PurposeTo compare the clinical outcomes of wavefront-guided and wavefront-optimized laser in-situ keratomileusis (LASIK). DesignProspective, randomized, fellow-eye controlled Methods: SettingSingle academic institution Study population110 eyes of 55 patients with myopia with and without astigmatism InterventionOne eye was randomized to undergo wavefront-guided LASIK by the AMO Visx CustomVue S4 IR excimer laser system while the fellow eye received wavefront-optimized LASIK by the Alcon Allegretto Wave Eye-Q 400 Hz excimer laser system. Corneal flaps were constructed using the Intralase FS 60 Hz femtosecond laser. Patients were followed at postoperative months 1, 3, 6 and 12. Main outcome measuresUncorrected visual acuity, stability of refractive correction, contrast sensitivity, wavefront aberrometry. Results12 months after LASIK more eyes achieved visions of 20/12.5 or better (30 eyes, 56%) in the wavefront-guided group compared to those receiving wavefront-optimized treatment (22 eyes, 41%) (P = 0.016). Average spherical equivalent refractions were -0.13 ± 0.46 D in wavefront-guided eyes while wavefront-optimized eyes were -0.41 ± 0.38 D at 12 months. Wavefront-guided eyes also achieved better best-corrected visual acuity (BCVA) at both the 5% and 25% contrast levels (P = 0.022 and P = 0.004, respectively). There were no differences in levels of residual astigmatism (P = 0.798) or in higher order aberrations (P = 0.869). ConclusionsBoth wavefront-guided and wavefront-optimized treatments are able to safely and effectively correct myopia with and without astigmatism. However, wavefront-guided treatment platforms appear to offer significant advantages in terms of residual refractive error, uncorrected distance acuity, and contrast sensitivity.