PURPOSE: To determine the effects of cataract extraction with intraocular lens placement on scanning laser polarimetry of the peripapillary nerve fiber layer. DESIGN: Cohort study. METHODS: Thirty-four eyes of 33 patients undergoing phacoemulsification cataract surgery with intraocular lens were imaged using the GDx Nerve Fiber Analyzer within 4 weeks before and at least 4 weeks after cataract surgery. Preoperative and postoperative mean images were compared. The effects of cataract severity and type, and intraocular lens material, were also examined. RESULTS: Comparison of preoperative and postoperative mean scanning laser polarimetry measurements revealed that eyes in which acrylic intraocular lenses (n = 11) were placed had a significant increase in scanning laser polarimetry for the total band circumference, and superior, inferior, and nasal quadrants ( P ≤ .041). Placement of silicone (n = 15) and polymethylmethacrylate (n = 8) intraocular lenses did not result in statistically significant changes in scanning laser polarimetry measurements. However, eight of 34 eyes (23.5%) had changes of 15% or more postoperatively in the total circumference measurement, including eyes with acrylic, silicone, and polymethylmethacrylate intraocular lenses. CONCLUSIONS: Cataract extraction with intraocular lens was associated with a statistically significant change in mean scanning laser polarimetry values in eyes that received an acrylic intraocular lens. In individual patients, clinically important changes (15% or greater) in scanning laser polarimetry measurements were not uncommon irrespective of intraocular lens type. New baseline scanning laser polarimetry measurements may be warranted in eyes that undergo cataract extraction with intraocular lens.