Objective To compare and analyze the visual outcome and safety of phacoemulsification with small incision non-phacoemulsification for cataract and provide a reference for the selection of surgery methods in Tibet.Methods A prospective cohort study was performed.Eighty eyes of 80 consecutive patients with age-related cataract were included in Titet Autonomous Region Tibetan Tradition Medicine Hospital from July to August 2016.The eyes were assigned to non-phacoemulsification extracapsular cataract extraction with small incision combined with intraocular lens (IOL) implantation group (small incision group) and phacoemulsification extracapsular cataract extraction combined with IOL implantation group (phacoemulsification group),with 40 eyes for each group.The uncorrected visual outcome and complications were compared between the two groups after surgery.Results There were no significant differences in gender,age,preoperative visual acuity,and lens nuclear hardness between the two groups (all at P＞0.05).The eyes in various post-operative uncorrected visual acuity outcome was not significantly different 1 day and 5 days after surgery between the two groups (both at P＞0.05).In the fifth day after surgery,the eye number in various post-operative uncorrected visual acuity outcome was not significantly different in the eyes with grade Ⅱ and Ⅲ nuclei between the two groups (Z =0.503,P =0.478;Z =0.952,P =0.329).The eye number of acuity ≥0.5 in the small incision group was significantly more than that in the phacoemulsification group in the eyes with grade Ⅳ nuclei (Z =4.501,P =0.034).The eye number with post-operative transiently ocular hypertension was increased in small incision group compared with phacoemulsification group.Conclusions Non-phacoemulsification surgery with small incision has comparable visual outcome with phacoemulsification surgery,and small incision nonphacoemulsification surgery combined with IOL implantation can serve as the preferred surgical method in basic level medical institutions of Tibet.