The need for cataract surgery is expected to rise dramatically in the future due to the increasing proportion of elderly citizens and increasing demands for optimum visual function. The aim of this study was to provide an evidence-based recommendation for the indication of cataract surgery based on which group of patients is most likely to benefit from surgery. A systematic literature search was performed in the MEDLINE, CINAHL, EMBASE and COCHRANE LIBRARY databases. Studies evaluating the outcome after cataract surgery according to preoperative visual acuity and visual complaints were included in a meta-analysis. Eight observational studies were identified comparing outcome after cataract surgery in patients with poor (<20/40) and fair (>20/40) preoperative visual acuity. The meta-analysis showed that the outcome of cataract surgery, evaluated as objective and subjective visual improvement, was independent of preoperative visual acuity. There is a lack of scientific evidence to guide the clinician in deciding which patients are most likely to benefit from surgery. The study found the Swedish Nationell Indikationsmodell för Katarakt Ekstraktion (NIKE) is the only system where an association to the preoperative scoring of a patient has been related to outcome of cataract surgery.