Purpose <p>We evaluated the efficacy of small incision lenticule extraction (SMILE), femtosecond-assisted laser in situ keratomileusis (FS-LASIK), and toric implantable collamer lens (TICL) implantation for correcting myopia with high astigmatism by vector analysis.</p> Methods <p>This retrospective study included 155 patients (155 eyes) with myopia and high astigmatism who underwent SMILE, FS-LASIK, or TICL implantation at our hospital. Patients were selected and divided into three groups based on the surgical procedure. The safety and effectiveness of three methods in correcting high astigmatism were compared, and the efficacy on high astigmatism were compared using Alpins’ vector analysis.</p> Results <p>Six months after surgery, operative safety and effectiveness did not differ significantly among the implantation types. Postoperative cylinder and SE were higher in the SMILE and FS-LASIK groups compared to the TICL group (<i>P</i> &lt; 0.05). Among the three groups, significant differences were observed in surgically-induced astigmatism (1.91 ± 0.46D vs. 2.14 ± 0.56D vs. 1.89 ± 0.63D), difference vector (0.43 ± 0.28 vs. 0.34 ± 0.24 vs. 0.80 ± 0.52), correction index (0.96 ± 0.15 vs. 1.02 ± 0.15 vs. 0.87 ± 0.21), angle of error (-3.38 ± 5.87°vs. -0.54 ± 4.04° vs. -7.23 ± 10.09°), flattening effect (1.87 ± 0.47 vs. 2.13 ± 0.57 vs. 1.74 ± 0.64), flattening index (0.93 ± 0.14 vs. 1.01 ± 0.15 vs. 0.80 ± 0.22), and index of success (0.23 ± 0.16 vs. 0.16 ± 0.12 vs. 0.38 ± 0.24) (<i>P</i> &lt; 0.05).</p> Conclusions <p>SMILE, FS-LASIK, and TICL implantation are all safe and effective for correcting myopia with high astigmatism. FS-LASIK demonstrated the best correction effect on high astigmatism, followed by SMILE and TICL implantation.</p>