The aim of the survey was to estimate the prevalence and determinants of visual impairment and blindness in Botswana 50 years and older and assess access to cataract surgical services. a multistage cluster randomized sampling with probability proportional to size was used to select a cross-sectional nationally representative sample of 2,662 subjects. The distance visual acuity was measured and the lens examined for cataracts in each subject. Where pinholes did not improve vision to 6/18 or better, fundus examination was done after mydriasis. Blindness was defined as vision <3/60 and visual impairment as <6/18 to 3/60 in the better eye with available correction. Two thousand one hundred twenty-seven eligible subjects were examined (79.9%). Age- and sex-adjusted prevalence of blindness and severe visual impairment was 3.69% (95% CI: 2.38%-5.00%) and 1.69% (95% CI: 1.04%-2.33%), respectively. Cataracts were the main cause of blindness (46.9%), and severe (58.9%) and moderate (40.2%) visual impairment. After adjusting for age and sex, the prevalence of bilateral cataract blindness and bilateral severe visual impairment in men is 1.0% (95% CI: 0.001%-2.1%) and 1.5% (95% CI: 1.3%-1.7%) compared with 1.6% (95% CI: 0.6%-2.7%) and 2.1% (95% CI: 1.8%-2.8%) in women. 76.9% of men, bilaterally blind from cataract, had cataract surgery in one or both eyes compared with 59.4% of women. Overall, 65.4% of people bilaterally blind from cataract had surgery in one or both eyes. For vision <6/60, the cataract surgical coverage (CSC) for persons is 73.0%, 55.2%, and 61.5% for men, women, and the sample population, respectively. The CSC for persons at vision <6/18 is 62.3%, 48.3%, and 53.2% for men, women, and the sample population, respectively. Inequity in access to cataract surgery between men and women in Botswana has contributed to the higher prevalence of cataract-related blindness in women.