BACKGROUND Cataract surgery is the most frequently performed surgical procedure. The surgical outcome in terms of visual acuity depends on surgical technique and type of intraocular lens used. In this article, we are comparing Manual Small Incision Cataract Surgery (MSICS) and Phacoemulsification in senile cataract. The aim of this study is to compare the efficacy, visual results of MSICS and phacoemulsification for the treatment of senile cataract. MATERIALS AND METHODS Here, we studied 100 patients who were randomly grouped under MSICS and Phacoemulsification group. Both the groups had 50 patients each. Patients were examined at the end of 1 st and 6 th postoperative weeks and Surgically Induced Astigmatism (SIA) was calculated at 6 th postoperative week. The uncorrected and the best-corrected visual acuity was recorded and a slit-lamp examination and auto-refractometer and keratometry examinations were also done. RESULTS In our study at 6 weeks post-operatively, we found SIA in SICS group has an average value between 1 and 1.25D with a mean of 1.125D. On the other hand, SIA in Phacoemulsification group has an average value between 0.5D and 0.75D with a mean of 0.625D. CONCLUSION The postoperative improvement in visual acuity with manual small incision cataract surgery and with phacoemulsification was good. The improvement in visual acuity with small incision cataract surgery (SICS) was comparable to phacoemulsification, although phacoemulsification gives better visual acuity at 6 weeks. Lower rate of surgically induced astigmatism was found with phacoemulsification when compared to the small incision cataract surgery.