Eyeworld

MAR 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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March 2012 Chief medical editor's corner of the world Do you have something to teach? Try making a film by Richard S. Hoffman, M.D. ceremony. This rivals Hollywood's Academy Awards for suspense and pageantry as judges adorned in formal black tie attire present the excited win- ners with their statuette onstage. Besides the fun and entertainment O value, the ceremony celebrates the tremendous teaching value of a care- fully edited and narrated video—a medium that is particularly important for surgical education. Of course, pro- ducing a quality teaching film is a spe- cial skill all unto itself. As anyone who has ever entered the film competition can attest, this is a time intensive proj- ect that combines innovation, scientific discovery, creativity, and teaching. Last year, from approximately 170 films submitted, the ASCRS Film Festival grand prize was awarded to Richard S. Hoffman, M.D. In his film ti- tled "Minimally Invasive Glaucoma Mini Shunt Implantation Without Conjunctival Dissection," Rich demonstrated an innovative new method for trabeculec- tomy. For this month's column, I asked Rich to discuss how he planned and produced his award-winning video. The details of his innovative surgical method are then explained in Rich's monthly "Tools & techniques" column, which immediately follows this article. I hope you'll enjoy reading his "behind the scenes" commentary. David F. Chang, M.D., chief medical editor Watch these videos on your smartphone or iPad using your QR code reader. (Scanner available for free at your app store.) ne of the most highly anticipated events at the ASCRS Annual Meeting is the Film Festival awards P roducing a film for the ASCRS Film Festival is a labor of love. The first time I submitted a film was in 2008 ("Scleral Fixa- tion Without Conjunctival Dissec- tion"), and it won first place in the New Techniques category. It was a great honor to accept the award on the Film Festival stage. Two years later I submitted my second film, presenting options for treating a par- tially subluxed one-piece IOL that was causing recurrent vitreous hem- orrhages. It won first place in the In-House Production category. Win- ning an award at the Film Festival is a product of having a good case or topic, producing a high quality video, and a little bit of luck. When producing a video, I like to adhere to my three Es for success: educate, entertain, and exude elegance. When deciding to begin a film, the producer needs to decide if he/she is going to submit a case study, a topic for review, a new tech- nique, etc. The easiest film to pro- duce is a simple surgical case, but even these films require sophisti- cated editing, thought, and good narration. For PC users, Adobe Premiere Elements is an inexpensive program (Figure 1) that allows for very sophisticated editing but is sim- ple and intuitive to use. The most complex editing features can be learned in under a week. For Mac users, iMovie or Final Cut seem to be the programs most widely used. A good way to start the framework for a film is to structure it like one would if he/she was writing a paper on the topic. The third film I sub- mitted, "MI" ("Minimally Invasive Glaucoma Mini Shunt Implantation Without Conjunctival Dissection"), was first written as a paper for publi- cation, and it was very easy to de- sign the film around the structure of the manuscript. When I started "MI," I decided to divide the film into multiple sec- tions: a brief intro, a description of the technique, a proof of concept in the wet lab, a demonstration of the technique in vivo, and a brief con- clusion. When I create a film, I like to have a background image that is consistent throughout the video, similar to a background in a Power- Point presentation. For this film, I created a fractal movie using a so- phisticated program called Ultra Fractal. The fractal movie gave the sensation of moving down a tunnel but was "turned down" to a 20% opacity setting so that it was barely visible except when the section title dividers faded in, at which time the opacity setting was increased. The fractal movie was set in the back- ground and all other videos and im- ages were layered on top. For the intro section, I showed an edited trabeculectomy with still images that faded in over the edges of the central film and then showed a routine EX-PRESS shunt (Alcon, Fort Worth, Texas) implantation. These were edited clips from my partners. The next phase of the film was "drawings" that I created in Adobe Photoshop. Each drawing probably took a week to create and was originally meant for the written manuscript. The drawings were cre- ated by taking various images of a human eye and cutting and pasting the conjunctiva, iris, and other fea- tures and layering them on top of each other within the Photoshop program. For anyone who has not used Photoshop, it can be thought of as layered pieces of clear glass, with each layer containing an image. By cutting and pasting surgi- cal instruments or wound configura- tions, and casting shadows and light reflexes, very detailed and realistic images can be created. The problem with having drawings within the movie is that images do not move, and this is, after all, a movie. I got around this problem by using a technique popularized by Ken Burns in which he would narrate over old photographs while slowly panning in or out of the image to give a per- ception of movement. I also transi- tioned from one drawing to the next using a "page turn" feature, which gave the static drawings the sense of movement. When something spe- cific in a drawing needed to be pointed out, a cutout of a photo of my hand would fade in to point out the precise location of interest. When editing video clips, there Or view Dr. Hoffman's award-winning videos at www.eyeworld.org/replay.php. Figure 1. Dr. Hoffman suggests using Adobe Premiere Elements to edit films on a PC Source: Richard S. Hoffman, M.D. is a lot of work that goes into creat- ing a smooth, elegant-appearing clip. All extraneous waiting between maneuvers must be cut out, and the remaining components are pasted together. I like to increase the mag- nification of images so that the eye fills the entire screen. In addition, the centration of the image can be manipulated within the clip using "key bindings" so that the image is always centered on the screen. The pieces of remaining video are "pasted" together using cross fades so that the movement from one ma- neuver to another appears seamless. I also like to time-stretch each small clip to speed up the action and make me look faster and more competent than I actually am. Time-stretching allows a clip to be sped up or slowed down. Slowing it down can be useful to repeat a maneuver or misadven- ture in slow motion for effect. Slightly speeding up the clip avoids boredom. When speeding up a clip, I like to avoid compressing the time more than 25%. If the clip is sped up more than this, it starts to look un- continued on page 20 EW NEWS & OPINION 19

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