Aim: A comparative study to evaluate visual outcome in post-operative patients of Manual Small Incision Cataract Surgery and Phacoemulsification. Design: A prospective, comparative hospital based interventional study was conducted on 246 eyes having visually significant senile cataract undergoing cataract extraction surgery by either of two methods vis Manual Small Incision Cataract Surgery or Phacoemulsification at Regional Institute of Ophthalmology, Pt.B.D.Sharma PGIMS, Rohtak. A detailed post-operative examination was carried out on first post-operative day, then follow-up of patients of both the study groups regarding BCVA was carried out in Eye O.P.D. on 7th, I month. Results: Although the initial visual recovery on the 1st postoperative day was better in the patients who underwent phacoemulsification, with the uncorrected visual acuity better than or equal to 6/18 in 74% of the patients, whereas the percentage was 58.5 % in the SICS group. Similarly BCVA 6/18 or better on 7th post-operative was 100 % in the Phacoemulsification study group as compared to 87% SICS (p=0.010) group. Initial difference in visual outcome was nearly equalized within 1 month in both the study groups. There was no significant difference between the M-SICS & Phacoemulsification in terms of BCVA at Post-Operative 1 month, Post-Operative Spherical Refraction at 1 Week (p = 0.693) and 1 month (p = 0.640). But there was significant difference between two groups in terms of Cylindrical Refraction at Post-Operative 1 Week) (p=<0.001) and at 1 Month (p = <0.001) with the median Post-Operative Cylindrical Refraction higher in M-SICS group at 1 week & 1 Month. The median Post-Operative Cylindrical Refraction difference is all due to the fact that M-SICS had larger surgical incision causing higher surgically induced astigmatism. Conclusions: Phacoemulsification gives better uncorrected visual acuity (UCVA) at post-operative day 1 and better BCVA at 1week and Post-Operative Cylindrical Refraction at 1 Week and at 1 month. Whereas, BCVA at 1 month is similar in both the study groups MSICS and Phacoemulsification.