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Purpose: To report 12-month visual and refractive outcomes following topography-guided femtosecond laser–assisted laser in situ keratomileusis (LASIK) for myopia and compound myopic astigmatism correction. Methods: This prospective, single-center observational study was conducted in an outpatient clinical practice at the Stanford University Byers Eye Institute in Palo Alto, California. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, 5% and 25% contrast sensitivity CDVA, and manifest refraction following topography-guided femtosecond laser–assisted LASIK were assessed. Refractive measurements were used to perform a vector analysis. Results: Sixty eyes of 30 patients (mean age: 32.8 ± 7.0 years; range: 23 to 52 years) undergoing topography-guided LASIK for the correction of myopia and compound myopic astigmatism were analyzed. Mean postoperative UDVA was −0.09 ± 0.10 logarithm of the minimum angle of resolution (logMAR) at 12 months. Mean preoperative CDVA was −0.09 ± 0.09 and −0.13 ± 0.08 logMAR at postoperative 12 months. At 12 months, 26.9% of eyes had gained one or more lines of postoperative UDVA compared to baseline CDVA. Mean pre-operative 5% contrast sensitivity CDVA was 0.68 ± 0.07 and 0.64 ± 0.12 logMAR at 12 months (P =.014) following LASIK. Conclusions: Topography-guided LASIK for myopia and myopic astigmatism correction provided excellent visual and refractive outcomes that were predictable, precise, and stable up to 12 months postoperatively. [J Refract Surg. 2024;40(9):e595–e603.] [ABSTRACT FROM AUTHOR]