Debra F writes:
I have been going to Park Avenue Laser for the past year. After living with perfect vision for over 25 years, I was worried when my vision started to become a little blurry. I never thought I would need any kind of vision correction and I was nervous about the idea of needing glasses or contact lenses. Dr. Ahlmeida was extremely reassuring and made the process of adjusting to glasses and contacts easy. He explained all of the vision tests before administering them and answered all of my “first timer” questions. I didn’t need a very high prescription but the difference in my vision is fantastic. I will continue to come to Park Avenue Laser in the future to keep up my now perfect vision.

I had a VERY high prescription of -10, and most Laser centers weren’t able to perform surgery on me because I have thin Corneas too! Luckily for me, Park Ave Lasek was able to correct my vision with it’s contemporary no-cut technology! Dr. Chynn is a genius who used tough love on me to make sure that I clearly understood the entire process and all of my medications.The staff, all patients themselves, were all able to give me excellent advice and answer all of my questions! I recommend Park Ave Laser to anyone serious about having only the best!

Peace out,
Marisa

Naveed A. writes:

I am in Saudi Arabia and i dont trust the local vision correction centres as they are not that advance and my friend who got treatments from them (LASIK) are not comfortable and suffering from problems. Weak eyes makes my life depress. I cannot swim cannot play football and other sports with ease.To get rid off glasses. Correct vision will change my life.
good decision! i know some harvard MDs who went to saudi arabia for a few years to practice and gain a lot of surgical experience, and they said the same thing–medical care is much better here in the US (no offense)

I just want to get ridd off glasses, so my concern is that i dont want to be wearing glasses again after the surgery.

——————————

Dr Chynn Responds:

i have dry eyes because i had a LASIK, which cuts the corneal nerves when the flap is cut, thereby causing dry eyes
this means that 100% of LASIK patients have some form of dry eyes afterwards
this is a main reason i switched to LASEK because it’s non-cutting, so no flap is cut, so no dry eyes afterwards!
pls visit my site below to learn more about LASEK
then call my office to set up your appointments
thanks
we do have people fly in every week from abroad for our more advanced LASEK procedure, by the way!

there is a 99% chance we will make you see as well or glasses afterwards. almost 100% if you allow for an enhancement procedure 

– 
Emil William Chynn, MD, MBA
Dartmouth + Columbia + Harvard + Emory + NYU-trained
1st LASIK surgeon in NYC to have LASIK himself (in ‘99)
Only pure refractive surgeon in NYC who exclusively performs No-Cut/Flap LASEK!
15,000+ cases - 100% Legal To Drive!
Member AAO, ASCRS, MENSA

www.ParkAvenueLaser.com
NY’s Only 100% No-Cut/Flap LASEK Center
#1 LASEK Center in NYC-CBS News TV,
NY Times, Wall St. Journal, Herald Tribune, Daily News, Fox News TV, Ch. 9, SNL, WPLJ
102 E. 25th St. (& Park Ave. So.) NY NY 10010
(212) 741-8628        (212) 741-2390-Fax
(888) I-WANT-2020   1-888-492-6820

Hi, I used to pass your office on my way to school at Baruch. I am interested in corrective surgery but was told that my results would not be good enough to warrant the cost. My right eye is very slightly near-sighted (and 1 lasik specialist told me to not even bother correcting it) and my left eye is far-sighted with a very bad astigmatism. I was told that in the best case, I would still need to wear glasses when I drive.

Any thoughts?

Dr Chynn responds:

hi kevin

when i used to cut flaps in LASIK, i also would not treat prescriptions less than -1.00, because the risk of cutting a bad flap was not worth the benefit for small prescriptions. 

since i switched to the noncutting LASEK i’m more comfortable fixing low Rxs, as there is almost no risk, since i’m not cutting any flap. LASEK also corrects astigmatism more reliably than LASIK

pls call my office and set up an appt for a free consult. i will see you then with one of my MDs

thanks and see you soon!

yours

Emil William Chynn, MD, MBA
Dartmouth + Columbia + Harvard + Emory + NYU-trained
1st LASIK surgeon in NYC to have LASIK himself (in ‘99)
Only pure refractive surgeon in NYC who exclusively performs No-Cut/Flap LASEK!
15,000+ cases - 100% Legal To Drive!
Member AAO, ASCRS, MENSA

www.ParkAvenueLaser.com
NY’s Only 100% No-Cut/Flap LASEK Center
#1 LASEK Center in NYC-CBS News TV,
NY Times, Wall St. Journal, Herald Tribune, Daily News, Fox News TV, Ch. 9, SNL, WPLJ
102 E. 25th St. (& Park Ave. So.) NY NY 10010
(212) 741-8628        (212) 741-2390-Fax
(888) I-WANT-2020   1-888-492-6820

Ambient humidity and post-op treatment regimens may differ depending on geography and type of surgery

The state of a person’s ocular surface will usually help a surgeon determine if the candidate is appropriate for laser vision correction, and if so, which type (LASIK, advanced surface ablation, or LASEK). Aside from refractive error, the ocular surface may be the most important factor in planning a surgical strategy. Yet it’s not the only factor. Humidity, both ambient and in the operating room, can inadvertently play a role in the outcome and is most certainly a factor in timing the surgery.

The OR suite

Most refractive surgeons know maintaining a consistent level of humidity in the operating suite should not be overlooked.
At Durrie Vision Center, Overland Park, Kan., all the refractive suites have built-in humidifiers that were integrated into the building’s plans. “All of our suites are ASC [ambulatory surgery center] quality, and we were able to do that because we built our facility from scratch,” said Daniel S. Durrie, M.D., clinical professor of ophthalmology, University of Kansas, Overland Park, Kan., and president, Durrie Vision.
At Park Ave Laser, New York, “We carefully control temperature and humidity with two dehumidifiers, one cool mist and one warm mist humidifier, plus the expected air conditioning and fan, etc.,” said Emil W. Chynn, M.D., founder, Park Ave Laser. Careful control of the temperature and humidity eliminates much of the seasonal variation in results that may occur otherwise, he said.
Humidity control can be difficult if “the doors to the room are not kept closed and when there are more than a few people in the room at a time. Maintaining constant room humidity is part of the process of establishing a reliable nomogram to achieve accurate results,” said Joseph Rosenshein, Ph.D., president, Metatron Associates Inc. Technical Consultants in Cataract and Refractive Surgery, Victor, N.Y. “This is as true in summer with air conditioning as it is in the winter with heating.”
He added that in his facilities, the evaporator surfaces of individual room humidifiers are treated with antibacterial agents and bacteriostat is added to each refill. He recommends having qualified professionals install Liebert whole-suite HVAC units; improper installation can lead to an inability of the units to maintain a reasonable temperature and humidity ranges (42%-46% is recommended, he said).
Dr. Chynn added that when multiple people are in the operating room, as may happen with a live seminar, “We need to turn the air conditioning way up or their body heat elevates the room temperature, causing the laser to sense a change in energetics and forcing a ‘boost.’”
Richard L. Lindstrom, M.D., adjunct professor emeritus, Department of Ophthalmology, University of Minnesota, Minneapolis, and founder, Minnesota Eye Consultants, Minneapolis, said his centers maintain humidity levels around 35%-40%, and the air is continuously cleaned via high efficiency particulate absorbing filters. To further reduce the possibility of wild fluctuations, all instrument sterilization takes place outside the surgical suite, he said.
“We also strictly control the temperature to keep it around 68-70 degrees,” he said. “Any warmer than that and the lasers don’t like it.”
Dr. Rosenshein agreed, noting “Fluctuations in humidity can lead to unexpected results, especially if there is a burst of humidity as from a steam sterilizer in the surgical suite.”
He added, “Ablation of the stroma depends on the hydration of the exposed surface. Once the flap is laid back, evaporation begins to dehydrate the exposed stroma.”
Dr. Rosenshein also said excimer laser optics absorb more energy and degrade more rapidly at higher temperatures, “requiring the noted ‘boost’ to get higher laser output energy at the higher temperatures. Near the end-of-life of the laser optics, at temperatures above about 75 degrees Fahrenheit, the energy delivered to the eye can fluctuate and decrease more rapidly during treatment leading to under-corrections.”
Conversely, in southern California where temperatures and humidity levels are very stable, humidity “isn’t a significant factor in outcomes,” said Capt. (Ret.) Steven C. Schallhorn, M.D., San Diego, and medical director, Optical Express, London. In addition, he recently completed an analysis for Optical Express looking at “more than 5,000 eyes with three months of follow up after LASIK, and we, surprisingly, found very little difference in outcomes as it related to the humidity levels. The average humidity of the surgical suites was 42%, with a standard deviation of six and a range of 20%-70%. The level of humidity in the laser room did not correlate with the refractive outcome.”
In Dr. Schallhorn’s opinion, “It is possible that humidity may influence outcomes, but its impact is much less than I would have previously predicted.”

Patient selection

In 2003, a study about humidity in laser vision correction suites was published in the Journal of Cataract & Refractive Surgery. “It showed a 0% enhancement rate in the winter and a 50% enhancement rate in late summer,” said Dr. Chynn. “The study showed a tendency toward under-correction when humidity was high and overcorrection when humidity was low.”
About that same time, the consumer press picked up on the study results; Dr. Chynn said one of his obstacles is getting patients to focus more on being compliant with aspects of their post-op/pre-op care that they can control and less on the aspects of what the surgeon already knows needs to be controlled.
“We can’t control the amount of water patients drink, or ensure they avoid alcohol or caffeine, or buy and use a humidifier in their home, or take all their drops correctly,” he said. “But they worry about things they can’t control like the humidity level in the operating room.”
While humidity levels can be controlled inside the operating room, “the patient aspect and how humidity affects them is relevant,” Dr. Durrie said. “Humidity here [in Kansas] is very low in the winter. If a patient has pre-existing dry eye, I’ll recommend he wait until spring to have the surgery. Since it’s not emergency surgery, there’s every reason in the world to wait until the patient has the best chance for a good outcome.”
He will also prescribe Restasis (topical cyclosporine 0.05%, Allergan, Irvine, Calif.) for all patients during the post-op period and finds he uses punctal plugs more in the winter than in the summer months.
Individual hydration matters immensely, Dr. Lindstrom said. “The laser can be obstructed by water if you’re overhydrated just as easily,” he said. Post-op, “we’re big believers in having a specific regimen with lubricating drops, and we recommend everyone take the drops, even if their eyes don’t feel dry, for at least the first three months,” he said.
“Recovery times can be slower for the patient if the eyes are dried out. Flap slips can increase in the winter,” Dr. Durrie said, adding it’s a bit more crucial he personally see each of his patients on the day one post-op visit.
“It’s not a big deal to smooth the flap if there’s a little slip, but you don’t want to miss it. We always have our patients come back on day 1 in the winter,” he said.
The ocular surface “has an epithelialization phase in PRK, but sometimes you’ve chosen to do that because of the patient’s dry eye,” Dr. Durrie said. “We also use punctal plugs as an addition for people who are on Restasis but have found that’s not as necessary in the summer months.”

Ambient humidity

Post-op, the ambient humidity “is much more important for patients who undergo LASEK than it is for those undergoing LASIK,” Dr. Chynn said, “and even more so for those undergoing advanced surface ablation.”
He finds asking patients to eliminate—or at least limit—their caffeine and alcohol consumption for a month post-op “really does help the surface heal quicker.” He also advises patients to use humidifiers, especially in the dry winter months in New York, and will prescribe Restasis.
“It’s really about selecting the right patients and educating them about how the environment is going to affect their recovery,” Dr. Durrie said.
Preparing the ocular surface before contemplating surgery is key, Dr. Lindstrom said, and ambient humidity/time of year determine how long he will treat before selecting a patient for laser surgery.
“Surgeons need to develop a standard routine,” he said. “The minute you start your surgery, the cornea begins to dehydrate. You could take a normal corneal thickness from 550 to less than 300 in five minutes. You need to keep a comfortable pace, and if you have a situation where you need to stop, be sure to remove the speculum to keep the cornea as hydrated as possible.”
Dr. Rosenshein added the pre-op state of corneal hydration is an important factor in determining flap thickness and ablation rate during treatment. A surgical suite in which he operated in Detroit had large swings in ambient humidity between summer and winter months.
“As an attempt to compensate for the varying ambient humidity, which can affect the patients’ state of corneal hydration upon arrival, we established a pre-operative protocol of a sequence of moisture drops following the antibiotic and anti-inflammatory drops as an attempt to achieve a more uniform state of pre-operative hydration prior to entering the surgical suite,” Dr. Rosenshein said. “The patients were instructed to keep their eyes closed between the administration of the drops and until called into the OR. We didn’t have sufficient follow-up data to use in detecting the influence of such a protocol since we had over 12 surgeons operating at our open center, but the overall enhancement rate was about 3%.”
Ambient humidity in the workplace and home “will impact their dry eye, their speed of visual recovery, etc.,” Dr. Schallhorn said. “We’re blessed here in southern California where we don’t see variation on healing responses attributable to ambient humidity.”
Of interest, however, is that the six-month post-op results in the European study indicate the incidence of dry eye is the same with surface ablation or LASIK, Dr. Schallhorn said.
“There is more dry eye in the early post-op period with LASIK compared to PRK, but that evens itself out over six months,” he said.
Post-op hydration is an issue for people undergoing surface ablation, Dr. Chynn said.
“The epithelium heals from the limbus in, so I tell my patients it’s like they’re swimming, and you can’t do that over a dry surface. They can swim when their eyes are closed but not when they’re open and dry,” Dr. Chynn said. “If the suture doesn’t heal in the first week, it may scar. Visual outcomes may still be 20/25, but it’s not great. We do what we can to make sure they’re hydrating, using humidifiers in the winter, etc.”
One of his pet peeves from when the issue of humidity and LASIK was first reported was that patients and the lay press “seemed to take away the wrong point,” he said. “They started to ask us, ‘Is there a best season for me to have my surgery?’ I think we need to better educate the public about what the real message is.”

Editors’ note: The physicians interviewed have no financial interests related to their comments.

Contact information

Chynn: 212-741-8628, toplasikdoc@gmail.com
Durrie: 913-491-3330, ddurrie@durrievision.com
Lindstrom: 952-567-6051, rllindstrom@mneye.com
Rosenshein: 585-474-4695, jrosensh@alum.mit.edu
Schallhorn: 858-695-3849, steveschallhorn@opticalexpress.com

Seema S, age 29,  writes:

Contact Insurance:                Cigna

Contact Company:                  Department of Homeland Security

Contact Prescription Right:       -3.00
Contact Prescription Left:        -3.00

 I do not want to wear contacts or glasses anymore.  A few years ago I went for a consultation for Lasik and was told that my cornea was too thin and I was not a good candidate for Lasik and I could have PRK done; but when I was told that it can be very painful and it also has a long recovery time I dedcided against it.  A friend of mine had the same problem and told me about Lasek that they got done by you.

——————————————————————–

Dr Chynn responds:

this is a very easy rx for me to fix w lasek–only 20 seconds of treatment time per eye–that’s it!

you’re in luck as i am a cigna provider so bring your card in w you at your free consult so we can tell how much we can get them to pick up of your cost!

perfect age to get LASEK as your rx is now essentially stable and you’re still young enough your recovery will take only 1 wknd!:)

this is a very easy rx for me to fix w lasek–only 20 seconds of treatment time per eye–that’s it!

good thing you waited as PRK is an outdated procedure; i did my last PRK 10 YEARS ago
what you need is a LASEK as your friend had!
pls call my office and set up your free consult so we can discuss this in person
see you soon!

– 
Emil William Chynn, MD, MBA
Dartmouth + Columbia + Harvard + Emory + NYU-trained
1st LASIK surgeon in NYC to have LASIK himself (in ‘99)
Only pure refractive surgeon in NYC who exclusively performs No-Cut/Flap LASEK!
15,000+ cases - 100% Legal To Drive!
Member AAO, ASCRS, MENSA

www.ParkAvenueLaser.com
NY’s Only 100% No-Cut/Flap LASEK Center
#1 LASEK Center in NYC-CBS News TV,
NY Times, Wall St. Journal, Herald Tribune, Daily News, Fox News TV, Ch. 9, SNL, WPLJ
102 E. 25th St. (& Park Ave. So.) NY NY 10010
(212) 741-8628        (212) 741-2390-Fax
(888) I-WANT-2020   1-888-492-6820

Lol hey doc, I have some serious astigmatism. Do you do PRK as well?

———————
Dr Chynn responds:

hm this is funny as it seems like you and i being good monitors for bitches’ bs is going to help us both, ie we’re being rewarded:)

as you may know, if you have a large amount of astigmatism, LASIK will not fully correct it. this is because
the laser reshapes your cornea to get rid of your astigmatism
but then you put the flap back, and it doesn’t fully conform to the new correct shape of your cornea
it’s like if you had a hat, changed the shape of your head, then stuck it back–the hat would partially replicate it’s old shape

therefore, not all of the astigmatic correction would be retained, leaving you with residual astigmatism and not seeing 20/20

you seem to have gotten some partially correct information elsewhere.
true, if you do a surface ablation, ie reshape the cornea wo any flap, the entire astigmatic correction and new shape are retained

because i only perform surface techniques, i’m successfully fixing people w astigmatism worse than yours every day or the week
these are people who cannot even find contacts that fully correct their astigmatism, as toric lenses only go so high
or people who were rejected by LASIK centers for that reason
or people who are forced to be in hard lenses to fully correct their cyl (cylinder = astigmatism in eye MD lingo)

but you should NOT have a PRK, as that is an OUTDATED procedure
i did my last PRK over a decade ago, just to make this point clear

PRK got replaced by LASIK about a decade ago
and a few years ago, top surgeons across the US started to “return to the surface” but with ADVANCED SURFACE TECHNIQUES

the term advanced means NOT PRK!

advanced surface techniques include LASEK and epi-LASEK, and guess what–this is EXACTLY what we SPECIALIZE IN
and ALL WE DO HERE:)

in other words, every center does these advanced techniques sometimes–we prefer to do them 100% of the time

this means that i actually have performed more LASEKs than any other surgeon in NYC
actually, i have performed more LASEKs than ALL  OTHER SURGEONS IN NYC COMBINED!

so please CALL MY OFFICE
speak to ALEX TODAY
and make an appt to come in and discuss this w us

the consultation is free anyway, and there’s no obligation
come in on a wed, th, or fri pm and you can actually watch me perform an advanced surface ablation live!:)

i’d like to meet you anyway and chat about our mutual CL experiences, so that will also be fun/funny

so looking forward to hearing fr you today, and to meeting you sometime later this month!

yours,

–
Emil William Chynn, MD, MBA
Dartmouth + Columbia + Harvard + Emory + NYU-trained
1st LASIK surgeon in NYC to have LASIK himself (in ‘99)
Only pure refractive surgeon in NYC who exclusively performs No-Cut/Flap LASEK!
15,000+ cases - 100% Legal To Drive!
Member AAO, ASCRS, MENSA

www.ParkAvenueLaser.com
NY’s Only 100% No-Cut/Flap LASEK Center
#1 LASEK Center in NYC-CBS News TV,
NY Times, Wall St. Journal, Herald Tribune, Daily News, Fox News TV, Ch. 9, SNL, WPLJ
102 E. 25th St. (& Park Ave. So.) NY NY 10010
(212) 741-8628        (212) 741-2390-Fax
(888) I-WANT-2020   1-888-492-6820

 It is my responsibility to write you and tell you how skeptical i was to take the first steps to have my eyes examined

for lasek surgery.  The free initial consultation was not only generous in time,  but most informative to me so i could

collect and process all the information addressing my concerns. Even though i could not see well at all (near or far),

I never really realized how serious my vision deteriorated until the exam.  Nearly legally blind in my right eye,  i don’t have to tell

you how handicapped i became performing simple tasks from putting a key in the door, to my profession which is solely dependent

on quality vision.  When i was at your office i never expected to leave with a “contact lens trial”  to actually see what it will be like

when the permanent solution was performed.  At first when i left,  i was disappointed  on the eye sight the lenses were giving me.

Even honestly disheartened and considering abandoning the whole idea.  All i can say now,  and the reason for my e-mail is

for some reason i stayed the course.  I cant thank you enough for explaining to me in the office,  how the brain will compensate

and adjust to the new vision treatment.  Everyday it gets a little better and better….you have NO IDEA  how this has really changed

my life. I thank GOD….and the angel that just made another day go by without letting me take them out.  Patience and perseverance

really paid off.  I cant imagine ever going back to, or through the rest of my life with the crippling vision i had.  BTW…i am so used to the contacts,

i forget they are in…..i cant wait for the surgery.  You must really project to your patients how important it is to “stay the course”…..

If anyone of your patients has any doubts what so ever about this,  PLEASE feel free to give them my number.  I cant put “a number”

on the value of my eyesight.  I don’t think anyone who sees as clearly as i do now can.

Thank you so much…and most of all….thank you for the truth of the matter and not a ridiculous sales pitch.

You are a genuine professional.