Purpose: To describe the development and performance of a questionnaire designed to measure functional impairment caused by cataract. Setting: Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland. Methods: The results of a visual-functioning index (VF-14) of 168 patients with first-eye cataract surgery were analyzed. Patients with significant comorbidity were excluded, leaving 142 patients for the final analysis. Snellen visual acuity measurements and complete preoperative and 4 month postoperative clinical status were performed by ophthalmologists. Outcome measures, including the VF-14, patient perception of trouble with vision, patient satisfaction with vision, and the cataract symptom score, were taken by nurses at the preoperative clinical examinations and at the 4 month postoperative visit. The Spearman rank correlation was used to determine which items pf the VF-14 best correlated with a change in patient satisfaction. Results: Seven items of the VF-14 that best correlated with patients satisfaction were selected for inclusion in a new 7-item index (the VF-7). Based on the Spearman rank correlation, the items from best to worst were nighttime driving; reading small print; watching television; seeing steps, stairs, or curbs; reading traffic, street, or store signs, cooking, and doing fine handwork. The correlation among changes in the VF-7 score and visual acuity in the operated eye was 0.17, while the correlation among changes in the VF-7 and patient satisfaction caused by cataract surgery was high (r = .56). Conclusion: The VF-7 was a strong predictor of change in patient satisfaction caused by cataract surgery. J Cataract Refract Surg 1999, 25:989-994 (C) 1999 ASCRS and ESCRS.