Should I choose monovision or multifocal for cataract surgery?

The choice is always a tradeoff and each person may have different priorities, so there is no single best choice for everyone.

Symfony and multifocal IOLs have side effects that affect night vision with circles/spiderwebs and/or halos/starbursts.

For someone who drives a lot at night, those effects may be too much negative compared to the positive of a larger focus range.  Monovision may be a better choice in that case.

For someone who rarely goes out at night, the opposite may be a better choice.

There are also other combinations such as a monofocal IOL in one eye with a multifocal or Symfony in the other eye - kind of a more advanced form of monovision.

It is a hard decision to make.  Financially due to the fact I live in Canada the cost variance wasn’t big.  The surgery is completely covered by our Medicare system no matter which lens I chose.  I chose Symfony lenses and paid a total of $1,800.  

There are compromises to either decision and only you can decide which is more important to you.  All things being equal it was important for me to have an excellent surgeon that could hit the target (or close to it) so that my day vision was good.  I don’t wear glasses and can see to read from 11 inches and beyond.   At night I see concentric circles around some light sources.  Those in addition to the glare and starbursts first 5 or 6 weeks made driving challenging.  Glad the glare and starbursts subsided and I am left with the concentric circles which I doubt will go away.   Overall I  happy with my vision and decision.

I probably won't add a whole lot of useful information here, but just to say that I'm in the same decision "boat" so to speak.    I went in thinking I was going to be recommended a multifocal lens of some kind and was then told to consider mono-focal in one eye for distance and use my other (non-cataract) nearsighted eye for near.   To me it's coming down to a decision of halos vs clarity.  I'm probably going to choose clarity because I do see myself doing some night driving.    

For what it's worth, I've also read that many mono-focal lens users often see well at intermediate distances, and some see quite well at reading distance too.  So if I find myself using reading glasses occasionally, I don't think I'll mind it too much.  I still need to schedule my surgery but I believe I've made up my mind to go with a mono-focal lens in my cataract affected eye. 

G

I have had a bad night time problem with my one Symfony Lens with huge starbursts from oncoming headlights and a general glare issue.  So, I put a monofical  in my other eye and it is much better.  I’m considering having the Symfony taken out and replaced with monofocal.   

As some others have said, starbursts are possible with any type of IOL I was debating between a monofocal IOL with multi-focal contacts, a low add multifocal IOL and a Symfony EDOF. I ended up choosing a Restor 2.5D, which is a low-add multi-focal. I'm 23-days post surgery (so still in the healing stage) and while I still have some issues that I'm dealing with, I can say for sure that night vision isn't one of them. I'm able to compare the operated eye to one that is still quite good so I don;t have to rely on memory to make this comparison.

The loss in contrast sensitivity is there, but barely perceptible and the halos are still distinct and rather bright but also small enough that they don't bother me at all. If you go with a higher-add multifocal, the halos will be larger and I that's what is going to make nighttime driving difficult. 

I've been describing this like this to other people -  If you look at a car and the headlight appears 2X it's "true" size that still means that the edge of the light from the headlight that you see still ends before the edge of the car, so if there is an obstacle just past that car, you'd still be able to see it. However, if the halo was 4X the size of the headlights, the edge of the headlight glare would extend past the edge of the car and it would obscure your view of other objects.  

It's a personal thing though as to whether or not you can personally live with this artifact or the ones possibly with Symfony lenses. I think that most doctors will tell you that your brain will eventually disregard these types of artifact, but if you understand them and decide that you can live with them (in advance) then you'll be much happier with the results. 

Since you are contact lens wearer, you could also try multifocal contacts (if one of your eyes is still good). If you try them, do not get discouraged if one type or two (or even five) test lenses doesn't work. My personal experience is that these types of lenses have a very narrow band over which they will work given different eye characteristics, but if you get one that does work for your eyes it it can work extremely well. You have to persistent with your optometrist to keep experimenting with samples.