Pneumatic retinopexy is increasingly recommended to treat some patients with retinal detachment to avoid the complication of induced refractive changes sometimes associated with scleral buckling procedures. Prospective evaluation of refractive changes after scleral buckling procedures was performed in 75 eyes of 69 patients. Encircling scleral buckles caused an average increased axial length of 0.99 mm and average induced myopia of 2.75 diopters. Induced astigmatism was likely to occur in patients undergoing scleral buckling surgery, but it was not related to whether a radial element was used.