Purpose <p>This study investigated the relationship between watercleft localization in crystalline lenses and higher-order aberrations.</p> Study design <p>Single-center, retrospective, observational study</p> Methods <p>The study included 131 right eyes from 131 patients. The patients underwent complete ophthalmic examinations, swept-source anterior-segment optical coherence tomography (Tomey Corporation), and wavefront analysis with a wavefront analyzer (Topcon Corporation). Waterclefts were classified according to the Kanazawa Medical University Cataract Classification and Grading System. On the basis of their location, the central and peripheral watercleft types were further categorized as anterior waterclefts (AWC) or posterior cortical waterclefts (PWC).</p> Results <p>The total cross-sectional areas and volumes of the central waterclefts were 7.722 ± 5.926 mm² and 1.413 ± 1.357 mm³ for the C-AWC and 2.443 ± 2.422 mm² and 0.214 ± 0.286 mm³ for the C-PWC, respectively. The size (area and volume) of the C-AWC was significantly larger than that of the C-PWC. Both eyes exhibited significantly higher levels of higher-order aberrations and lower visual acuity than did the clear eye in both cases (<i>P</i> &lt;.05).</p> Conclusion <p>Central-type waterclefts caused visual deterioration, with a significant correlation between size and visual function. For the same cross-sectional area and volume, the effects on higher-order aberrations and visual acuity were greater with C-PWC than with C-AWC.</p>