Special mention about pediatric post-cataract patients should be made here. A large percent of infants who undergo cataract surgery will develop aphakic / pseudophakic glaucoma. The onset of this glaucoma may be early after surgery or occur later in childhood. The average age of onset is approximately 8 years after cataract surgery, but it can occur at any time. Children who undergo surgery for cataract in the first 6 months of life, represented by infants with microphthalmia, nuclear cataracts, or PHPV are at the highest risk. But any child after cataract surgery can develop open or closed angle aphakic glaucoma. These post-cataract patients should be frequently examined for glaucoma and on a regular schedule. Glaucoma screening should be part of every follow-up examination for the remainder of the lives of these children, even when IOP measurements are not possible. Early signs of glaucoma may include decreased aphakic refraction (reduced plus power from globe elongation), corneal clouding or enlargement (at an early age), or optic nerve cupping. Note of the optic nerve heads is a necessary part of any post-cataract examination in the office or in the operating room. As mentioned above the IOP is very important but the diagnosis of glaucoma initially or in follow up is best made from the optic nerve primarily with IOP as the main risk factor.