Although there are numerous great pearls I have learned, many from the pages of this magazine and the videos on Eyetube.net, my recent favorite has to be phacoemulsification of the tear film for eradicating bothersome and potentially dangerous oily meibomian and tear film debris before cataract surgery. The pearl, which is credited to Robert J. Cionni, MD, of Salt Lake City, Utah, is simple and effective yet sort of odd and a bit shocking at first (which is why I, and everyone I have taught it to thus far, find it so intriguing). Upon learning of it, most people, myself included, are initially incredulous that it actually works. To prove its efficacy, I created Tear Film Phaco, a short video of the technique, which can be viewed at http://eyetube.net/?v=smibi.
The objective of this article is not to promote my video but to inspire you, the reader, to create and submit your own videos. By walking you through the steps I used to create the Tear Film Phaco movie, you will see just how easy it is to make a high-quality surgical video using technology you likely already own or have access to.
GETTING STARTED
The first step in making a surgical video is, of course, filming the live surgery. At Weill Cornell Medical Center in New York, our ophthalmic operating rooms are equipped with Ikegami MKC-507 cameras (Ikegami Electronics USA Inc., Maywood, New Jersey) for capturing video directly from the microscope. The video, while projected on an external monitor, can be recorded directly to a computer’s hard drive via an IEEE 1394 connection such as FireWire (Apple, Inc., Cupertino, California). Once the FireWire connection is made with the computer (in my case, a MacBook Pro [Apple, Inc.]), iMovie (Apple, Inc.), the movie-editing software that comes free with every Apple computer, immediately recognizes the camera and enables live video capture (Figure 1). With one click of the capture button, the raw surgical footage is recorded in real time as a new event in iMovie. Because video footage takes up a lot of hard drive space, I recommend having ample free space on your internal drive or connecting a larger external hard drive while you record.
EDITING YOUR VIDEO
Working with raw footage. The real fun begins when you transform your raw footage from the event library into a polished movie or project, as it is called in iMovie (Figure 2). When starting a new project, you will be greeted with an initial screen that allows you to choose a theme (in Tear Film Phaco I used the comic book theme) and aspect ratio (I used standard 4:3 because that is the native aspect ratio of our recording equipment). The first step toward completing your movie masterpiece is editing down the typically voluminous raw footage. This is easily accomplished by selecting short sections of video from the event library (lower window) and dragging and dropping them into your project in the upper left window in iMovie. Each section becomes a clip in the project, and each clip can then be endlessly edited, trimmed, arranged, and rearranged easily and intuitively from within the project editor pane.
Special effects. Once you have the video clips arranged to your liking, you can spice up the movie by adding transitions, effects, and text to clips (also called titles) and, as I did in Tear Film Phaco, adding a voiceover track and background music. To add voiceover narration (a requirement for Eyetube.net submissions), you simply click the microphone icon, which is just below the project editor pane, and start recording. Since most computers have a built-in microphone, you do not need an external one.
However, for the highest-quality audio, a USB-powered microphone is recommended. I used a USB2200a cardioid microphone (sE Electronics, Hitchin, Hertfordshire, United Kingdom). After a 3-second countin, begin recording your voice over the video in real time as the clip plays. Once finished, listen to your audio track. If you do not like it, erase it and start again. It is that simple.
Although unnecessary, adding background music to your video is a nice touch and is as simple as clicking on the iTunes (Apple, Inc.) tab from within iMovie, selecting the song, and dragging it into the appropriate clip in your project. From there, you can set and normalize the volume and edit its timing and duration. In Tear Film Phaco, I used two songs (both recorded by my strictlyfor- fun band Vitreous), one that plays under my voiceover at low volume and the other that plays during the end credits at higher volume. Please note that it is important not to inappropriately use any copyrightprotected material in your movies; otherwise, they will likely be rejected by the editorial staff. If you want to add a photograph or still image to your video, it can be done just as easily by clicking on the iPhoto (Apple, Inc.) tab in iMovie and dragging your picture to the appropriate location in the movie timeline.
The finishing touches. No Hollywood film is complete without end credits, so in that spirit I added an extra 24 seconds of credits to Tear Film Phaco. To do this, I selected the ripple transition, which segued the video into a text title called scrolling credits. You can choose from a variety of titles and transitions from within their respective iMovie browsers. By doubleclicking on the project clip, its inspector pops up, and from there you can select a background color or theme. You can then add text and select fonts, colors, and sizes from within the video pane in the upper right corner of iMovie. If you want to overlay text to any of your video clips, drag the title of your choice from the title browser, drop it onto the project clip, and then type the text from within the video pane. Simple.
SHARING YOUR VIDEO
Once you are satisfied with your completed movie, you will want to share it with the world, and that is where Eyetube.net comes in. First, save your movie in a file format useable by Eyetube.net. Under the Share menu in iMovie, click the Export using QuickTime tab and save your movie to your computer in any of the acceptable formats, including but not limited to .mov, .avi, or .mp4. Then, at the bottom of any page in Eyetube.net, under the heading Other Pages, you will see a link called Submit a Video. Follow the simple directions and upload your video. (There is a 4-GB size cap, so be efficient with your editing.) After being cleared by the editorial staff, the video will be live on Eyetube.net within a few days, and then the whole world will be able to learn from you.
Szilárd Kiss, MD, is an Assistant Professor of Ophthalmology at Weill Cornell Medical College in New York. Dr. Kiss statest that he has no financial interest in the products or companies mentioned. He may be reached at e-mail: szk7001@med.cornell.edu.
Christopher E. Starr, MD, is an Assistant Professor of Ophthalmology at Weill Cornell Medical College in New York. Dr. Starr states that he has no financial interest in the products or companies mentioned. He may be reached at e-mail: cestarr@med.cornell.edu.
WATCH IT NOW ON THE CATARACT SURGERY CHANNEL AT WWW.EYETUBE.NET
direct link to video: http://eyetube.net/?v=smibi
