PURPOSETo compare treatments with wavefront optimized and custom-Q ablations. METHODSTwo consecutive groups of eyes were treated for myopia and astigmatism with surface ablation. One group was treated with wavefront optimized ablation and the second group was treated with custom-Q ablation. Preoperative and 3-month postoperative Q-values, higher order aberrations, low contrast visual acuity, and classic outcome parameters were analyzed. RESULTSThe wavefront optimized ablation group was comprised of 46 eyes of 23 patients with a mean spherical equivalent refraction (SE) of –3.64 diopters (D) (range: –1.15 to –8.25 D); mean Q-value changed from –0.33 preoperatively to 0.06 postoperatively. The custom-Q ablation group was comprised of 42 eyes of 21 patients with a mean SE of –3.24 D (range: –1.47 to –8.00 D); mean Q-value changed from –0.36 preoperatively to –0.03 postoperatively. A statistically significant difference in postoperative change in Q-values (P=.049) between the two groups was noted, but there was no such difference in higher order aberrations, low contrast visual acuity, or classic outcome parameters. CONCLUSIONSCustom-Q ablation resulted in a mean postoperative asphericity that was closer to preoperative compared to wavefront optimized ablation, whereas the other outcome parameters showed no statistically significant differences. [J Refract Surg. 2008;24:779-789.] ABOUT THE AUTHORS From the Eye Department, University Hospital of North Norway and SynsLaser Kirurgi, Tomsø, Norway (Stojanovic); School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical College, Wenzhou, Zhejiang, China (L. Wang, Q. Wang); Milos Klinika, Medical Academy – US Medical School, Belgrade, Serbia (Jankov); and Øyelegesenteret, Tomsø, Norway (Nitter). This study was supported by SynsLaser Kirurgi, Tomsø, Norway. Dr Jankov is a paid consultant for WaveLight AG, Erlangen, Germany. The remaining authors have no proprietary or financial interest in the materials presented herein. Correspondence: Aleksandar Stojanovic, MD, Fløyvn 32, 9020 Tromsdalen, Norway. Tel: 47 90693319; Fax: 47 77647929; E-mail: aleks@online.no Received: February 26, 2007 Accepted: November 7, 2007 Posted online: March 15, 2008