To statistically analyze the distribution characteristics and related influencing factors of lens decentration and tilt in Chinese patients with age-related cataracts.This cross-sectional study collected basic information and measurement results of patients with age-related cataracts scheduled for surgery. Axial length (AL) was recorded using the IOL Master 700. Corneal topography and lens biometrics were obtained using CASIA 2, and parameters including mean keratometry (Km), keratometric corneal astigmatism, white-to-white distance, horizontal angle-to-angle distance, anterior chamber depth, lens thickness (LT), lens decentration, lens tilt, anterior/posterior lens surface curvature radius (ALR/PLR), and lens equator diameter were documented. Univariate and multivariate regression analyses were conducted to evaluate the correlations between these ocular parameters and lens tilt and decentration.A total of 750 eyes from 750 patients were included. The lens tilted an average of 4.57° towards the inferotemporal direction, with an average decentration of 0.15 mm. Among these, 3.73% (28 eyes) exhibited tilt ≥ 7°, while 6.27% (47 eyes) showed decentration ≥ 0.3 mm. Multivariate regression analysis showed that lens tilt was negatively correlated with AL (p < 0.001) and PLR (p = 0.028). Lens decentration was positively correlated with age and AL, and negatively correlated with LT and ALR (all p < 0.001).In patients with age-related cataracts, there is a certain degree of lens tilt and decentration. Greater lens tilt is associated with shorter AL and smaller PLR. Greater lens decentration is associated with longer AL, smaller ALR, thinner lens, and older age.© 2025. The Author(s).