PURPOSE: To assess the effectiveness of small incision lenticule extraction (SMILE) as a function of the astigmatism level and type. METHODS: A total of 102 right eyes were included in this study. Refractive astigmatism and corneal astigmatism measured with Scheimpflug technology were retrieved from the preoperative visit and the 3-month follow-up visit. Patients were split into three groups according to the preoperative refractive astigmatism (0.50, 0.75 to 1.25, and 1.50 diopters [D] or greater) and the effectiveness among each group was evaluated according to the with-the-rule (WTR), against-therule (ATR), and oblique classifications. The standard Alpins method was used for the analysis.