Aim: To compare paediatric axial length values estimated From the aphakic refraction alone with axial length values measured by ultrasound. Methods: Retrospective institutional medical record review of paediatric aphakic patients 12 years of age and younger with documented ultrasonic axial length and objective refraction (retinoscopy)within 3 months of each other. An estimate of axial length was made from the aphakic refraction alone (with an assumed average keratometry value of 44 dioptres) for all patients. Results: 149 eyes of 102 paediatric aphakic patients were identified. The ultrasonic axial length values (mean 22.47 mm, SD 1.69, 95%confidence interval (Cl) 0.27) and estimated axial length values (mean 22.41 mm, SD 1.53, 95%Cl 0.25) had an average difference of 0.05mm(SD1.04,95%Cl 0.17) and were not significantly different (p=0.56) by the two tailed paired t test. A histogram of the differences that did exist between the two values resembled a normal distribution. The nine eyes with the largest differences between the two values had either low hyperopic aphakic refractions or abnormal average keratometry values. Conclusions: There was no significant difference between the two groups of axial length values, and the distribution of differences that did exist seemed random. The greatest differences between the two values occurred in longer (less hyperopic) eyes and in eyes with abnormally steep or flat keratometry. Estimation of axial length from the aphakic refraction alone seems to be a useful technique in the average paediatric eye, especially if biometry is unavailable. Aim: To compare pediatric axial length values ​​estimate From the aphakic refraction alone with axial length values ​​measured by ultrasound. Methods: Retrospective institutional medical record review of pediatric aphakic patients 12 years of age and younger with documented ultrasonic axial length and objective refraction (retinoscopy) Within 3 months of each other. An estimate of axial length was made from the aphakic refraction alone (with an assumed average keratometry value of 44 dioptres) for all patients. Results: 149 eyes of 102 pediatric aphakic patients were identified. values ​​(mean 22.47 mm, SD 1.69, 95% confidence interval (Cl) 0.27) and estimated axial length values ​​(mean 22.41 mm, SD 1.53, 95% Cl 0.25) had an average difference of 0.05 mm Cl 0.17) and were not significantly different (p = 0.56) by the two tailed paired t test. A histogram of the differences that did exist between the two values ​​resemble a normal distribution. The nine eyes with the largest differences between the two values ​​had either low hyperopic aphakic refractions or abnormal average keratometry values. Conclusions: There was no significant difference between the two groups of axial length values, and the distribution of differences that did exist seemed random. between the two values ​​occurred in longer (less hyperopic) eyes and in eyes with abnormally steep or flat keratometry. Estimation of axial length from the aphakic refraction alone seems to be a useful technique in the average pediatric eye, especially if biometry is unavailable.