High-order aberrations (HOAs) are optical defects that degrade the image quality. They change with factors such as pupil diameter, age, and accommodation. The changes in optical aberrations during accommodation are mainly due to lens shape and position changes. Primary spherical aberration (Z(4.0)) is closely related to accommodation and some studies suggested that it plays an important role in the control of accommodation. Furthermore, central and peripheral HOAs vary with refractive error and seem to influence eye growth and the onset and progression of myopia. The variations of central and peripheral HOAs during accommodation also appear to be different depending on the refractive error. Central and peripheral high-order aberrations are closely related to accommodation and influence the accuracy of the accommodative response and the progression of refractive errors, especially myopia.