#### Summary points Early attempts at refractive surgery used partial thickness corneal incisions to alter the curvature of the cornea, with the most popular technique being radial keratotomy. In 1990 the Prospective Evaluation of Radial Keratotomy study found that outcomes were unpredictable and unstable, and this led to the use of ablative laser refractive surgery instead.1 We review evidence for the efficacy of laser refractive surgery mainly from randomised controlled trials and discuss suitability, contraindications, and potential complications of the procedure to help generalists in answering patients’ queries. #### Sources and selection criteria We searched PubMed for articles in English on laser refractive surgery. We also consulted guidelines issued by the Royal College of Ophthalmologists, the American Academy of Ophthalmologists, and the National Institute for Health and Clinical Excellence. We identified systematic reviews and randomised controlled trials as well as informative and relevant level C research. Search terms were “laser assisted in situ keratomileusis”, “laser epithelial keratomileusis”, “photoreactive keratotomy”, “myopia”, “hyperopia”, “astigmatism”, and “laser surgery”. Refractive error was recently reviewed in the BMJ .2 Refraction (measured in dioptres) is the process by which light is focused on the retina. The optical components of the eye are the lens, the length of the eyeball, and the cornea. The cornea provides three quarters of the overall refractive power of the eye. If the eyeball is too long …