To examine the relationship between corneal higher-order aberrations (HOAs), scatter, and residual refraction with visual symptoms and visual acuity after small-incision lenticule extraction (SMILE) for myopia and astigmatism. University Eye Clinic, Aarhus, Denmark. Prospective case series. Eyes had small-incision lenticule extraction for myopiaor myopic astigmatism. Examinations were performed preoperatively and 1day, 7days, 1month, and 3months postoperatively and included subjective refraction, Pentacam HR measurements, scatter measurements (objective scatter index [OSI]), and questionnaires on visual quality and symptoms. The mean preoperative spherical equivalent (SE) was -7.08 diopters (D)±1.17 (SD). At 3months, the mean uncorrected distance visual acuity (UDVA) was -0.03±0.11 logarithm ofthe minimum angle of resolution and the mean SE, -0.17±0.33 D; the OSI increased by a mean of 0.22±0.53 (P=.06) and coma by 0.1±0.1μm(P<.001); spherical aberration did not change significantly. The severity of self-reported visual symptoms decreased postoperatively. Scatter, corneal HOAs, and residual refraction were not correlated with the degree of visual symptoms. On linear regression analysis, residual refraction was a significant predictor of UDVA (1day: adjusted R2=0.16, P=.02; 3months: adjusted R2=0.55, P<.001). Scatter and corneal HOAs were not associated with postoperative UDVA. Despite statistically significant changes in scatter and corneal HOAs, the severity of self-reported visual symptoms decreased postoperatively. Residual refraction was a good predictor of postoperative UDVA. Scatter and corneal HOAs had no effect on the postoperative UDVA.