Purpose: To evaluate the correlation between refractive error and HIGHER-ORDER aberrations (HOAs) in patients with myopic astigmatism.Methods: HOAs were measured using the Zywave II aberrometer over a 6 mm pupil. Correlations between HOAs and myopia, astigmatism, and age were analyzed.Results: One hundred and twenty-six eyes of 63 subjects with mean age of 26.4±5.9 years were studied. Mean spherical equivalent refractive error and refractive astigmatism were -4.94±1.63 D and 0.96±1.06 D, respectively. The most common HIGHER-ORDER aberration was primary horizontal trefoil with mean value of 0.069±0.152 mm followed by spherical aberration (-0.064±0.130 mm) and primary vertical coma (-0.038±0.148 mm). As the ORDER of aberration increased from third to fifth, its contribution to total HOA decreased: 53.9% for third ORDER, 31.9% for fourth ORDER, and 14.2% for fifth ORDER aberrations. Significant correlations were observed between spherical equivalent refractive error and primary horizontal coma (R=0.231, P=0.022), and root mean square (RMS) of spherical aberration (R=0.213, P=0.031); between astigmatism and RMS of total HOA (R=0.251, P=0.032), RMS of fourth ORDER aberration (R=0.35, P<0.001), and primary horizontal coma (R=0.314, P=0.004). Spherical aberration (R=0.214, P=0.034) and secondary vertical coma (R=0.203, P=0.031) significantly increased with age. Conclusion: Primary horizontal trefoil, spherical aberration and primary vertical coma are the predominant HIGHER-ORDER aberrations in eyes with myopic astigmatism.