Decentration occurs when surgical effects result in asymmetric alterations of the eye’s optical system, leading to higher-order aberrations and decreased vision quality. Subjective symptoms include blurred vision, ghosting, poor vision in low light, and glare or halo. Objective signs include decreased visual acuity, variable visual acuity, difficult refraction measurement, and increased higher-order aberrations. The key to preventing decentration is preoperative data validation, patient education, laser calibration, and proper patient positioning and fixation during surgery. Mild symptoms can be treated with laser enhancement, glasses or contact lenses, or miotic agents to help reduce symptoms by blocking peripheral light rays.