Manual small incision cataract surgery (MSICS) differs from traditional extracapsular cataract extraction (ECCE) surgery in that a smaller incision is used, resulting in less astigmatism, faster visual rehabilitation, and better early postoperative vision. Additionally, some studies have shown that MSICS is more cost-effective compared to ECCE (Jongsareejit A, Wiriyaluppa C, Kongsap P, Phumipan S. Cost-effectiveness analysis of manual small incision cataract surgery (MSICS) and phacoemulsification (PE). J Med Assoc Thail Chotmaihet Thangphaet 95:212–220, 2012). Outcomes are typically similar, and the initial incision is very similar to a scleral tunnel. Before beginning, IOL calculations should be obtained, and the surgeon should plan for a temporal approach if there is more than 1.00 D of astigmatism, as MSICS will still have a significant astigmatic impact. Prior to attempting MSICS, it may be best to have a basic grasp of scleral tunnel incisions and phacoemulsification techniques (Hausheer JR, ed. Basic techniques of ophthalmic surgery, 3rd ed. American Academy of Ophthalmology, 2019).