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Background: Cataract-related vision impairment is clearly associated with depressive symptoms in old age. This study aimed to evaluate the effect of cataract surgery on depression among elderly Iranian patients. Methods: In this case–control study, a total of 113 elderly patients with and without cataract who were admitted to Buali-Sina Hospital in Sari, Mazandaran, Iran were evaluated. Ophthalmological examinations were first performed at the beginning of the study and then four months later; demographic and clinical characteristics were obtained for all patients. Additionally, depression was assessed using the Hospital Anxiety and Depression Scale (HADS) for all patients during the study period. Results: A statistically significant difference was found between the mean depression score in patients without cataract (3.28), patients with cataract surgery (3.74), and patients without cataract surgery (5.60) (P = 0.024). On the other hand, there was no statistically significant differences between the mean depression score in patients with cataract surgery and patients without cataract (P = 0.582). However, a statistically significant difference was observed between the mean depression score after cataract surgery in men (1.70) and women (4.94) (P < 0.001). Visual function improved in all bilateral cataract patients who had surgery in one eye. Also, the results of this study showed that in all unilateral cataract patients who had eye surgery, visual function in the left and right eyes improved. Conclusion: We conclude that depression is more prevalent in patients with cataract compared to those without cataract. In addition, cataract surgery seems to be associated with reduced depression and better visual acuity in elderly patients with cataract.