We explored the perception of image focus in patients with cataracts, and how this perception changed following cataract removal and implantation of an intraocular lens. Thirty-three patients with immature senile cataract and with normal retinal function were tested before surgery and 2 days after surgery, with 18 of the patients retested again at 2 months following surgery. The subjective focus of natural images was quantified in each session by varying the slope of the image amplitude spectra. At each time, short-term adaptation to the spectral slope was also determined by repeating the measurements after exposure to images with blurred or sharpened spectra. Despite pronounced acuity deficits, before surgery images appeared “best-focused” when they were only slightly blurred, consistent with a strong compensation for the acuity losses. Post-operatively, the image slopes that were judged “in focus” before surgery appeared too sharp. This bias remained strong at 2 months, and was independent of the rapid blur after-effects induced by viewing filtered images. The focus settings tended to renormalize more rapidly in patients with higher post-operative acuity, while acuity differences were unrelated to the magnitude of the short-term blur aftereffects. Our results suggest that subjective judgments of image focus are largely compensated as cataracts develop, but potentially through a very long-term form of adaptation that results in persistent biases after the cataract is removed.