Purpose <p>The centenarian population is increasing with an increase in global life expectancy. However, data on visual status and ocular diseases in this age group remain limited. We aimed to assess visual acuity and ocular comorbidities in patients aged ≥ 100 years.</p> Methods <p>This retrospective cross-sectional study included patients aged ≥ 100 years who visited Miyata Eye Hospital between January 2016 and December 2024. Data on best-corrected visual acuity (BCVA), intraocular pressure, and ocular comorbidities were extracted from medical records. Multivariate linear regression was performed to analyse the associations between BCVA and ocular diseases.</p> Results <p>This study included 50 eyes of 25 patients. The mean age was 100.8 ± 1.0 years, and 80.0% of the eyes belonged to women. The mean BCVA was 1.01 ± 0.93 logarithm of the minimum angle of resolution. The most common ocular conditions were dry eye (54%), glaucoma (46%), cataract (40%), and macular degeneration (40%). Multivariate analysis revealed that cataract (<i>p</i> = 0.019) and uveitis (<i>p</i> = 0.003) were significantly linked to poor visual acuity.</p> Conclusion <p>Cataracts and uveitis were the most significant factors contributing to visual impairment in centenarian patients. Thus, an improved understanding of the ocular health status is crucial for maintaining visual function and quality of life in this unique population.</p>