A consecutive series of 721 eyes was followed for visual acuity changes after keratoplasty in four groups: keratoconus, Fuchs' dystrophy, pseudophakic bullous keratopathy with retained intraocular lenses, and aphakic/pseudophakic bullous keratopathy with secondary implants during keratoplasty. Follow-up ranged from 12 to 84 months. Keratoconus eyes showed the quickest recovery of visual acuity: by 12 months, 91% attained a best-corrected vision of 20/40, and the mean lines of visual acuity for the group plateaued thereafter. The other three groups showed continuing improvement in vision through 24 months. From 3 months through 3 years after keratoplasty, the keratoconus and Fuchs' groups consistently showed better visual acuity levels than either the retained or the secondary implant groups (P less than 0.0001). Reporting changes in visual acuity over time offers multiple advantages compared with providing best-attained or last-recorded visual acuities after keratoplasty.