The prevalence of good visual acuity following surgery for congenital unilateral cataract was examined in a group of patients seen between 1980 and 1986. Overall, 53% of patients obtained linear distance acuities of 20/80 or better by 3 to 7 years of age. The best outcomes followed surgery during the first two months of life, prompt lens fitting, aggressive occlusion therapy, and regular follow-up. Nonetheless, aphakic eyes did not achieve a visual acuity of 20/20 in the sample. Prospective "preferential-looking" data demonstrated a failure of aphakic eyes to keep pace with the normal developmental course after 18 months of age. Poor visual outcomes following late surgery appear to be due primarily to the development of amblyopia during the first months of life, which may aggravate compliance problems and further deteriorate prospects of visual rehabilitation.