Cataract remains the leading cause of blindness worldwide. Although the number of cataract operations has increased as a result of the WHO/IAPB Vision 2020 initiative, poor visual outcome following surgery remains a major concern. Populationbased studies in Asia, Africa, and Latin America have found that at least 20% of operated cataract patients have a presenting vision less than 6/60. Any surgical method that improves the visual outcome of cataract surgery would be an important contribution to Vision 2020. 

Phaco surgery in developing countries is only slowly coming up because of the high cost for the machine, the accessories and foldable IOL, inadequate phaco training centers and too many patients with advanced cataract, where often the nucleus is very hard, too difficult and dangerous for phaco.