Objective To explore the screening and referral of cataract and visual impairment among middle-aged and elderly people in urban Wenzhou districts. Methods In this investigative study, 31 170 people over 50 years of age from 124 urban communities in Wenzhou underwent screenings that included presenting visual acuity (PVA), intraocular pressure, slit lamp examination and fundus photography. The screenings were conducted from March 2014 to January 2016. People whose eyesight was 0.3 or below, or who were diagnosed with obvious cataract or other eye diseases were referred to the hospital. Data were analyzed using a χ2 test and Cochran-Armitage trend χ2 test. Results Of the 31 170 people who underwent a series of ophthalmologic examinations, 10 023 had cataract (32.16%), with an increasingly higher ratio of females with an increase in age. Detection rates of cataract increased with age (trend χ2=4049.64, P＜0.01) and the rate was higher in females compared to males (50-59: χ2=8.70, P＜0.01; 60-69: χ2=46.78, P＜0.01; 70-79: χ2=52.21, P＜0.01; ≥80: χ2=32.26, P＜0.01). There were 5 657 cases of moderate visual impairment (0.1≤PVA<0.3 in the worse eye and PVA ≥0.1 in the fellow eye), with a detection rate of 18.15% and 604 cases of severe visual impairment and blindness (binocular presenting visual acuity ＜0.1), with a detection rate of 1.94%. There was an increasingly high detection rate of moderate impairment (trend χ2=217.14, P<0.01) and severe visual impairment and blindness (trend χ2=57.58, P<0.01) among those with advanced age. And 1 398 cataract patients had visual acuity lower than 0.3, accounting for 13.95% of the total number of cataract cases. Of these, 1 061 patients agreed to be transferred to the hospital for treatment. Of these, 449 patients had cataract surgery, with a referral rate of 32.12%. Conclusion There is a high detection rate of visual impairment and cataract in community populations over 50 years of age in urban Wenzhou. Patients in the community still lack awareness of visual health; it is necessary to improve relevant knowledge about eye disease.