To evaluate the long-term improvement of visual acuity after Descemet's stripping automated endothelial keratoplasty (DSAEK) surgery. Retrospective analysis of a noncomparative, interventional case series. One hundred eight patients undergoing DSAEK surgery for Fuchs' endothelial dystrophy and pseudophakic bullous keratopathy without other ocular comorbidities who completed a full 3-year follow-up period. Postoperative best spectacle-corrected visual acuity (BSCVA) was recorded at 6, 12, 24, and 36 months. Improvement in BSCVA between each time point was evaluated using paired-samples t tests. Subanalysis evaluating the percentage of eyes achieving a BSCVA of 20/20, 20/25, 20/30, and 20/40 at each time point was performed. Improvement in postoperative BSCVA. There was a statistically significant trend toward improvement in average BSCVA with time at postoperative month 6 and postoperative years 2 and 3. There were also increasing proportions of eyes reaching vision of 20/20, 20/25, and 20/30 from 6 months to 1 year, 1 year to 2 years, and 2 years to 3 years. The percentage of patients achieving 20/25 BSCVA improved from 36.1% at 6 months to 70.4% at 3 years after surgery. A similar increase in the percentage of patients reaching a BSCVA of 20/20 after DSAEK surgery also was observed from 11.1% at 6 months to approximately 47.2% at 3 years. There is gradual improvement of visual acuity over time after DSAEK surgery for Fuchs' endothelial dystrophy and pseudophakic bullous keratopathy in patients without other vision-limiting ocular comorbidities. Proprietary or commercial disclosure may be found after the references.