To investigate the changes of refraction and visual quality after ray-tracing guided femtosecond laser-assisted in situ keratomileusis (FS-LASIK) in Chinese high myopia compared to that of low-to-moderate myopia.38 eyes in the high myopia (HM) group and 34 eyes in the low-to-moderate myopia (LM) group were evaluated 6 months after ray-tracing guided FS-LASIK. The InnovEyes Sightmap device was used to acquire high-order aberrations and generate individualized 3D eye model ablation profile. The Quality of Vision and Ocular Surface Disease Index questionnaires were used to evaluate the subjective visual quality and dry eye syndrome, respectively.In the HM group, postoperative MRSE demonstrated an alternation from 0.19 ± 0.53 D at 1 month to 0.06 ± 0.35 D at 6 months (P = 0.029). Similar tendency of MRSE was observed in the LM, changing from 0.23 ± 0.33 D to 0.04 ± 0.32 D (P < 0.001). Visual symptoms gradually alleviated with time, especially the frequency and the severity of blurred vision (P = 0.007 and 0.018). None of the participants reported the bothersome of halos 6 months postoperatively. 80.95% of participants reported no dry eye discomfort 6 months after surgery. No correlations were found between preoperative MRSE and the postoperative subjective visual symptoms (all P > 0.05). Greater spherical aberration (SA) decrease at 6-mm pupil size was correlated to lower level of starburst (coef = 2.40, P = 0.046).Ray-tracing guided FS-LASIK demonstrated comparable efficacy and visual quality in high myopia compared to low-to-moderate myopia. The decline in SA may contributed to the relief of subjective visual complaints, especially the starbursts in high myopia.Copyright © 2025. Published by Elsevier B.V.