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Keep up-to-date on the latest vision-related news and eye care events in our Practice.

8 Tips to Relieve Winter Dry Eyes

Whether you live in a climate with cold winter weather or you are planning a ski trip up north, winter can be a challenge if you suffer from dry eyes. Dry, cool air, cold winds and even drier indoor heating can cause eye irritation, burning, itchiness and redness, and sometimes...

Diabetes and Your Eyes

Prominent NYC Park Avenue eye surgeon Dr Emil Chynn discusses how to preserve vision if you have diabetes

Have an Eye Safe Halloween New York, NY

Dr. Emil Chynn the top LASEK surgeon in the US discusses eye safety for Halloween

Exercise and Your Eye Health | New York, NY

Regular exercise is an essential component of overall health and wellness. It is proven that exercise reduces sickness and disease; it increases strength, immunity, and mental health; and it also helps regulate bodily functions and maintain a healthy weight. Research shows that exercise can lower our risk of chronic conditions...

Is Too Much Screen Time Dangerous For Your Kids?

Dr. Emil Chynn, MD, MBA discusses helpful hints to prevent damage to kids' eyes from screens

Healthy Aging for the Eyes

Dr. Emil Chynn provides some very useful tips on how to maximize eye health despite aging

Dr. Chynn bicycle riding for a good cause

Dr. Chynn was a part of Benz Lisbon bicycle event.

LASEK Testimonials

LASEK is the most advanced version of laser vision correction that is possible with modern medicine today. LASIK is 10x as risky, reduces the structural integrity of your eyes, can worsen glares, halos, and dry eyes, may not get you to your best vision possible. There are also issues of...

The power of CXL + PRK

James wrote to Dr. Chynn (dr. Chynn’s answers are bold): Emil, What brands and doses do you use for the topical and oral NSAIDs and the topical and oral steroids? The brand of oral NSAID matters not. It’s just for pain relief BC systemic anti-inflammatory. Use generic ibuprofen 800 mg w every meal to...

ASA Retreat

Dear David et al Sorry for my delay in responding. I’m visiting my girlfriend’s family in a rural part of Bulgaria wo internet – can you believe that?;) It’s important to always search very carefully for the cause of over and under-corrections, or you won’t really get at the root...

Research Methods Rigor

Minas, Clive, et al First of all, I’d like to congratulate Minas on finding an article I had published in Arch Ophth over 20 years ago, that I myself had forgotten about. It does speak to the point that I’ve both performed “real hard” research myself (eg as a PI...

Nursing and LASIK

Q: I think a lot of this can be simply answered by asking ourselves the following question: If your wife/sister/daughter were pregnant and wanted refractive surgery, would any of us do it? Or wait till post delivery and post nursing? No need for further studies, IMHO. — Kamran A by...

Dr. Elghobaier, former fellow

Working with Dr. Chynn as a refractive fellow at PAL is a great experience I will never forget. It’s very hard to summarise all what I gained in such few words. At PAL all staff are multifunction, well trained and continuously educated. Any mistake is analysed in front of all...

A doctor had post-LASIK complications, here is Dr. Chynn’s answer

Q: I would be most thankful if you could give me your precious input in this case. The 35 yo patient had a LASIK in both eyes 8 months ago, in her 1st post op day, she had both eyes dislocated flaps and epithelial ingrowth after that. However, the bilateral weird lesions were...

Dr. Chynn on SMILE procedure

A college of Dr. Chynn inquired about the new SMILE ReLEX procedure Q: I have a friend in London with myopia (-1.75 & -2.75, Aet ~ 40 & female) considering refractive surgery. Is it time for SMILE (1,2) or if it were your family member would you do LASIK … or...

Commenting on an article by another doctor

Q: Gurus I have been asked to defend the ophthalmic surgeons request to use multidose eye drops for dilating patients in pre op prior to ophthalmic surgery Our pharmacy and risk management  leaders are against this despite the recent and seemingly never ending shortage and high cost of single use...

Dr. Chynn’s comments on eye drop regime

Q: There being no hard evidence that postop antibiotics reduce the incidence of endophthalmitis, we do this because it makes some logical sense, and if challenged we can say we did “something” to prevent endophthalmitis postop. But, we could also make a defensible argument that they are not necessary. That...

Dr. Chynn’s comments on CXL

Q: Dear Not sure if this topic has already been discussed (and if so, can somebody please forward me the conclusion of that discussion?) If you receive a post LASIK Ectasia in one eye after bilateral LASIK treatment, would you do CXL only in the affected eye or would you...

Dr. Chynn on NSAID effects on overcorrections post PRK

Comment from another MD Evan’s post  was asking “anyone had issues with poor epithelial healing (or even corneal melting) with Besivance”.  My response is based on my clinical referral practice and the attached document. Please note this section from the attached document: These medications contain vehicles that have the potential...

Dr. Chynn on besivance

Q: Anyone had issues with poor epithelial healing (or even corneal melts) with Besivance? A: I’ve heard of this but think it’s BS because I’ve done literally 1,900 LASEKs using Besivance so if there was a true association I’d notice it by now as melts would be more common in...

Dr. Chynn on same day bilateral cataract surgery

Q: Was a bit surprised that OMIC has granted liability coverage for same day bilateral cataract surgery. They have suggestions but not underwriter requirements/ restrictions. Certainly a refusal to cover this could have discouraged ophthalmology from going further in that direction. I know same day cataract surgery has been discussed...

Thoughts on No-Touch-Prk modes on some lasers

I used to use MMC for Rx above -5, then had some late (>3 mo out) haze for -4, and rarely had it for -3 something so i reduced my limit for MMC (since it is really perfectly safe if diluted properly and applied on a sponge) to > -3...

49 yo after LASIK

Q: a 49 year old presents 2 months ago; she had Lasik in Ecuador early, 2014 and still doesn’t see well her exam shows an interface as to what appears an incomplete flap OU, just nasal to the visual axis and many nests of old epithelial cells in the interface...

Lid margin disease

Q: The conventional teaching for lid margin disease is to use an antibiotic oint to the lid margins at bedtime along with other therapy. If we continue ointment once alone for a long period, for maintenance, are we not using a subtherapeutic dosage and will this not promote drug resistance....

LASIK?

Q: I have a 26 yo healthy female (only med is a birth control pill, which she has been on for years) with the following refractive error: Current wear in glasses: OD: -2.50+1.00×83 OS: -1.75+1.25x96Manifest June 2014: OD: -2.25+1.75×80 OS: -1.75+1.50×100Manifest Dec 2014: OD: -2.50+1.00×85 OS: -1.75+1.25×95Her topos from June...

Dr. Chynn on The invention and basic science of the excimer laser

Fluence/mm2/sec but then got bogged down by the math and units and didn’t want to post something I wasn’t confident about I guess we should just say: “Haze can be induced by the (mild) thermal damage caused when the excimer laser photo disrupts covalent bonds of the collagen stroma. This...

ASA for High Astigmatism

Q: New pt came to see me earlier this week for a refractive evaluation. 26yo male with past ocular hx of high astigmatism, no family hx of keratoconus. Highly motivated, and understands higher likelihood for enhancement. I was thinking of ASA for him, but wanted some input. BCVA OD: +0.5-4.50×005...

ASA v PRK protocols

Q: Inspired by Emil, I made epithelial flaps for two patient on my last LVC day. One patient 20/20- POD#1 the other 20/30 POD#1 and 20/20 OD and 20/25 OS POW#1 (-3.50 preop MRx). Second patient had discomfort on POD#4; I think it likely was from a very tight CTL...

Epithelial Reattachment Following Surface Ablation

Q: Dear All, I’ve noticed during PRK enhancements over prior PRK, even years later, using a brush, that the epithelium is quite obviously not as adherent over the ablation zone as it generally is during primary PRK’s. This phenomenon would probably not be apparent during alcohol-assisted enhancements, since that method...

This Cornea and Refractive Surgery……

Q: Are there corneal thicknesses below which you would avoid any refractive surgery? I am considering PRK on this 34 y/o woman. Stable refraction for years. No family history of corneal disease MR: -3.00 -1.00 x 180 -3.00 -1.00 x 180 Pachymetry: 460 470 A: before 2005 or so we...

Trephine for ASA and alternate alcohol

Q: Emil: I’d like to try your technique. Can you share what your preferred trephine for ASA is (vendor, size, catalog #) ? For yours and the group’s interest: I’ve been using a corneal light protector sponge saturated with 70% Isopropyl alcohol (yep good old rubbing alcohol!) for 12 secs...

The role of non-peer-reviewed research (and forums like Keranet)

I’m not sure what the point of your original question was. You seem to be implying that if one of us shares his or her vast experience accumulated over decades of careful observations, until it’s published it isn’t in some sense “real” (or believable) We are all very busy and...

Rx of Granular Corneal Dystrophy in the USA in 2015

Q by Doctor Randy: Dear All, I have not seen the patient yet, but was called by a colleague who wanted to refer a 55 year old patient with the above to me for “corneal laser treatment”. I asked of the patient had any ocular surface disease/recurrent erosions, and was...

PRK or not to PRK

Q by Doctor P: I have a 37 yo high myope  (-9.00) with 500 u corneas. She has a small area in the left nasal cornea of endothelial haze No other signs/symptoms No history of HSV etc. specular right and left eyes clearly abnormal OS>OD (increased coefficient of variation, lower...

ANIRIDIA tatoo

Q: Dear Emyl I´m thinking if is a good case for corneal tattoo this case ? She is blind since child I would like to know more details about your thecnique What does it means  and how do you do ” injecting the ink orthogonal to the corneal surface using fine tattoo needles” Thanks A: i...

PRK v LASEK

PRK vs LASEK The basic difference has to do with the method of epithelial removal. In order of less cellular trauma, less inflammation, less pain and risk of scarring, and a cleaner bed, these are the generally recognized categories: “Old-fashioned PRK” – mechanically removing the epithelium with a spatula or...

Bulbar Conjunctival Tattooing

Q: Dear KeraNet Members, A 17 year old patient came into my office yesterday with her mother after having bulbar conjunctival tattooing done to both eyes four days ago with purple ink.  Pictures below. There is one entry point in each quadrant where the “body sculpting artist” dipped a needle into ink...

Custom LASIK over correction

Q: Kera-gurus: I have a 52 year old guy who had Custom LASIK one month ago for myopic astigmatism (OD -3.00 + 0.25 and OS -3.25 + 1.25).  He is slightly overcorrected with refraction of +0.50 + 0.25 in each eye.  He’s doing fine for distance activities such as soccer...

Bandage lenses for PRK or LASEK

Q: For many years I’ve been using the Alcon “AirOptix Night & Day” plano contact lens (base curve 8.4, diameter 13.8) as my go to bandage lens after PRK, but I’ve noticed that some of these fit a little tight and some a little loose. Enrique Corral suggested recently that...

Schirmer test

Q: I saw a patient today for the first time who is an internist has been treated for dry eye for years.  She really looked to me more like chronic inflammatory OSD due to blepharitis and possible allergy with Rosace, plugging of the glands, loss of lashes, conjunctivochalsis etc.  She...

CXL and epi-off?

Q: List, I am a member of the large keratoconus group on Facebook.  I dont really post much, but its interesting to read what patients with this condition are writing about.  Granted these are lay people, but often someone with a disease learns a lot about it. There is a...

EpiOn EpiOFF CrossLinking

Q: Is there any evidence that Riboflavin-soaked epithelium (or just plain old intact epithelium) blocks UV A to the stroma? Dr. P A: Why are so many people so averse to removing epithelium for CXL? Is this a religious prohibition or something?;) I remember assisting retina surgeons at Harvard/MEEI (including...

MDs Defending ODs Performing Procedures

Q: Good thought, John, but to what would we be responding on social media?  Though it is likely a small audience, posting a response to Ophthalmology/Optometry Times is at least relevant.  A post to Twitter/FB/etc. may seem like a random rant, unless the article has also been tweeted out, in...

Skewed topography

Q: 27 year old woman wants Lasik. MR -5.75 +0.50 x 95 20/20 – 5.25+0.50 x 85 20/20 Pachs 574 OD, 599 OS Topographies attached. What concerns me is the skewed topography left eye. Would you recommend: 1. No refractive surgery 2. PRK 3. Lasik Thanks, David Atlanta, GA A:...

25g needle bending

Q: When McLean originally published this technique (Ophthalmology, 1986), it was with a regular, non-bent 20g needle. The advantage of using such a large needle is that there is zero chance of perforating. When Peter Laibson discussed this technique at the AAO, he suggested maybe using a smaller (i.e. 25g)...

Re: Mitomycin-C OTA — published in June Ophthalmology

Q: Dear All, I would highly recommend the above EXCELLENT review article (link below). Many of our colleagues worked very hard to produce and excellent summary of the “state of the art”. Randy Highland Park, IL A: dear randy, parag, roy, and everyone else i just read this article in...

Re: Would you submit this 42yo woman to refractive surgery?

Q: Dear Kerafriends, Jim is right (as always) – I’m really not feeling safe in offering LASIK, as besides the skewed axis seen on axial curvature maps and the PTA quite near 40%, her Pentacam shows some suspect parameters, mainly: ART max < 386 and BAD-D > 1,22 – Sandra,...

Re: Myopic (Over)Correction in Younger Patients

Hi Kamran Pls see below — Emil William Chynn, MD, FACS, MBA Harvard/Columbia/Dartmouth/NYU/Emory-trained 1st eye surgeon in NY to get LASIK himself (1999) Performed 5,000 LASIKs from 1996-2002 Switched to non-invasive LASEK in 2003 Have performed more LASEKs than any MD in US www.ParkAvenueLASEK.com 102 E. 25th St. (& Park...

SMILE

Q: I will put my $0.02 here for what it’s worth. In theory the structural integrity from SMILE should be better but independent in vivo research is needed. Dan Reinstein is a consultant for Zeiss. SMILE has a lot of attractive features but sadly my evaluation from peers who used...

PRK for corneal scars

Dr. Chynn wrote in bold to a question from another doctor: Emil/KeraNetters Tangent from the December discussion on PTK in corneal scarring: I have a 24yo with history of traumatic recurrent erosion in the left eye. Had anterior micropuncture performed by another surgeon this past December but has started to...

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