PURPOSE. Assessment of the relative performance in measuring corneal shape and corneal aberrations for two specular reflection topographers: Keratron Placido Ring Topographer, VU Topographer, and two slit-lamp imaging instruments: Orbscan II and Topcon SL-45 Scheimpflug. METHODS. Corneal height maps of the anterior corneal surface were obtained from a group of 34 subjects with all four instruments; posterior corneal surface height maps were only obtained with the two slit-lamp imaging instruments. Corneal surface shapes are calculated in terms of radius of curvature and asphericity fitting an aspheric model. Wave aberrations for the anterior corneal surface and the total cornea are determined up to and including sixth order Zernike convention by means of ray tracing. RESULTS. Clinical relevant differences were observed for radius of curvature of the anterior corneal surface, where the slit-imaging instruments measure higher values (mean difference = 0.05 mm, p < 0.05) and anterior corneal astigmatism for which the Orbscan II measures higher values than the VU Topographer [mean difference = 0.174 μm (0.134 Equivalent Diopters), p < 0.01]. Small significant differences were observed for asphericity and spherical aberration of the anterior corneal surface; however, these are not clinically relevant. Clinically relevant differences were also observed for posterior radius (difference = 0.135 mm p < 0.001), total corneal astigmatism (difference = 0.207 μm (0.159 Equivalent Diopters), p = 0.001), and central corneal thickness (CCT) (difference = -18.6 μm, p < 0.001). The differences found for total corneal coma and trefoil were not clinical relevant. Furthermore, the precision of the specular reflection topographers is superior to that of the slit-lamp instruments by at least a factor of two. CONCLUSIONS. For traditional spectacle and contact lens applications, the corneal topographers are interchangeable except for measuring anterior radius of curvature. However, for more modern techniques as customized corneal refractive surgery, the subtle differences (e.g., total corneal astigmatism and CCT) between the instruments are clinically relevant. © 2009 American Academy of Optometry.