PURPOSE To evaluate the safety and efficacy of femtosecond-assisted wavefront-guided laser in situ keratomileusis (LASIK) as well as higher-order aberrometric changes in a population of active-duty United States Naval aviators. SETTING Navy Refractive Surgery Centers, San Diego, California, and Portsmouth, Virginia, USA. DESIGN Prospective noncomparative 2-site study. METHODS In this study of femtosecond-assisted wavefront-guided LASIK, 3 groups were differentiated according to the refractive status: myopia, mixed astigmatism, and hyperopia. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, mesopic low-contrast CDVA, higher-order aberrations (HOAs), and patient satisfaction were evaluated during a 3-month follow-up. RESULTS The study enrolled, treated, and included for analysis 548 eyes with myopia, 60 eyes with mixed astigmatism, and 25 eyes with hyperopia. The UDVA was 20/20 or better in 98.3% of eyes with myopia and mixed astigmatism at all postoperative visits and in 95.7% of hyperopic eyes 3 months postoperatively. The gain in CDVA was 1 or more lines in 39.2%, 41.1%, and 30.4% of myopic, mixed astigmatic and hyperopic eyes, respectively. Loss of 2 lines of CDVA after surgery occurred in 2 myopic eyes (0.4%). At 3 months, a mean change of +0.03 μm ± 0.10 (SD) and +0.05 ± 0.08 μm was observed in higher-order root mean square and primary spherical aberration, respectively. Of the patients, 95.9% said they believed that LASIK had helped their effectiveness as Naval aviators and 99.6% would recommend the same treatment to others. CONCLUSION Femtosecond-assisted wavefront-guided LASIK was an efficacious and safe option for refractive correction in Naval aviators, enabling a quick return to flight status. FINANCIAL DISCLOSURE Drs. Tanzer and Schallhorn are consultants to Abbott Medical Optics, Inc. No author has a financial or proprietary interest in any material or method mentioned.