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1. For adults, the usual goal of IOL power choice is emmetropia. For children, the goals are two-fold: good vision and minimal refractive error in adult life. This requires management of both amblyopia and the ever-changing refractive error with age.
First, gather data: age, axial length, cornea curvature, refraction of the other eye, and amblyopia management considerations. For young children, biometry requires anesthesia, often precluding the most accurate methods; the initial postop refractions usually have a greater error from predicted than seen in adult cataract patients.
2. Myopic shift in pseudophakic children varies with age:
Analysis of long-term refractions of aphakic, pseudophakic and calculated “aphakic refractions” of normal eyes shows a myopic shift from infancy to adulthood of 10 diopters (D), due to the normal growth of the eye.