AIM: To compare and analyze the therapeutic effects of laser in situ keratomileusis(LASIK)and optimized refra-ctive keratectomy customized ablation manager(ORK)for the treatment of high astigmatism. METHODS: LASIK was performed in 44 eyes of 30 patients with high astigmatism and 44 eyes of 31 patients with high astigmatism received ORK. Uncorrected visual acuity (UCVA),astigmatism,slit-lamp examination,intraocular pressure(IOP),corneal topography were observed in these patients in 1-month follow-up to compare the clinical effects on high astigmatism . RESULTS: One month after surgury, UCVA was 0.92±0.18 of ORK and 0.85±0.18 of LASIK,there was no significant difference of UCVA between ORK and LASIK (t=1.82,P=0.07).Remnant myopia of ORK was 0.12±0.98,and 0.16±1.24 of LASIK, there was no significant difference of remnant myopia between ORK and LASIK (t=1.87,P=0.07). Remnant astigmatism of ORK was -0.61±1.12,and -1.10±1.00 of LASIK, there was significant difference of remnant astigmatism between ORK and LASIK(t=2.12,P=0.04). CONCLUSION: For high astigmatism,ORK is more effective and more predictive than LASIK.