Accurate axial length measurements are needed before intraocular lens implantation in patients with asteroid hyalosis requiring cataract extraction. We suspected that falsely short axial length measurements may be obtained using automated A-scan biometry when we found an automated measurement of 15.90 mm in a patient with severe unilateral asteroid hyalosis. A manual biometry measurement of 21.90 mm was obtained for comparison; this was within 0.2 mm of the manual reading in the opposite uninvolved eye. A case-control study was performed on 20 unilateral asteroid hyalosis subjects using the uninvolved eye as the control, comparing automated biometry and manual A-scan biometry to assess the effect of asteroid hyalosis on automated biometry measurements. Five subjects (25%) with asteroid hyalosis had falsely short axial length measurements of more than 1.00 mm using automated biometry. This would result in more than 2.50 diopters of error in the implanted lens power. This case-control study demonstrates that falsely short axial length measurements may be obtained using automated biometry in patients with asteroid hyalosis, leading to significant error in intraocular lens power calculations.