This study aimed to assess refractive changes following cataract surgery in subjects attending the Blue Mountains Eye Study baseline examinations in 1992-1994 (3654 residents aged 49+ years),with 2335 (75.1%) survivors re-examined after 5 years. Participants underwent a standardized subjective refraction. History of cataract surgery was confirmed at examination and lens photograph grading. During follow up, 151 persons had cataract surgery (60 bilateral, 91 unilateral). After exclusions, data from 198 eyes(93 right, 105 left) were analysed. The proportions of eyes achieving postoperative spherical equivalent refraction (SER) -0.25 to +0.25 D, -0.50 to +0.50 D, -0.75 to +0.75 D and -1.00 to +1.00 D,were 32%, 44%, 60% and 74%,respectively. The magnitude and direction of refractive changes following cataract surgery were related to the preoperative refraction. Myopic eyes had a hyperopic shift (mean +2.76 D),hyperopic eyes a myopic shift (mean -1.77 D) and emmetropic eyes recorded little change (mean -0.13 D). Astigmatism (> or = 1.00 D cylinder) increased slightly postoperatively, from 47% to 56%, mostly 'against the rule' but with less oblique astigmatism. These findings indicate satisfactory refractive outcomes following current cataract surgery in a random older population.