To investigate accommodative response and accommodative lag changes after femtosecond laser small incision lenticule extraction (SMILE) for moderate to high myopia correction. A total of 32 eyes of 32 patients with no strabismus who underwent SMILE were enrolled in this prospective clinical study. The accommodative response was obtained viewing monocularly with spherical equivalent refractive error corrected, using an open-field autorefractor at different stimulus levels (2.00D, 2.50D, 3.00D, 4.00D and 5.00D) for the right eye before a standard SMILE surgery and at 1-month follow-up after surgery. The mean age of the patients were 23.34?±?2.90 years and the mean preoperative manifest refraction spherical equivalent was ?5.74?±?1.98 diopters. Significant differences were detected in both preoperative and postoperative accommodative responses to different stimulus levels (P?