To evaluate the objective and subjective visual quality 3 months after femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) performed with Q-value-guided optimized monovision scheme (Custom-Q) for correction of myopia with or without astigmatism and compensate for age-related accommodation deficiency.Prospective before-and-after study.Patients who had Custom-Q FS-LASIK for myopia with age-related accommodation deficiency were included in this prospective study. Distance, intermediate, and near visual acuities; refraction; Q value; corneal higher-order aberrations (HOAs); accommodative and binocular function measurements; defocus curve; contrast sensitivity and a subjective questionnaire assessing near visual ability and visual discomforts were evaluated before and after surgery.Clinical data of 48 cases were analyzed. The mean age was 42.73 ± 2.67 years (40 to 50 years). At the 3-month follow-up, there were 100% (48/48), 92% (44/48), and 56% (27/48) patients who achieved a binocular uncorrected distance, intermediate and near visual acuity (UDVA, UIVA, UNVA) not less than 20/20 separately. Defocus curves revealed better results postoperatively at - 1.00 D and - 1.50 D. The Q value in the dominant eyes was more positive postoperatively (P<0.001), and in the non-dominant eyes, the Q value and corneal spherical aberration (SA) became more negative (P<0.05). The accommodative amplitude (AA) and relative accommodation improved binocularly (P<0.001). The questionnaire demonstrated high patient satisfaction with near vision, and patients' perceptions of visual discomforts had no significantly difference compare with preoperative.For myopic patients with age-related accommodation deficiency, the Custom-Q ablation could improve near vision without compromising distance vision. It also led to minimal changes in objective optical quality, coordination of accommodative and binocular functions, contrast sensitivity, and subjective visual discomforts perceptions.Copyright © 2024. Published by Elsevier Inc.