OBJECTIVE To evaluate measurement repeatability and clinical results for pyramidal aberrometry in routine myopic wavefront-guided laser in situ keratomileusis (LASIK). METHODS Results from 265 consecutive eyes treated with myopic wavefront-guided LASIK using the Amaris 1050RS Excimer Laser and Peramis pyramidal aberrometer (SCHWIND eye-tech-solutions GmbH) were reviewed. Limits of repeatability were calculated for the aberrometric refraction spherical equivalent and higher order aberrations for the Peramis aberrometer using results from three consecutive scans acquired preoperatively and postoperatively for the first 100 eyes treated. RESULTS The 95% limits of repeatability for pyramidal aberrometric measurement were: 0.3 diopters (D) for sphere, 0.2 D for cylinder, and 0.1 D (dioptric equivalent) for 3rd and 4th order aberration indices. A total of 95% of eyes were within ±0.50 D of the manifest refraction spherical equivalent target postoperatively. Uncorrected distance visual acuity was 20/20 or better in 96% of 232 eyes with a plano refraction target outcome. A total of 97% of eyes had a refraction cylinder of 0.50 D or less. No eyes lost one or more line of corrected distance visual acuity. CONCLUSIONS These data demonstrate good measurement repeatability, safety, and efficacy for pyramidal aberrometry in routine myopic LASIK. [J Refract Surg. 2020;36(7):442-448.].