This paper gives an overview on the design process of modulated metasurface (MTS) antennas and focus on their performance in terms of efficiency and bandwidth. The basic concept behind MTS antennas is that the MTS imposes the impedance boundary conditions (IBCs) seen by a surface wave (SW) propagating on it. The MTS having a spatially modulated equivalent impedance transforms the SW into a leaky wave with controlled amplitude, phase and polarization. MTS antennas are hence highly customizable in terms of performances by simply changing the IBCs imposed by the MTS, without affecting the overall structure. The MTS can be configured for high gain (high aperture efficiency) with moderate bandwidth, for wide bandwidth with moderate aperture efficiency, or for a trade-off performance for bandwidth and aperture efficiency. The design process herein described relies on a generalized form of the Floquet wave theorem adiabatically applied to curvilinear locally periodic IBCs. Several technological solutions can be adopted to implement the IBCs defined by the synthesis process, from sub-wavelength patches printed on a grounded slab at microwave frequencies, to a bed of nails structure for millimeter waves: in any case, the resulting device has light weight and a low profile.