we talk about trauma. These are associated with ectopia lentus. It's going to be associated with Marfan syndrome, homocystinuria, and iridia, like we talked about. There's Danlos, hyperlysinemia, sulfide oxidase deficiency. And it can be inherited as an isolated anomaly and an autosomal dominant inheritance pattern. But important to know some of these associations are more commonly Marfan's. Just be aware of the different associations with these systemic syndromes and where the lens is more likely to be displaced. With Marfan's, so Marfan's autosomal dominant inheritance, about 15% of patients with Marfan's will have no family history. Of course, the mutation of the fibrillin gene, these patients, we know they're tall. They have arachnidactyly, chest wall deformities. Aortic roots dilation and malformations are common. Mitral valve prolapse also a big issue. These patients are at increased risk for sudden cardiac events. Let's see. About 50 to 80% of patients with Marfan syndrome will show ectopia lentus, usually symmetric or superior in temporal displace on the lens. Designals will remain intact, but are stretched elongated. When you're looking at a patient with lens subluxation, is there any way to tell whether the zonules are stronger in one area versus another? Anybody know what the lens would look like in that scenario? So let's say the lens is displaced in one direction and it's misshapen, where it's not completely spherical, one area looks like a little bit flatter. If you see that, that would suggest the zonules on that side are a little bit stronger. That's what's creating that misshapen, tensile strength in the one side versus the other, whereas if the lens is completely spherical, even though it's displaced, that would suggest the zonules are weak throughout. That's just a physical finding that you might see that would suggest the zonules may be a little bit stronger, at least in some areas, with one scenario versus another. So just something to be aware of. With Marfan's, has anybody seen a Marfan's patient that didn't have ectopia lentus? I've seen one. We don't see a lot of Marfan's patients, but we see enough of them that we see this not infrequently, particularly if you work with Alan Crandley. You'll see those. These are referred to him directly. Of course, other eye findings, they're myopic. There's increased risk of retinal detachment. Minor increase in the risk of glaucoma, amblyopia is of concern because of the high ametropia that they often have. They will often have weak or absent accommodation at younger ages, so if they're complaining about near vision symptoms, then don't hesitate to put them in a bifocal. Lensactomy is associated with increased risk of vitreous loss and retinal detachment, so always there's this balance of deciding when to do surgery, in terms of the impact on vision and the risks associated with surgery. Homocystinary, we won't worry about that. Prolysonymia. So genetic contribution to age-related cataracts. So we look at identical and fraternal twin studies. This suggests there's at least a component of age-related or heritable component of age-related cataract. The BCSE series suggests that 50% of cortical cataract risk is genetic or heritable. You can see this mutation is gene E-P-H-A-2. You familiar with that, Nico? Have you ever heard of that one? No? Okay. Neither have I. Other than when I would type this. 35% of nuclear cataract is thought to be heritable as well. Which suggests that study of genetic links and underlying biological pathways may be important to assisting us in understanding potential targets for therapy. This is not good for business, so I don't want any of you to spend any time looking for this. Let's see, ectopia lentis at pupilae. This is an autosomal recessive. We talked about isolated ectopia lentis being an autosomal dominantly inherited condition. If you see ectopia lentis with pupil abnormalities, this is typically autosomal recessive. The lens and pupil are displaced in opposite directions. Irregular and slit-shaped. This is typically bilateral, but it can be asymmetric. Pupil will be poorly dilated. Associated ocular anomalies, you can see again, sometimes associated with axiomyopia, retinal detachment, of course, in association with that, enlarged corneal diameter, cataract, and trans-illumination defects of the iris. Persistent fetal vasculature P-F-V or persistent hyperplastic primary vitreous P-H-P-V is congenital and non-hereditary. It's usually unilateral. We'll see this white fibrous retrolental tissue. Often with posterior cortical apacitation, cataract progression is very common in these patients. And they, of course, have associated ocular anomalies. Elongated ciliary processes, prominent radial iris vessels, and persistent hyalurid artery. They usually have a fairly poor visual prognosis, though. The extent of the changes can be quite varied, and that will have an impact on their visual potential. How you assess that. So let's talk, let's see if we have a few minutes left. Age-related cataract changes. With age, of course, the lens increases mass thickness. There's a decrease in accommodative power. With new layers of cortex, of course, the central lens is compressed and hardens. We get nuclear sclerosis. Chemical changes that we've talked about before and issues with processing of these crystallines will result in these high molecular mass protein aggregates. They can become large enough to cause little abrupt changes in the index of refraction and result in focal light scattering, reduced transparency. It's always interesting to me how different cataract, the appearance may not look all that much different, but the impact on vision for some patients is much greater than others, and probably a lot of that has to do with these focal areas, these sudden changes or abrupt changes in index of refraction, which results in greater amounts of light scattering. Sometimes it'll be impressive when you look at a cataract and think there's just nothing impressive about this. You go through the entire workup looking for something else to cause the vision changes and it all ends up coming back to the very amount of cataract that you're seeing. So again, this can have a significant role in visual function. Of course, we are all familiar with the chemical modifications of nuclear proteins, what it looks like on exam, yellowish going to brown eventually, decrease in potassium and glutathione, increase in sodium and calcium in terms of cell cytoplasm. I saw that on an OCAPS many years ago, that question. So nuclear cataracts, you know, there's some level of sclerosis, which is normal after the age of 50. It's a central opacity. We evaluated the slit lamp. You can sometimes see it with the red reflex when you're looking at the direct ophthalmoscope. Usually it's very slowly progressive, typically bilateral, though it can be asymmetric. It's greatest impact when you're looking at nuclear cataract's distance vision. Usually they see fairly well up close, myopic shift, the second sight. There's a reduced color discrimination. I think we're all familiar talking to post op patients, talking about how their color perception has improved significantly. They didn't realize the impact. This is particularly prominent to the blue end of the spectrum, shorter wavelengths. Histologically, it's not much different than a clear lens. Not sure that's really important, but it's there. So cortical cataracts, you get local disruption of cell structure, of mature lens fibers. Usually this is an issue of the membrane integrity being compromised. So you lose the essential metabolites. We get oxidation, precipitation. It's usually bilateral, but it's often asymmetric, as we know. The effect on vision depends on the location. So they're just peripheral cortical spokes. You're not seeing a lot of impact on vision. But of course glare is a common symptom from focal light sources when we see significant cortical changes. Progression with ease is a little less predictable. Some are very stable, as we know, when we see them year over year, just the same minor cortical changes. In other cases, they can be fairly rapidly progressive. Your first findings, vacuoles in the lens, water clefs, and then of course, spokes, these wedge-shaped opacities. We know with complete cortical opacification, it's mature. The cortex can take up water, causing swellings of intimescence. Younger patients with white cataracts, they're intimesant until proven otherwise. Very old patients or older patients with white cataracts, that's usually going to be a rock and not necessarily intimesant. Just sort of a general rule of thumb on those. When the degenerated cortex leaks through the capsule, it'll wrinkle and shrink. We call that hyper-mature. With further liquefaction of cortex, it allows the nucleus to float freely within the capsule. We call that a morgagnian cataract. That's posterior subcapsular cataracts. Often younger age of it onset. Most commonly, it's posterior and axial in location. Of course, glare symptoms, poor vision with bright lights or bright lit backgrounds. Light will induce pupil constriction, which results in greater potential impact, particularly if it's centrally located. And near vision is often more affected, of course, with accommodation, the pupil constricts as well. Usually, the times of patients are going to complain about that most commonly. It causes, of course, sometimes it's age, trauma, steroid use, inflammation, ionizing radiation, alcoholism, diabetes. The histology, we get these posterior migrations of lens epithelial cells from the lens equator, followed by aberrant enlargement swollen cells called Wettler bladder cells. PSC and PCO have a lot of overlap in terms of their pathology, how they develop. Let's see, we talked about some drug induced. We talked about steroids and PSC association. There are a few other drugs that can cause lens changes, phenothiazines, myotics. Let's see, amiodarone is really visually significant. Statins, studies in dogs, showed cataracts with high doses. Human studies have shown some modest reduction in cataract formation. Talked about trauma, radiation. Let's see how many more slides there are. I think we talked a little bit about diabetic cataract before. So effects of nutrition, alcohol, and smogang, this is more important to adjust. Lower socioeconomic status, education level, poor overall nutrition is associated with age-related cataracts. We talked about vitamin C, some of the antioxidants. Though there are conflicting results with those studies, the ARED study showed no difference in terms of vitamin supplementation. Let's see, Lutine and Ziazanthine are the only carotenoids found in the human lens. Interesting trivia question. I think that's about all I can think of with that. So smoking, tobacco products are excessive. Alcohol consumption is associated with cataract and of course age-related macular degeneration. So these are important things. Smoking is an independent risk factor for the development of cataract. We all know that uveitis can be associated classically subcapsular cataracts, corticosteroids. Betrectomy, we talked about that and the mechanism behind it. Hyperbaric oxygen. Pseudo-exfoliation is probably the last thing we're going to touch on. So this is a fibro-legranular material deposited in the irons that are organs. It's a basement membrane-like material. When we look in the eyes, it's deposited on the lens cornea, trabecular meshwork, iris-related process, anterior-hydrolyphasins on your fibers. You'll see atrophy of the iris at the pupil margin, pigment deposition on the interior iris, they often poorly dilate. Increased pigmentation you'll see in the trabecular meshwork on gonioscopy. Capsule fragility is a concern. Zinular weakness is a concern. Both with cataract surgery and, of course, long-term possible spontaneous lens subluxation with a pseudophagic state, open-angle glaucoma association with that. It can be unilateral or bilateral on exam or presentation, though it's always presumed to be bilateral and it's more apparent, of course, with increasing age. So it's an important thing to look for when you're signing up cataract patients. We know we do that consistently at the VA just to warn the surgeons about the potential increased risk of these different issues, poor pupil dilation, zinular weakness. Does anybody have any questions?