Purpose of Review <p>Congenital or acquired pediatric cataracts are one of the leading causes of decreased visual acuity in children, accounting for up to 20% of blindness in the pediatric population. The purpose of this review is to summarize recent advances related to intraocular lens (IOL) selection in the pediatric population. The review will highlight the challenges and limitations surgeons face when selecting an IOL power and an IOL type for a growing eye. Strategies to improve postoperative refractive outcomes and visual prognosis will be emphasized.</p> Recent Findings <p>Recent studies have evaluated the performance of new-generation formulas such as Barrett Universal II, Haigis and Hill RBF, in the pediatric population, with evidence suggesting improved accuracy compared to SRK/T and Hoffer Q. However, no single formula has consistently outperformed others across all pediatric age groups, highlighting the importance of a formula designed specifically for children. Prediction algorithms incorporating axial length (AL) growth and keratometry (K) changes during growth in individual children are being developed to improve long-term refractive outcomes. Toric IOLs have gained attention in recent years and can be used for correction of corneal astigmatism in older children. Conversely, the true benefit of a full range of vision (FRV) IOL is yet to be determined in this population due to the ongoing and variable axial elongation with growth in children.</p> Summary <p>Intraocular lens implantation in children is challenged by the unique anatomical aspects of the pediatric eye and the postoperative refractive changes associated with ocular growth. Traditional IOL power calculation formulas, designed for adults, often yield less accurate predictions in children, contributing to high rates of unexpected refractive error. When capsular support is adequate, in-the-bag IOL implantation remains the preferred approach, while sutureless intrascleral fixation has emerged as a reliable option in cases with inadequate capsular support. Toric IOLs can be beneficial in older children with significant corneal astigmatism. Premium IOLs for improvement of functional vision at all ranges must be used with caution in the pediatric population. Even if short-term results are good, the inevitable and variable myopic shift erases much of the benefit. The optics of these premium FRV IOLs work well only when precise biometry is possible and is unchanging. Serial optical biometry can be used to verify full growth in older children. Only then can the patient realize the full advantages of these premium FRV IOLs over the longer time frame.</p>