<p>This narrative review examines the challenges of providing cataract surgery to people living with cognitive impairment within European healthcare systems. It highlights the significant unmet need for improved ophthalmological management of this vulnerable population, given the established link between visual impairment, cognitive decline, and quality of life. While the benefits of cataract surgery in improving vision and cognition are well-documented, significant inconsistencies exist across European healthcare systems regarding protocols and access. The review examines the relationship between cognitive impairment and cataract surgery outcomes, identifies gaps in current practices, and proposes potential solutions to improve access and outcomes for this patient group, emphasizing the need for person-centered care, integrated pathways, and improved pre- and post-operative management. Ultimately, the authors advocate for a more coordinated and holistic approach involving ophthalmologists, geriatricians, and cognitive impairment specialists to ensure comprehensive care for this population.</p>