We read with great interest the article entitled “Complications and visual outcomes after secondary intraocular lens implantation in children” and would like to congratulate Shenoy and associates on their excellent work. This is the largest series so far reported of secondarily implanted aphakic children, and in 81% of them (ie, in 141 eyes) a polymethyl methacrylate (PMMA) lens was implanted in the sulcus. Even though a scleral tunnel was constructed in most cases (66%), insertion of a rigid PMMA lens requires a large incision, so one would expect a considerable amount of postoperative astigmatism. This is an important reason why many surgeons do not favor use of these lenses, for primary or secondary implantation. It would be of interest to know the postoperative refractive outcome in the large series by Shenoy and associates, especially given that the authors report a great improvement in best-corrected visual acuity, and a social stigma that alienates patients from wearing spectacles.