The authors designed and distributed a survey to assess the economic impact of the pandemic on US paediatric ophthalmologists over the sustained lockdown period of 18 months in 2020/21. They captured information on clinical and surgical revenue, staff hiring and retention, and plans for retirement. This was a two-part, 14 question multiple-choice survey. A 6.3% response was obtained (129/2051 AAPOS members). After initial lockdown, most gradually reopened their workplace over April to June 2020 and 38.3% never stopped seeing patients in person. Further, 15.6% had to supplement income with work outside paediatric ophthalmology and 69.8% had difficulty hiring new staff. Private practices had significantly greater decreases in surgical revenue and income than academic responses, and 11.7% had limited numbers of Medicaid or publicly funded patients. There was a greater decrease in clinical revenue for those in private practice for longer years. About 21% intended to retire earlier than planned and about five percent had sold their private practice. Concerns are raised given US paediatric ophthalmology already has issues in relation to funding and attracting new trainees.