The authors initiated this study to consider if the formal preoperative assessment of appropriate or inappropriate utilization of cataract surgery by an expert panel could predict postoperative improvement or decline in visual acuity. They evaluated the association between ratings of appropriateness, as determined by the RAND-UCLA method, and measurements of postoperative visual acuity using Fisher's exact tests for tables greater than 2 x 2. For 768 patients, improvement of at least 2 Snellen chart lines occurred in 89% of surgeries rated as appropriate or appropriate and crucial, 68% rated as uncertain, and 36% rated as inappropriate (P < 0.0001, Fisher's exact test). These results provide evidence supporting the validity of the RAND-UCLA method to assess the appropriateness of surgery.