Purpose: To evaluate the clinical outcome of wavefront-guided laser in situ keratomileusis (LASIK) for the treatment of moderate to high myopia associated with a thin cornea. Setting: Enaim Laser Medical Center, Tel Aviv, Israel. Methods: This retrospective study included 98 eyes of 49 patients with moderate to high myopia (-5.20 to -10.35 diopters [D]) and thin corneas (456 to 498 μm) treated with wavefront-guided LASIK (Zyoptix, Bausch & Lomb) and followed for 36 months. Preoperative wavefront analysis was performed with a Hartmann-Shack aberrometer, and treatment was performed with the Technolas 217 z excimer laser system (Bausch & Lomb). Final refraction data, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), optic zone size, ablation depth, optical aberrations, and night glare complaints were evaluated. Results: Mean patient age was 28 years ± 7 (SD), and mean preoperative spherical equivalent refraction was -7.06 D (range -5.20 to -10.35 D). Final UCVA ranged between 6/6 and 6/30. The safety index of the technique was 1.03, and the efficacy index was 0.67. Undercorrection of more than 0.50 D was observed in 41.3% of the high-myopic eyes (-7.00 to -10.35 D, n = 58) compared with 10% in the moderately myopic eyes (-5.00 to -6.75 D, n = 40). A significant reduction in spherical aberration (Z40) was found 12 months postoperatively in all eyes. Night glare was documented in 4 eyes (4%) in the high myopia group. There were no cases of corneal ectasia. Conclusion: Zyoptix was safe in eyes with moderate to high myopia with relatively thin corneas (< 498 μm). For myopia between -7.00 D and -10.35 D, a small optical zone (4.3 to 5.6 mm) may be applied as night glare was relatively rare, but significant undercorrection should be expected.