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PURPOSE To evaluate the feasibility and accuracy of measuring axial length (AL) by a new optical low-coherence reflectometry (OLCR)-based device in eyes with central posterior subcapsular cataract (PSC). SETTING Department of Ophthalmology, Assaf-Harofeh Medical Center, Zerifin, Israel. DESIGN Retrospective case series. METHODS Consecutive cases of patients who had uneventful cataract surgery and whose preoperative AL measurements were not feasible with the partial coherence interferometry (PCI) device because of a central PSC were assessed. Preoperative AL was measured by the OLCR device and immersion ultrasound (US). Preoperative results were compared with the postoperative AL measurements obtained by the PCI. RESULTS Twenty-seven patients (27 eyes) were enrolled in the study. The median difference between the OLCR and the PCI AL measurements (0.07 mm) was lower than the median difference between the US and the PCI AL measurements (0.13 mm) (P = .016). The ranges of the limits of agreement were 0.15 mm between OLCR and PCI, and 0.88 mm between US and PCI. The proportion of eyes with an AL difference of less than 0.1 mm was significantly higher between the OLCR and the PCI devices (24 eyes [88.9%]) than between the US and the PCI devices (9 eyes [33.3%]) (P = .001). CONCLUSIONS The OLCR-based device successfully measured the preoperative AL in all eyes with central PSC for which preoperative PCI scans were not feasible. These measurements had a high level of agreement with the postoperative AL measurements obtained by the PCI device.