PurposeTo evaluate the safety, efficacy and predictability of the Optimized Prolate Ablation (OPA) profile of the NIDEK Advanced Vision Excimer laser platform (NAVEX) for myopia treatment, report the ocular higher order aberrations and to compare the visual quality with the Conventional algorithm of the same platform.SettingGerman Egyptian Eyecare center, Private practice, Cairo, Egypt.DesignProspective randomized clinical trial.MethodsPatients were randomized to have bilateral Laser in Situ keratotomileusis (LASIK) either with the OPA algorithm and or with the conventional algorithm. Visual acuity, manifest refraction, ocular Root Mean Square higher-order aberrations (RMS HOAs), corneal asphericity (Q value), spherical aberation (SA), coma and modulation transfer function (MTF) in the 2 groups were compared preoperatively and 3 months postoperatively.ResultsThe study enrolled 94 myopic eyes of 47 patients: 56 eyes in the prolate ablation group and 38 eyes in the conventional group. The mean manifest refraction spherical equivalent at 3 months was 0.00 diopter (D) ± 0.18 (SD) in the prolate ablation group and -0.11D ± 0.48 (SD) in the conventional group. Predictability (±0.50 D from intended refraction) at 3 months was 93% and 89%, respectively. 55 eyes (98.2%) in the prolate ablation group and 36 (94.7%) in the conventional group had an uncorrected distance visual acuity of 20/20 or better. 3 eyes in the prolate ablation group and 4 eyes in the conventional group lost 1 line of corrected distance visual acuity. At 3 months the prolate ablation group had statistically significant lower values of Root mean square (RMS), Coma and Q value and a higher value of Strehl ratio than the conventional group. SA value was also lower in the prolate ablation group, 0.0066±0.122 versus 0.0829±0.299 in the conventional group, however the difference between the 2 groups was not statistically significant. In the prolate ablation group the SA showed no statistically significant difference from “0” which is the preset target in this group. The MTF was higher in the prolate ablation group, than in the conventional ablation group. ConclusionThe prolate ablation algorithm gave similar predictable visual outcomes. However it induced fewer ocular HOAs, and conserved more preoperative corneal asphericity and contrast sensitivity than the conventional algorithm.