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Phaco or SICS: which cataract surgery is right for me?

Two methods of cataract surgery are in wide use in India: phaco and manual small-incision cataract surgery (SICS). Our eye surgeon at ReNew Vision Eye Hospital does both. This guide explains how each is done and how the choice is made, so that the advice you are given at the consultation makes sense. For the full picture of cataract care, see cataract surgery in Vasco, Goa.

What is phaco surgery?

Phaco is short for phacoemulsification. The surgeon makes a very small opening, about 2 to 3 mm, at the edge of the cornea, the clear front window of the eye. A round opening is made in the front of the lens capsule, the thin bag that holds the natural lens. A fine probe then uses ultrasound energy to break the cloudy lens into tiny pieces and remove them, while fluid keeps the eye's shape.

The capsule is left in place. A foldable artificial lens is pushed in through the same small opening, rolled up like a tiny tube, and it unfolds inside the capsule. The opening is small enough that it usually seals by itself. Phaco is often done with numbing drops alone, sometimes with an injection near the eye as well.

What is SICS?

In manual small-incision cataract surgery, the surgeon makes a tunnel-shaped opening of about 6 to 7 mm in the white of the eye (the sclera), just behind the edge of the cornea. The tunnel runs at an angle, like a pocket, so that the pressure inside the eye later presses it closed. The cloudy lens is eased out whole through the tunnel, without ultrasound, and the artificial lens is placed in the capsule.

Because the opening is wider, the surgeon can use either a rigid or a foldable lens; you will be told which is planned. SICS is usually done after a numbing injection near the eye. It is widely used in India and suits the kind of cataracts often seen here, including very hard, brown or white ones.

How are phaco and SICS different?

• Size and place of the opening: phaco uses about 2 to 3 mm at the edge of the cornea; SICS uses about 6 to 7 mm in the white of the eye.
• How the cataract comes out: in tiny pieces with ultrasound in phaco; whole, by hand, in SICS.
• Hard cataracts: a very hard cataract needs a lot of ultrasound energy to break up, which can strain the cornea. SICS often suits these eyes.
• Stitches: both openings are designed to seal by themselves; occasionally a stitch is needed with either method.
• Recovery: vision often clears a little sooner after phaco, and its smaller opening changes the shape of the cornea less. With spectacles, the final vision after both is similar in studies; without spectacles, phaco may give slightly sharper vision.
• Special lenses: toric and multifocal lenses need very precise placement and a predictable cornea, so they are usually put in with phaco.
• Cost: phaco often costs more, because of the machine, its consumable parts and the foldable lens. See what decides the cost.

Which cataract surgery is better?

Neither is better for everyone. Large studies in India and Nepal have compared the two, and both can give good vision when done well. The right method is the one that suits your eye. Our eye surgeon looks at:

• How hard and how mature the cataract is
• The health of the cornea
• How wide the pupil opens with drops
• Other eye conditions, such as glaucoma, diabetes changes in the retina or an old eye injury
• The lens you want, since toric and multifocal lenses usually need phaco
• Your general health, for example whether you can lie flat and still for half an hour

The surgeon explains the reasons for the advice, and you decide together. If you are choosing a lens at the same time, read choosing a lens for cataract surgery.

Is cataract surgery done with a laser?

Many people think so, but phaco uses ultrasound, not a laser, and SICS uses neither. At ReNew Vision, cataract surgery is done by phaco or SICS. A laser does come in later for some people: if the capsule behind the new lens turns cloudy months or years after surgery, a YAG laser clears it in a few minutes. Read YAG laser after cataract surgery.

Are the risks different?

Both are established operations, and serious problems are uncommon with either. The possible risks are of the same kinds: infection inside the eye (rare but serious), inflammation, a rise in eye pressure, swelling of the cornea or of the centre of the retina, a tear in the capsule, and rarely retinal detachment. Your surgeon explains the risks for your eye, which depend more on the eye itself than on the method.

Is the day of surgery the same?

Yes, broadly. Both are day-care operations under local anaesthesia, both often take about 15 to 30 minutes, and you usually go home the same day with a shield and eye drops. The precautions afterwards are much the same. The step-by-step day is described in cataract surgery: what to expect.

What should I ask the surgeon?

• Which method do you advise for my eye, and why?
• Which lens will be used, and is it rigid or foldable?
• Will I have drops alone, or an injection as well?
• Does anything about my eye make the surgery more complex?

To book a cataract check-up, call or WhatsApp ReNew Vision Eye Hospital on 072489 88039. The eye OPD in Vaddem, Vasco is open Monday to Saturday, 4 pm to 7 pm.

Questions patients ask

Is phaco better than SICS?

Neither is better for everyone. Both are established methods that can give good vision. Phaco uses a smaller opening and vision may clear a little sooner; SICS often suits very hard cataracts. Your surgeon advises the method that suits your eye.

Are stitches needed in phaco or SICS?

Usually not. Both openings are designed to seal by themselves. Occasionally a stitch is needed with either method, and your surgeon will tell you if one was used.

Which method is used for a very mature cataract?

SICS often suits very hard or white cataracts, because breaking them up with ultrasound needs a lot of energy. The surgeon decides after examining the eye.

Can a toric or multifocal lens be put in with SICS?

These lenses need very precise placement, so they are usually put in with phaco through a small opening. Your surgeon will tell you which lenses suit the method planned for your eye.

Is recovery different after phaco and SICS?

Both are day-care operations with much the same drops and precautions. Vision may clear a little sooner after phaco, but after a few weeks most eyes have settled with either method.

This page is general eye-health information, not personal medical advice. Your eye doctor advises you after examining your eyes.