AIM: To determine the clinical outcomes of laser in situ keratomileusis (LASIK) treatments using LaserSight AstraPro Planner 2.2 Z software for myopia with asymmetric corneal shape.METHODS:Four hundred and eighty-five eyes [243 patients; spherical equivalent (SE), -5.93±1.88 diopters (D)] were treated with asymmetric ablations using LaserSight SLX laser (version 5.3, 300Hz) were retrospectively analyzed and LaserSight AstraPro Planner 2.2 Z software. Preoperative and postoperative uncorrected visual acuities (UCVA), spherical equivalent (SE) refraction, pachymetry, and corneal asphericity (Q value) and decentration were evaluated. RESULTS:At 12mo postoperatively, the decimal UCVA was 1.0 or better in 449 (92.6%) eyes. Two eyes (0.4%) lost 1 line of the decimal best spectacle-corrected visual acuity (BCVA), 316 (65.2%) did not change, 149 (30.7%) gained 1 line, and 18 (3.7%) gained 2 lines or more after surgery. Three hundred and thirty-two eyes (68.5%) were within 0.5 D in SE. The mean tissue saving ablation depth was 4.28±2.86 (0-16) μm (median, 4 μm). The mean attempted remaining central corneal thickness was 435.79±29.56 μm, the mean postoperative pachymetry was 444.94±28.93 μm. The mean preoperative Q value was -0.19±0.18, the postoperative was 0.30±0.48 (P=0.000). The mean postoperative decentration was 0.39±0.19 mm. CONCLUSION:Topography-guided LASIK with AstraPro Planner 2.2 Z custom ablation planning software in an asymmetric ablation mode was an effective, safe, predictable, and stable refractive procedure for the myopia with asymmetric corneal topography.