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Zeyad Alzaben, 1 Yazan Gammoh, 1, 2 Marta Freixas, 1 Ahmad Zaben, 3 Miguel A Zapata, 4 Dana N Koff 2 1Department of Optometry, Opticalia Clinic, Olot, Spain; 2Department of Optometry Science, Faculty of Allied Medical Sciences, Al-Ahliyya Amman University, Amman, Jordan; 3Optipunt Eye Clinic, Figueres, Spain; 4Ophthalmology Department, Vall d’Hebron Hospital, Barcelona, SpainCorrespondence: Zeyad AlzabenDepartment of Optometry, Opticalia Clinic, (Plz/Clarà, 12), Olot, Catalonia 17800, SpainTel +34 678922564Email drzaben@yahoo.comObjective: Inter-ocular asymmetry in anterior corneal high-order aberrations has previously not been investigated. This study aims to investigate the normal range of inter-ocular asymmetry in corneal high-order aberrations (HOAs) using a Placido disk-based corneal topographer to explore the relationship between the HOA parameters of the anterior corneal for each eye individually and the refractive error.Patients and Methods: A total of 257 subjects (98 males and 159 females) were participated, with an age range of 6 to 81 years (average of 40.2 ± 17.53). Participants were divided into three groups: myopia (spherical equivalent (SEQ) of refraction ≥− 0.50 D), hypermetropia (SEQ ≥+0.50 D), and emmetropia. For all patients, high-order aberrations were measured using a corneal topographer (CA.200TM; Topcon). Inter-ocular asymmetry was represented by RMS (root mean square) for three, five, and seven mm as pupil entry; aberrations for five mm pupil (vertical and oblique trefoil, vertical and horizontal comma, and primary spherical aberration) were recorded using the instrument’s built-in software.Results: Hypermetropes exhibit the highest inter-ocular asymmetry of all RMS values, mostly in spherical aberrations, and higher-order trefoil values. Oblique trefoil aberrations had the highest interocular asymmetry in the myopic groups. The interocular asymmetry in horizontal coma values was the highest in emmetropes and the lowest in hypermetropes.Conclusion: To our knowledge, this is the first observational study of inter-ocular differences in high-order aberrations of the anterior corneal surface of the human eye. This study’s results could be used to establish normal values of inter-ocular asymmetry of HOAs of the anterior cornea. The use of such normal values should be investigated further to serve as a guideline for clinicians when establishing the best management route for the patient’s refractive error.Keywords: anterior corneal aberrations, high-order aberrations, inter-ocular asymmetry, Zernike analysis