Abstract Background: To compare the outcome of femtosecond lasik ablation and small incision lenticule extraction for the management of high myopic astigmatism regarding visual acuity, residual ser and astigmatism pre and postoperative HOAs and TBUT. Patients and Methods: The visumax surgical platform was used for surgery. The femtosecond laser was used for flap creation in FS - LASIK group and for lenticule creation for the SMILE group. The MEL 90 excimer laser used for ablation in FS - LASIK while manual dissection and extraction of the lenticule in SMILE group patient is examines regularly one, three and six month post surgery. Visual acuity improved earler in FS-Lasik earler than SMILE group. TBUT worsen in FS-Lasik group more than SMILE group. The postoperative HOAs were higher in smile than LASIK group. There is slight myopic regression in LASIK group also there is hyperopic shift in some patients of l ASIK as an overcorrection. Results: Postoperative SER improved in both groups. The residual SER in LASIK is –0.05±0.57 and –0.25±0.43D. Both groups got 57.5% 20/20, and for 20/16 30% and 25% respec-tively. TBUT affected markedly post surgery in LASIK group but improved later while smile did not affected so much. HOAs was above one in smile group while near one in FS-Lasik group. Conclusion: Both procedures are same effective in man- agement of high myopic astigmatism.