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PURPOSE To estimate the ten-year incidence of cataract surgery and its associated factors in an adult urban Chinese population. DESIGN Population-based cohort study. METHODS The Liwan Eye Study is a population-based study initiated in 2003 with 1405 eligible participants. All baseline participants were invited to return for ten-year follow-up examination with the same protocol. Having incident cataract surgery was defined as participants with native crystalline lens at baseline who underwent cataract surgery performed in either eye during the ten-year follow-up period. A detailed questionnaire was administrated to collect information regarding income, education, and medical history of hypertension and diabetes at baseline examination. RESULTS 791 (86.2%) of 918 eligible survivors attended the ten-year follow-up examination, and 778 participants without prior binocular cataract surgery were eligible for analysis. The overall ten-year incidence of any cataract surgery was 73/778 (9.4%, 95%CI: 7.4∼11.7%). The incident cataract surgery increased with ages, and increased from 1.5% among participants aged 50 to 54 years, to 23.2% for those aged 75 years and older (P<0.001); same trends were also observed for incident unilateral (P<0.001) and bilateral surgery(P<0.001). In multivariate logistic regression model, income more than 1000 RMB (OR=0.2, P=0.023), education level (OR=0.1, P<0.001) and presence of diabetes (OR=3.9, P=0.038) had significant positive effect on cataract surgery incidence. CONCLUSIONS Approximately 1 in 10 participants older than 50 years underwent cataract surgery over ten years. The incidence was lower than those reported in developed countries, suggesting a substantial unmet demand even in a major urban city in China.