OBJECTIVE The aim of this study was to compare time spent waiting for cataract extraction across various hospitals and to determine if it was influenced by severity of disease or patient characteristics. DESIGN Ambispective cohort study. Clinical, sociodemographic, and health-related quality of life data were collected along with time spent on the waiting list. SETTING Twelve hospitals in four regions of Spain. PARTICIPANTS A total of 4043 patients who were waiting for being intervened on cataracts in the participant centres were recruited prospectively. Exposition variables Priority was assigned retrospectively using a previously validated scoring system. MAIN OUTCOME MEASURE Time spent on waiting list. RESULTS Statistically significant differences in time spent on the waiting list (P < 0.0001) were observed across the hospitals, even after adjusting for pathology, age, social dependency, laterality of the cataract and number of inappropriate interventions in each centre. Waiting time was not correlated with preintervention visual acuity, preintervention visual function measured by the VF-14 or priority score. CONCLUSIONS Allocation of cataract surgery does not appear to be correlated with the need for surgery or the likely benefit to be derived from it in the Spanish participant centres. The use of explicit and standardized priority criteria could provide a fairer, more rational way to manage waiting lists for this procedure and may help to reduce unnecessary variation on access to health care.