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Purpose: To compare visual outcomes and aberration outcomes in small incision lenticule extraction (SMILE) versus femtosecond laser LASIK (FS‐LASIK). Methods: This prospective, comparative, nonrandomized clinical study included 68 eyes of 37 patients receiving SMILE and 55 eyes of 30 patients receiving FS‐LASIK between December 2011 and January 2013 at the Fudan University Eye and ENT Hospital (Shanghai, People's Republic of China). Patients were followed up at 3, 6 months and 5 years after surgery. Main outcome measurements included uncorrected (UDVA) and corrected (CDVA) distance visual acuity, manifest refraction, central corneal thickness (CCT), total corneal refractive power (TCRP) and wavefront aberrations. Results: About 98% (49/50) of treated eyes in the SMILE group and 95% (39/41) in the FS‐LASIK group had a postoperative logMAR UDVA of 0 or better. Spherical equivalent (SE) after 5 years was −0.01 ± 0.35 D in the SMILE group and −0.23 ± 0.41 D in the FS‐LASIK group. A regression of −0.02 ± 0.39 D in the SMILE group and −0.12 ± 0.32 D in the FS‐LASIK group was observed between 6 months and 5 years postoperative time‐points. TCRP increased by 0.39 ± 0.38 D in the SMILE group and 0.45 ± 0.49 D in the FS‐LASIK group between 6‐month and 5‐year time‐points. However, no statistically significant difference was found between the SMILE and FS‐LASIK groups in terms of ∆SE, ∆CCT and ∆TCRP between 6 months and 5 years postoperative time‐points. Conclusion: Myopic regression was observed in terms of TCRP but not in subjective refraction. No statistically significant difference in stability was found between SMILE and FS‐LASIK. [ABSTRACT FROM AUTHOR]