Objective To investigate and analyze modifications to the diameters in different optical zones in higher order aberrations after small incision lenticule extraction surgery （SMILE）. Methods Twenty-six patients （26 eyes） with a 6.0 mm optical zone diameter and 29 （29 eyes） with a 6.5 mm optical zone diameter were randomly included in a retrospective study. Only right eyes were investigated in the study. The higher order aberrations were measured with a WaveScan wavefront analyzer before surgery and at 1 month and 3 months postoperatively. A repeated measures analysis of variance and independent t test were used to analyze the collected data. Results   At 1 month after SMILE， the total higher-order aberrations （HOA） and spherical aberrations in the 6.0 mm group， and the total HOA and coma in the 6.5 mm group were 0.273±0.098 µm， 0.100±0.077 µm， and 0.224±0.080 µm， 0.142±0.077 µm， which were higher than preoperative measurements （P＜0.05）. At 3 months after SMILE， spherical aberrations were 0.083±0.065 in the 6.0 mm group， and the total HOA， coma and trefoil were 0.238±0.082 µm， 0.154±0.074 and 0.103±0.056 in the 6.5 mm group， which were also higher than preoperative measurements（P＜0.05）. At 1 month the coma in the 6.5 mm group was significantly lower than that in the 6.0 mm group （t=2.416， P＜0.05）. And the vertical coma in the 6.5 mm group was also lower than that in the 6.0 mm group （t=-2.021， P=0.049）. No significant differences between the two groups were found for the other parameters （P＞0.05）. Correlation analysis showed that lenticular thickness was positively correlated with HOA and coma in the 6.0 mm group and the HOA， coma and trefoil in the 6.5 mm group one month after surgery（r=0.502， 0.661， 0.672， 0.580， 0.383； P＜0.05）. While at three months after surgery， lenticular thickness was positively correlated with HOA， coma and trefoil in the 6.0mm group and HOA in the 6.5 mm group（r=0.697， 0.629， 0.560， 0.501； P＜0.05）. Conclusion Different optical zones show various results in parts of high order aberrations （coma） in the early stage after SMILE surgery. This might be related to the specific principle of the surgery and the reaction to corneal wound healing.