Two groups of visually impaired children now benefit from refractive surgery and stand to further benefit with future advances. These children have difficulties with spectacle-wear and are unsuitable for contact lens-wear. The majority are neurologically normal and have anisometropic amblyopia. They are treated by advanced surface ablation using the excimer laser. Surface ablation is safe in children; the drawback is the high rate of pediatric refractive regression. Ametropia beyond this range may be treated using phakic intraocular lens implantation or clear lens extraction, with or without implantation of a posterior chamber intraocular lens. The minority are neurobehaviorally impaired children with high bilateral ametropia. Spectacle noncompliance relegates them to a blurred level of legal blindness, exacerbating their handicaps. Refractive surgery, performed using the same techniques, can dramatically improve their quality of life.