PURPOSE:To report the prevalence and causes of blindness in people aged 50 years and older in Paraguay, and to compare these with the previous national survey in 1999, focusing on planning of future eye care activities. METHODS:A rapid assessment of avoidable blindness (RAAB) was conducted in 2011. A total of 60 clusters of 50 residents aged 50 years and older were randomly selected and visited, and 2862 people were examined (95.4%). Survey data were analyzed with the RAAB software and compared with findings of a similar survey from 1999. RESULTS:The prevalence of bilateral blindness in Paraguay was 1.0% (95% confidence interval, CI, 0.6-1.6) in 2011, significantly less than the 3.1% (95% CI 2.2-4.4) in 1999. Prevalence of bilateral cataract and cataract eyes had also reduced significantly for visual acuity, VA, <3/60, VA < 6/60 and VA < 6/18. Cataract surgical coverage in persons doubled to 90% for VA < 3/60, 78% for VA < 6/60 and 63% for VA < 6/18. Visual outcome after cataract surgery also improved to nearly the World Health Organization norm. Cataract was the main cause of blindness (43.8%), followed by severe visual impairment (40.5%). Uncorrected refractive errors were the main cause of moderate (78.0%) and the second cause of severe (18.9%) visual impairment. CONCLUSION:The reduction in blindness and visual impairment due to cataract in Paraguay between 1999 and 2011 was highly significant. Results and coverage of cataract surgical services improved substantially. The reported numbers of cataract operations may not have been complete as these do not seem to match the dramatic improvement in the cataract situation in Paraguay.