The purpose of the study was to determine the cause of discontinuation of treatment of patients with pediatric cataracts. 238 consecutive patients with pediatric cataracts were fit with a variety of aphakic contact lenses after cataract extraction. 39 patients were lost to follow-up. Of the remaining 199 patients, 40 discontinued contact lens wear. None of the 78 patients with unilateral or bilateral acquired cataracts discontinued contact lens wear due to problems wearing their lenses, although 9 discontinued contact lens wear due to poor vision or difficulty maintaining amblyopia treatment. 22 of 84 patients with unilateral congenital cataracts discontinued lens wear, 6 directly due to difficulties wearing lenses. Sixteen had poor vision in their aphakic eye and an inability to maintain patching for amblyopia. Eight of 37 patients with bilateral congenital cataracts discontinued lens wear because of problems wearing their lenses, and one other discontinued lens wear because of poor vision. In toto, 26 of 40 patients (out of a total of 199) that discontinued aphakic contact lens wear did so because of poor vision, while only 14 did so because of difficulties wearing the contact lenses. Eleven of these 14 patients were able to wear aphakic spectacles in lieu of contact lenses. Much of the recent literature on pediatric cataracts has centered on the perceived difficulty in the long-term use of aphakic contact lenses. Some authorities advocate the use of epikeratophakia or intraocular lens implants as the only effective means of optical correction. This study shows that most pediatric patients with cataracts fail at treatment because of problems related to treatment of amlbyopia, and not problems related to the fitting and wearing of contact lenses.