Over one million Americans have undergone refractive keratoplasty since the introduction of radial keratotomy into the United States in 1978. There are now a number of alternative techniques available for reshaping the corneal surface to alter ocular refractive errors. Numerous technologic advances in the past decade now enable us to perform these procedures in a safer and more reliable fashion. The ability to control precisely the refractive outcome, however, continues to elude us and appears to be limited, in part, by interindividual variability in the wound healing response. Presently, we review the corneal wound healing response to various keratorefractive approaches and suggest some interventional strategies which might enable us to modulate more precisely our refractive results.