To evaluate epithelial remodeling, corneal power distribution and corneal higher-order aberrations (HOAs) after ray tracing-guided femtosecond laser-assisted in situ keratomileusis (RG FS-LASIK) for myopia.66 eyes from 33 patients were included in this 6-month observational case series. Epithelial thickness (ET), total corneal refractive power (TCRP), corneal HOAs, corneal volume (CV), and Quality of Vision questionnaire were assessed. Concentrical TCRP gradient was calculated (△Kmn = Kmn+1 - Kmn).ET in 0-2 mm only increased by 2.97 ± 4.57 μm with the myopic correction of - 6.24±1.78 D. No difference between steep and flat meridians was identified (P > 0.050). Km maintained a rate of decline in 1-3 mm and gently raised across 4-6 mm. ET thickening in 2-5 mm showed positive associations with TCRP gradient (r of △Km3, △Km4, and △Km5 were 0.304, 0.399, and 0.357; all P < 0.050). And greater mean and inferior remodeling in this annulus were related to increased spherical aberration and vertical coma at 6 mm (r = 0.414 and -0.505; both P < 0.001), correspondingly severer focusing difficulties and milder double vision occurred (coef = 8.665 and 3.612, both P < 0.050). CV3 consumption correlated negatively with △Km1 and △Km2 (r = -0.522 and -0.475, both P < 0.001).Epithelial thickening was minimal in central zone and comparable between astigmatism axes after RG FS-LASIK. Though the visual symptoms were subtle, pronounced paracentral remodeling associated with novel ablation profile and postoperative development of corneal HOAs still requires continuous monitoring.Copyright © 2025. Published by Elsevier B.V.