If you’re a beginner cataract surgeon eager to gain independence, there’s a strong chance you’re focusing on phacoemulsification first. After all, phaco is the gold standard, right? Every high-end hospital and premium practice runs on phaco, and no one wants to be left behind.
But here’s the harsh reality: jumping straight to phaco without mastering SICS will make you a slower, weaker, and more dependent surgeon.
Surprised? Let’s break it down.
Why Beginner Surgeons Struggle With Phaco
Phaco is not technically hard— it’s just unforgiving. Mistakes snowball fast. A shallow chamber, a slightly aggressive foot pedal movement, or poor fluidics can turn a simple case into a nightmare. If you’re hesitant, slow, or unsure about basic steps, your trainer will have to keep jumping in to rescue you.
This is why many trainees, even after months of exposure to phaco, still lack confidence. They hesitate, wait for their seniors to guide them, and remain stuck in the observer mindset. They may complete cases, but they don’t own them.
And the worst part? They feel like they’ve “learned” phaco but can’t operate independently.
How SICS Forces You to Think Like a Surgeon
SICS (Small Incision Cataract Surgery) is the best training ground for developing true surgical independence. Here’s why:
1. You Are in Full Control From Start to Finish
SICS is manual surgery. You’re responsible for every step—wound construction, capsulorhexis, nucleus delivery, and cortex wash. You don’t have phaco fluidics or ultrasound to “help” you; you must learn how to mechanically handle the eye.
This forces you to develop good hands, solid tissue handling, and decision-making ability under pressure—all essential for phaco.
2. You Learn to Handle Any Nucleus, Not Just the Easy Ones
Phaco beginners often get soft nuclei to start with. The moment they encounter a hard nucleus, they struggle with chopping, foot pedal control, and fluidics.
SICS doesn’t let you hide from hard cataracts. You learn nucleus management early, so when you switch to phaco, you already understand how different densities behave.
3. You Become Fearless About Wound Construction and Suturing
One of the biggest fears in phaco is wound-related complications—leaks, iris prolapse, poor tunnel construction. In SICS, you build a strong foundation in wound architecture. You’ll also master suturing, which is a dying skill among phaco trainees.
This confidence translates directly to phaco: you’ll create better clear corneal incisions and know how to fix them if needed.
4. You Become Faster
Since SICS doesn’t rely on expensive machines, it’s often performed in high-volume settings. If you do enough cases, you develop speed naturally— something many phaco trainees struggle with.
When you transition to phaco, your hands are already trained to work efficiently and decisively. Instead of struggling with basic hand movements, you can focus on mastering the finer points of phaco technique.
Why SICS First = Faster Independence
Many surgeons delay independence because they are stuck in a passive training cycle: they keep waiting for “permission” to take full control of their cases.
SICS forces you out of this mindset. Since it’s a complete, stand-alone technique, you won’t have an excuse to let others step in. The more you operate alone, the faster you gain confidence.
When you later transition to phaco, you won’t be a hesitant, overcautious beginner anymore—you’ll already think like an independent surgeon.
Counterargument: “But Phaco Is the Future”
Yes, phaco dominates in urban practices. But ask yourself:
- Do you want to be a surgeon who can handle only ideal cases, or do you want to be the one people trust with any case?
- Do you want to struggle through phaco training for years, or become fully independent in a few months with SICS as your foundation?
In the long run, surgeons who build their skills first (through SICS) transition to phaco faster and more confidently than those who avoid SICS altogether.
Bottom Line: If You Want to Be Independent Fast, Start With SICS
If your goal is to be a confident, self-sufficient cataract surgeon, learning SICS first will get you there faster. It builds your core skills, makes you fearless, and prepares you to take full control in surgery.
Don’t fall into the trap of chasing phaco too early. Master the basics, develop real independence, and then take on phaco like a pro.
What’s Next?
- If you’re struggling with confidence in your training, start asking for more SICS cases instead of waiting for phaco.
- If you’re already learning phaco but feel dependent, it might be better to consider strengthening your SICS skills.
The surgeons who win are the ones who build real skills, not just those who chase the latest technique/technology.