PURPOSE: To compare the effect of suction on macular and retinal nerve fiber layer thickness during femtosecond lenticule extraction and femtosecond laser assisted laser in situ keratomileusis (LASIK) with the Visumax FS system. SETTING: Ophthalmic Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing, China. DESIGN: Prospective comparative case series. METHODS: Fourier-domain optical coherence tomography was used to measure macular and retinal nerve fiber layer thickness preoperatively and through 6 months postoperatively. RESULTS: The study evaluated 196 eyes. In the femtosecond lenticule extraction group, the mean foveal, parafoveal, and perifoveal retinal thicknesses 1 day and 1 week postoperatively were diminished, although the changes were not statistically significant. The retinal thickness did not change significantly 1, 3, or 6 months postoperatively (P>.05). In the LASIK group, the mean foveal, parafoveal, and perifoveal retinal thicknesses did not change significantly at any postoperative timepoint (P>.05). The differences in all 3 retinal thicknesses between the 2 groups were not significant 1, 3, or 6 months postoperatively (P>.05). The ganglion cell complex and retinal nerve fiber layer thickness did not change significantly from preoperatively to any postoperative timepoint in either group (P>.05). CONCLUSION: Suction had no significant clinical effects on the macular thickness and retinal nerve fiber layer during femtosecond lenticule extraction or femtosecond laser assisted LASIK.