Spherical aberration (SA) is a core factor affecting postoperative visual quality in refractive surgery. With the continuous development of refractive surgery techniques, individualized surgical protocol selection based on SA characteristics has become a key strategy for optimizing postoperative visual quality. It has been demonstrated that the increase in SA following small incision lenticule extraction (SMILE) is generally lower than that after femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). The matching relationship between optical zone size and pupil diameter, preoperative refractive status, and corneal biomechanical properties collectively determine postoperative SA levels. Individualized surgical protocol selection based on SA characteristics is crucial for optimizing postoperative visual quality. Future research should establish predictive models integrating multi-dimensional parameters to advance refractive surgery toward precision medicine.