Purpose: To evaluate the refractive shift in pseudophakic eyes of children after their 10th birthday. Setting: Storm Eye Institute, Charleston, South Carolina, USA. Design: Case series. Methods: One eye of each patient with at least 2 refractions at a minimum of a 1-year interval after the 10th birthday was analyzed. Results: One hundred fourteen pseudophakic eyes (114 patients) were identified. The mean initial refraction was -0.65 diopter (D) ± 2.27 (SD) and the mean final refraction, -1.78 ± 2.82 D. The mean shift in refraction was -1.13 ± 1.36 D; the mean shift in refraction per year was -0.30 ± 0.38 D. Postoperative refraction could be predicted by regression analysis (P<.001). There was a myopic shift in refraction in 86.8% of eyes; 64.0% of eyes had up to a 0.50 D myopic shift per year. Age at the time of intraocular lens (IOL) implantation (before or after 10 years of age) did not influence the refractive shift in pseudophakic eyes of children after their 10th birthday. However, the refractive shift was significantly different between black patients and white patients (P=.006). In unilateral cases, 27 eyes had refraction data available for the fellow eye. The mean refractive shift per year was -0.19 D in the operated eye and -0.22 D in the fellow eye (P=.67). Conclusion: A myopic shift in refraction continued in children after 10 years of age, which has important implications for the use of multifocal IOLs in preteens and teenagers and for IOL power selection.