SIGNIFICANCE Small incision lenticule extraction (SMILE) is advanced as the most minimally invasive and least traumatic corneal procedure for correcting refractive errors using a single laser. Although SMILE obtains similar results to femtosecond laser in situ keratomileusis (LASIK) with spherical myopia, it has deficiencies in astigmatism correction. PURPOSE The purpose of this study was to compare refractive outcomes and high-order aberrations (HOAs) between SMILE and femtosecond LASIK corneal procedures at 1 year post-operative. METHODS Ninety-two patients (181 eyes) with myopia/myopic astigmatism underwent either SMILE (group 1) or femtosecond LASIK (group 2). The refractive target was to achieve emmetropia in all cases. Data were analyzed to determine significance of change in refraction and HOAs. Furthermore, astigmatism was subjected to vector analysis using the Thibos (calculation of change, , in J(0) and J(45) values) and Alpins (calculation of difference, C, between target-induced astigmatism [TIA] and surgically induced astigmatism) methods. RESULTS Forty-five patients (89 eyes) from group 1 and 47 patients (92 eyes) from group 2 completed the study. The main significant (P .001) findings were as follows: (a) residual astigmatism was greater in group 1 ; (b) group 1, J(0) = 1.015J(0) + 0.040 (R = 0.861), J(45) = 1.082J(45) + 0.019 (R = 0.792), C = 0.401TIA + 0.323 (R = 0.489), and mean spherical aberration increased from -0.003 (SD, 0.059 ; 95% confidence interval [CI], -0.015 to 0.009) to 0.028 m (SD, +/- 0.041 ; 95% CI, -0.037 to -0.020) ; and (c) group 2, J(0) = 0.952J(0) - 0.005 (R = 0.921), J(45) = 0.962J(45) - 0.002 (R = 0.923), C = 0.187TIA + 0.101 (R = 0.272), mean coma reduced from 0.114 (SD, +/- 0.087 ; 95% CI, 0.096 to 0.132) to 0.077 m (SD, +/- 0.059 ; 95% CI, 0.065 to 0.089), and trefoil from 0.089 (SD, +/- 0.049 ; 95% CI, 0.079 to 0.0990) to 0.056 m (SD, +/- 0.047 ; 95% CI, 0.046 to 0.066)