In 54 patients, 92 eyes with different degrees of compound, myopic astigmatism underwent photorefractive keratectomy with the VISX 20/20 excimer laser. The eyes were grouped by degree of refractive astigmatism into: high (-2.75 to -5.0 diopters), moderate (-1.25 to -2.50 diopters), and low (< -1.0 diopter) astigmatism. At 6 months after the procedure the mean reduction from the preoperative refractive cylinder was 80.7% in the high, 68.4% in the moderate, and 47.6% in the low astigmatism group. 89.2% of the eyes with low, 81.8% with moderate, and 85% with high cylinders had achieved a final, uncorrected visual acuity of between 6/6 and 6/10. The VISX laser is an effective tool for the correction of high and moderate astigmatism, but is less effective for low astigmatism.