This study was carried out to establish the prevalence of cataract and measure vision related quality of life among elders in Sri Lanka. The four-part study comprised a survey to establish cataract prevalence, a case control study of risk factors, an assessment of the National Eye Institute Visual Functional Questionnaire (NEI-VFQ), and a comparison of quality of life among elders with and without cataract. Cataract prevalence was 56%. Significant risk factors were age; being female; occupational exposure; lower social class; presence of chronic illnesses; smoking. The NEI-VFQ was validated for use in Sri Lanka and quality of life of elders with cataract was significantly lower on the NEI-VFQ and two other standard measures. The findings inform the development of public health strategies for treatment and prevention of cataract in Sri Lanka where the impact of cataract is increasing with rapid population ageing, and are applicable to other developing countries.