This question is posed and answered in greater detail in my blog on important factors to consider before cataract surgery. This is a link to this authors posting: http://www.medhelp.org/user_journals/show/841991
The fact that you say you "only needed reading glasses till last year" calls into question whether part or all of the astigmatism is from the cataract, especially if the catarct seems to have impacted your prescription to make you myopic. Its possible you did have the astigmatism before and it just wasn't causing enough issues to bother correcting it. Did you have prescription readers before, did they have a correction for astigmatism?
If the cataract is inducing the astigmatism, then it may be you don't actually need a toric IOL or other astigmatism correction since the astigmatism goes away when the natural lens is removed. When my cataract first appeared in one eye at age 49 it went from -0.75D to -4D of astigmatism within 3.5 months, while a corneal scan, rounding to nearest 0.25D showed only 0.25D of astigmatism. That reduced a bit over time before surgery (with the eye getting far more myopic instead). The more precise reading at the preop visit the week of surgery showed only -0.17 of astigmatism in that eye, and I got a spherical IOL and postop all my refractions have shown 0D of astigmatism for that eye.
Even if the cataract isn't shifting the astigmatism, the prescription doesn't tell how much corneal astigmatism you have. The refraction is the result of the entire eye acting as a lens, and there can be astigmatism on the cornea but also in the natural lens itself. Unless a cataract is impacting it, lenticular astigmatism is usually fairly small, but it could be in either direction so it might counterbalance corneal astigmatism, or add to it.
If they did a corneal scan that might give a clue how much astigmatism you have, though sometimes they won't be measuring "total astigmatism" until he preop visit since many corneal scans used for other purposes only measure anterior corneal astigmatism, the surface of the eye. Surgeons used to assume posterior corneal astigmatism was small enough to ignore, but they figured out unexpected levels of postop astigmatism were due to posterior corneal astigmatism that wasn't being measured. Not all equipment measures it still, so ideally you'd have a doctor with up to date equipment to be sure they are measuring posterior corneal astigmatism as well.
If your prescription astigmatism of 1D and 0.75D were your actual corneal astigmatism, those are in the range where it depends on the surgeon how they'd prefer to correct it. Some prefer to correct low levels of astigmatism via surgical incisions which cause the eye to reshape (often LRIs, Limbal Relaxing Incisions), which can be less predictable, while others prefer toric IOLs. It may partly depend on if they are using a laser to make more precise incisions which they prefer.
Low levels of astigmatism can extended depth of focus a bit, which can be useful with a monofocal, but as it grows the blur outweighs the benefit. With premium IOLs they tend to want <= 0.5D of astigmatism postop. (although my first eye has 0D cylinder, my 2nd eye was at -0.5D initially postop, but last check -0.25D).
In terms of "it suggests that multifocals come with a lot of issues. ". The vast majority of people are happy with multifocals, the issue is merely that a minority of people have problems so that needs to be taken into account. In my case having a cataract at an atypically young age, I decided the high odds of having more useful vision for what might be a few more decades (at your age you have almost 30 years more expected) made it it worth the tiny risk I'd need a lens exchange for a monofocal (with the very slight risk that adds).
It partly depends on how much you value not needing to wear correction. I was extremely nearsighted and needed contacts/glasses for everything before surgery. I figured if I were going to need surgery anyway, it'd be nice to not need correction the rest of my life, e.g to never need to worry about not having it during an emergency or accident, etc.
It also depends on how much you like monovision. Usually when people have cataracts that are ready for surgery their vision is too reduced to be able to get an accurate test of options, otherwise a contact lens test of contact lenses in monovision, or multifocal contacts, would provide at least some clues about preferences (even if they aren't the same as IOLs would be). I liked monofocal contacts and didn't notice any loss of depth perception, but when I switched to multifocal contacts I'd seen the world get subtly more 3D than it had been. I also figured planning for the future that some studies showed a slight risk of falls in the elderly for those with monovision corrections or those wearing progressive glasses or bifocal glasses. Even now I figure when jogging/hiking on rocky trails its likely useful to have crisper vision with both eyes.
I went with the Symfony, which is an extended depth of focus lens rather than a multifocal. Some surgeons confuse it with a multifocal since it also provides more near then a monofocal, and uses diffractive rings, but it uses diffractive optics differently and so it has a low incidence of night vision artifacts. The risk seems to be comparable to monofocals, but not as low as the best monofocals like the Tecnis control it was studied against. e.g. see:
"High rates of spectacle independence, patient satisfaction seen with Symfony IOL"
and here is a recent publication that asked what some surgeons would use if they needed cataract surgery:
In my case I was planning to go outside the US to get a trifocal that wasn't approved here, and then the Symfony was approved in Europe a couple of years before it was available here and I figured it was a better fit for my needs. I had both eyes done in the Czech Republic for less than I'd have spent for my deductible if I'd gotten it done here, including travel (and technically one eye wouldn't have been covered since its cataract wasn't yet advanced enough, it was clear lens exchange).
I really appreciate all the information you and Dr Hagan have provided!!
After much reading I am looking to investigate the symfony IOL
I was wondering what you and Dr Hagan thought of the Sympfony IOL VS the minimonovision in my case
In terms of choosing monofocals, I just saw a news article about a meta-study (study of multiple studies) about the issue of blue blocking IOLs, which notes in summary:
“On the basis of currently available evidence, one cannot advocate for the use of blue-light-filtering IOLs over UV-only filtering IOLs,” wroite X. Li, Waterford Institute of Technology, Waterford, Ireland, and colleagues. "
Here are some recommendations I got from doctors when I had emailed them last year.
San Antonio - Harrison Bowes,
Bill Flynn: http://www.rashidriceflynn.com/doctors.html
Dr. Robert P. Green, Jr., at 414 Navarro
Dr. Dudley H. Harris, at 800 McCollough
Dr. Nader Iskander, MD
Dr. Gregory Parkhurst, MD
Houston: Dr Stephen slade, Michael Mann, Douglas Koch
Austin, there is Steven Dell.