| Summary: | <b>Background</b>: This retrospective chart review compared the higher-order aberrations (HOAs) among photorefractive keratectomy (PRK), laser-assisted in situ keratomileusis (LASIK), and small incision lenticule extraction (SMILE) alongside changes in spherical equivalent (SEQ) and corneal shape (Q-value). <b>Methods</b>: Analyzing 371 myopic eyes, including 154 LASIK, 173 PRK, and 44 SMILE cases, Pentacam imaging was utilized pre-operatively and at one-year post-operative visits. <b>Results</b>: All procedures resulted in 100% of patients achieving an uncorrected distance visual acuity (UDVA) of 20/40 or better, with 87% of LASIK and PRK, and 91% of SMILE patients having 20/20 or better. Significant increases in HOAs were observed across all procedures (<i>p</i> < 0.05), correlating positively with SEQ and Q-value changes (LASIK (0.686, <i>p</i> < 0.05), followed by PRK (0.4503, <i>p</i> < 0.05), and SMILE (0.386, <i>p</i> < 0.05)). Vertical coma and spherical aberration (SA) were the primary factors for heightened aberration magnitude among the procedures (<i>p</i> < 0.05), with the largest contribution in SMILE, which is likely attributed to the centration at the corneal apex. Notably, PRK showed insignificant changes in vertical coma (−0.197 µm ± 0.0168 to −0.192 µm ± 0.0198, <i>p</i> = 0.78), with an increase in oblique trefoil (<i>p</i> < 0.05). <b>Conclusions</b>: These findings underscore differences in HOAs among PRK, LASIK, and SMILE, helping to guide clinicians.
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