To compare the visual outcomes in myopic astigmatic refractive error correction by customized femtosecond laser and mechanical microkeratome LASIK. This was a prospective observational study, performed on 200 eyes of 100 patients treated between 2016 to 2020 for myopia and astigmatism (sphere ≤ -6.00 diopters; cylinder ≤ -6.00 diopters). The first 100 consecutive eyes that had LASIK flaps created with a femtosecond laser were compared with the first 100 consecutive eyes that had flaps created with a mechanical microkeratome. All eyes received wavefront-guided LASIK treatments performed with a VISX S4 IR Advanced CustomVue excimer laser (AMO). Refractive predictability, change in mean spherical equivalent refraction, postoperative uncorrected visual acuity (UCVA), and best spectacle-corrected visual acuity (BSCVA) were compared at 1 day, 1 week, and 1 month following surgery. The refractive accuracy was the same for both groups. At all follow-up, the percentage of eyes that achieved a postoperative UCVA of 20/20 or better was significantly higher in the femtosecond laser group than in the mechanical keratome group. In addition, a higher percentage of eyes in the femtosecond laser group achieved a postoperative UCVA of 20/16 at 1 month. Creating LASIK flaps with the femtosecond laser resulted in faster visual recovery and better UCVA.