In a conversation with Dr. David Goldman, Dr. Elizabeth Davis outlines recent improvements in microincisional coaxial phacoemulsification and shares her wisdom on phaco techniques. The trend is toward decreasing incision size. This is a result of better viscoelastics (VSDs), antibiotics, NSAIDs, steroids, and advancements in foldable IOLs. Adoption of bi-axial phaco in the US was slow for a host of reasons. The move toward coaxial-MICS: no real technique change is required. The sub 2.0 coaxial phaco fluidics enhancements have allowed for better followability and control, reduced phaco energy, while allowing chamber stability. Fitting the IOL through the sub 2.0 incision is still a challenge. Making a new incision may be the solution: it seals better and reduces astigmatic change (less than 0.25D change). Dr. Davis then reviews her 1.8mm technique and her patient outcomes. Now uses Stellaris system and supra-capsular approach with a venturi mode and 600mm mercury. Systems that allow for MICS are adaptable to all techniques and all surgeons. New lenses that may fit through a 1.8 (such as the Akreos) may be available in the US in 6 months to a year.