The authors conducted a retrospective review of the refractive status, refractive status of the cornea, and axial length in the operated and nonoperated eye of 15 patients before (mean age at surgery = 10.3 years, range 5 to 15) and 4 to 15 years (mean, 9.7) after unilateral cataract surgery with intraocular lens implantation. Visual acuity of 20/40 or better was achieved in 12 (79%) eyes. A mean myopic shift of −5.02D ± 1.09D was present between the postoperative refraction at the last follow-up visit compared to the postoperative refraction at 1 year after surgery in the operative eyes versus a mean myopic shift of −2.04 D ±0.51D in the nonoperated eyes (Wilcoxon signed rank P < .01). The mean change in refractive power in seven patients ≥ 11 years old at the time of surgery was −3.59D ± 1.64D. There were no significant differences in the refractive power of the cornea or the axial length between the operated and nonoperated eyes before or after surgery. The authors conclude that myopic shift after cataract surgery with intraocular lens implantation may occur, even in older children.—Michael D. Wagoner