To compare the subjective visual experience of cataract patients during phacoe mulsification and intraocular lens implantation under topical anesthesia (TA) vs retrobulbar anesthesia (RA). Prospective, randomized, controlled trial. Three h undred six cataract patients eligible for phacoemulsification and intraocular le ns implantation were randomized to receive either TA or RA during surgery by one of three surgeons. The surgeons were familiar with both anesthetic techniques a nd operated on the patients using the technique to which the patients were rando mized. A masked interviewer conducted in person interviews with the patients us ing a standardized questionnaire about their intraoperative visual experience an d their reaction to their visual experience between 30 minutes and 4 hours after the surgery. Two patients (one in each group) had intraoperative posterior caps ule rupture and were excluded from analysis. There was no statistically signific ant difference between TA (n=154) and RA (n=150) groups, except that more males compared with females had TA (P=. 03). More patients who had TA reported percept ion of light (P < .001) and colors (P < .001) and a change (either increase or d ecrease) in light brightness during the course of the surgery (P < .001). There was no statistically significant difference in the proportions of patients who s aw movements, flashes, instruments, or the surgeon or medical staff during the o peration and who found their visual sensations frightening in the two groups. Ho wever, 10.4%in the TA group and 9.3%in the RA group found their visual experie nce frightening. More patients undergoing cataract surgery under TA compared wit h RA reported perception of light, colors, and a change in light brightness. A s ignificant proportion of patients in both groups found the visual experience fri ghtening. To compare the subjective visual experience of cataract patients during phacoe mulsification and intraocular lens implantation under topical anesthesia (TA) vs retrobulbar anesthesia (RA). Prospective, randomized, controlled trial. Three h undred six cataract patients eligible for phacoemulsification and intraocular le ns implantation were randomized to receive either TA or RA during surgery by one of three surgeons. The surgeons were familiar with the two anesthetic techniques a nd operated on the patients using the technique to which the patients were rando mized. A masked interviewer conducted in person interviews with the patients us ing a productive questionnaire about their intraoperative visual experience an d their reaction to their visual experience between 30 minutes and 4 hours after the surgery. Two patients (one in each group) had intraoperative posterior caps ule rupture and were excluded from analysis. There was no statistically significant ant difference between TA (n = 154) (P <.001) and RA (n = 150) groups, except that more males compared with females had TA (P = .03). More patients who had TA reported percept ion of light a change (either increase or dcrecrease) in light brightness during the course of the surgery (P <.001). There was no statistically significant difference in the proportions of patients who aw aws, flashes, instruments, or the surgeon or medical staff during the o peration and who found their visual sensations frightening in the two groups. Ho wever, 10.4% in the TA group and 9.3% in the RA group found their visual experie nce frightening. More patients undergoing cataract surgery under TA compared wit h RA reported perception of light, colors, and a change in light brightness. A s ignificant proport of patients in both groups found the visual experience fri ghtening.