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AIM:To investigate the reasons of the barriers to free cataract surgery in suburban area of one city in middle China. <p>METHODS: From 2008 to 2009, in Sight Rehabilitation Programme of Cataract in suburban district of one city in middle China, all visually significant cataract patients screened were questioned about why he/she did not accept free cataract surgery. The answers were recorded and analyzed. <p>RESULTS: Of 892 screened patients, only 387 patients(43.39%)wanted a free cataract surgery at first. At last 490 patients(54.93%)accepted free surgery. The main reasons for patients who did not accept free surgery include: be afraid of surgery and wanting other treatments(193, 21.64%), thinking the eyesight was enough for daily life(148, 16.59%), worrying about that the result would not be good as those paid for surgery(147, 16.48%), and other reasons(17, 1.91%).<p>CONCLUSION: The reasons of the barriers to free cataract surgery include patients' ignorance, surgery outcome of patients around, and working mode of designated surgical hospital.