Refractive laser surgery has become one of the most successful and commonly performed elective ophthalmic procedures. Since the introduction of photorefractive keratectomy, followed closely by the advent of laser in situ keratomileusis, the field of laser refractive surgery has continued to rapidly evolve. Surgical techniques are constantly refined to improve patient outcomes and minimize complications, and technology continues to advance to provide more precise and customizable treatment options. New applications of refractive procedures continually emerge in the literature. Breakthroughs in the field have led to novel applications of refractive procedures that may offer options to patients that previously had been considered poor surgical candidates. It is important for the clinician to maintain awareness of the current trends and new developments in refractive surgery to provide appropriate counseling and treatment for their patients.