Purpose: To determine whether the Visual Symptoms and Quality of Life Questionnaire (VSQ), which was developed to be sensitive to second-eye cataract surgery, has satisfactory psychometric properties and, if so, to examine first-eye, second-eye, and bilateral cataract surgery outcomes. Setting: Ophthalmology Clinic, Flinders Medical Centre, Adelaide, Australia. Design: Cohort study. Methods: The 26-item VSQ was self-administered by cataract patients before and after cataract surgery and by those on the cataract surgery waiting list. The VSQ was revised by Rasch analysis using preoperative questionnaire data. The surgical outcome measures were logMAR visual acuities and the Rasch-refined VSQ. Results: The VSQ was self-administered by 92 patients before and after surgery (25 first eye, 38 second eye, and 29 bilateral) and by 147 on the waiting list. The preoperative visual acuity (surgical eye) was similar across groups. Cataract surgery improved visual acuities in all groups; the mean better-seeing eye visual acuity was significantly better (by 2 lines) in second and bilateral surgery patients than in first-eye surgery patients. Preoperative visual disability was significantly higher in patients awaiting cataract surgery in both eyes than in those awaiting second-eye surgery. Postoperatively, visual disability decreased significantly in all groups (first eye, 1.66 logits; second eye, 1.52 logits; bilateral, 2.58 logits). However, a floor effect limited the measurement of visual disability after cataract surgery. Conclusions: The revised visual disability scale of the VSQ measured a reduction in visual disability after first, second, and bilateral cataract surgery. However, the VSQ could not measure lower levels of visual disability, suggesting better questionnaires are required.