To present the outcomes of a retrospective study of treatment of radial keratotomy-induced corneal irregularity with topographic guided ablation and a trans-epithelial approach based on epithelial compensation.Sixty eyes of 31 patients were treated for radial keratotomy-induced corneal irregularity utilizing a customized trans-epithelial topographic guided ablation photorefractive keratectomy (PRK) for treatment of corneal higher-order aberrations and lower-order astigmatism. Three-month results were analyzed via measurement of vision, refraction, residual higher-order aberrations (HOAs), residual lower-order and higher-order aberrations, as well as for loss or gains of lines of best corrected visual acuity.Higher-order aberrations (HOA) were reduced by 69%, with an 80% reduction of higher-order aberrations grouped with lower-order aberrations (Grouped). Most (95%) of eyes achieved 20/40 vision or better, 50% of eyes gained 1-9 lines of best corrected vision, and no eyes had loss of best corrected vision.Use of the CREATE protocol to treat RK-induced corneal irregularity resulted in a significant decrease in HOA, as well as a significant improvement in corrected distance visual acuity.