AIM: To explore choroidal thickness (CT) and choroidal vascularity index (CVI) changes around the macula and optic nerve head (ONH) using swept-source optical coherence tomography (SS-OCT) after small-incision lenticule extraction (SMILE) and evaluate their associations with accommodation and aberrations. METHODS: Participants were divided into more myopic group (43 eyes) and less myopic group (33 eyes) according to refractive error. SS-OCT, negative relative accommodation (NRA), and positive relative accommodation (PRA) were analyzed before and 1d, 1wk, and 1mo postoperatively. Root mean square higher-order aberrations (RMS HOAs), spherical aberrations (SAs), and coma were compared preoperative, 1wk, and 1mo postoperatively. RESULTS: After surgery, RMS (0.29±0.26) and Coma (0.16±0.19) all increased. In the more myopic group, central and T1 macular CT (247.58±63.81 and 276.45±62.52 µm) increased. NRA (0.41±0.51) and PRA (0.10±1.30) decreased, and SAs (0.21±0.21) increased. In the less myopic group, all regional and mean macular CT increased. NRA was correlated with mean and inferior CTs and mean ONH CVI. SE was correlated with macular CT, CVI, and ONH CT. Mean macular and ONH CTs were associated with RMS HOA, SA, and coma. Macular T2 CT was a significant predictor of SA. Macular T2 and N1 CT were correlated with coma. CONCLUSION: More variations in accommodation and aberrations and fewer choroid thickens on macular and ONH are found in more myopic eyes after SMILE. Choroidal values are associated with accommodation and aberrations during SMILE. Choroid parameters on SS-OCT varies in eyes with different refractive errors after SMILE and has an association with accommodation and visual quality.