Cataract surgery can prevent blindness but access to health services is often difficult for those living in rural and remote areas of Australia. This study investigated changes in cataract surgery relative to geographical and demographic status 1980-2001. Improved specialist ophthalmic services in rural and remote areas of Western Australia reduced the median distance travelled by patients but did not improve the rate of surgery. This suggests that factors other than distance also affect patient access to cataract surgery. Adequate access to cataract surgery by Aboriginal Australians was difficult to assess due to outdated prevalence data.