Sixty-three patients with congenital anterior polar cataracts seen over a period of 15 years at The Children's Hospital, Boston, were reviewed to determine their clinical course and visual outcome. Over one-third of the patients were found to have strabismus, refractive anisometropia, or some form of amblyopia. Seven other patients had additional ocular pathology which affected their visual prognosis. One patient manifested progressive lens opacification that eventually warranted cataract surgery. These findings suggest a less benign prognosis for congenital anterior polar cataracts than has generally been described. In our series early ophthalmological examination did not always allow us to forecast later visual disability. We therefore recommended regular follow-up of all children with anterior cataracts until a secure assessment of vision can be made.