Lights, Camera Ophthalmology!

Creating great videos. Dr Soosan Jacob MS, FRCS, DNB

Digital media in all its forms has become the most widely used means of communication, education, entertainment, and marketing. It has certainly come to play a key role in ophthalmology. I personally like using digital media as an educational tool, harnessing YouTube, messaging apps, and my social media handles to transmit information. My YouTube educational channel has more than 10,000 subscribers. It is my favourite since I get to do something I am passionate about—teaching and demonstrating surgical techniques!

Video-based education has many advantages. The entire surgical concept can be presented in a clearly and crisply. The video, or a part of it, can be repeatedly viewed if required. The surgeon’s explanations for the surgical choices made or the events that happened can be understood. If recorded through the surgical microscope, the viewer gets the surgeon’s view.

Creating a video and making it educational and useful to the viewer needs preparation and time. In this article, I will discuss some tips on preparing good surgical videos and optimizing them for streaming. THE SUBJECT FOR THE VIDEO? If planning to demonstrate a routine surgery, a case may often be picked from the surgical list for the day. If a special type of cataract or a particular surgical manoeuvre is planned as a video, it may be necessary to wait till a suitable case presents. For videos on complex cases, planning starts right in the clinic while seeing the patient and deciding management.

It is good practice to keep the recorder on for all cases when facilities are available to get videos on a wide variety of situations, both planned and unplanned. Often rare and interesting videos get captured when something unanticipated happens while operating.

When planning to demonstrate a routine manoeuvre, it helps to select a good case, for instance, a cooperative patient, an eye that is not deep set, a clear cornea, and a well-dilated pupil. THE SETTING? A superior quality surgical microscope with clear optics and good coaxial lighting is essential in making high quality anterior and posterior segment videos. An understanding of the coaxial and paraxial lights—as well as the balance to be maintained between them—is necessary since the coaxial gives a good red

Video editing and narration on Final Cut Pro. Different software are available for this purpose. reflex, thereby making the rhexis, cortical aspiration, and margins of a PCR clearly visible. On the other hand, the paraxial gives a larger view of the operating field while also giving better depth perception due to the shadows created from the slightly off-centred light. The Monoglots is a stereo-coaxial red reflex device—an accessory designed by Jagdeep Kakadia that can enhance the red reflex of lower-end microscopes. Extra-ocular surgeries need special tactics while recording. Though these may be recorded under the microscope (the author personally prefers recording strabismus, lid surgeries, and even blow-out fracture repairs using the surgical microscope), there is some loss of freedom of movement. To avoid this, and for those accustomed to operating through surgical loupes, a camera fixed on a tripod can give excellent results. Kruger et al have described an excellent and simple technique of attaching a divergent lens just below the objective of the operating microscope, thus increasing the working distance while still allowing high-quality recording through the microscope. For any recording, it is essential to get clean, in-focus images that show the entire operating field. Mediocre quality, low-resolution, outof-focus video with inadequate zoom, show of gloves in the field, etc., distract from the object of the video. A good video very often does not end with surgery but also shows postoperative outcomes. Therefore, it is useful to have a good slit-lamp image capturing system to take pre- and postoperative photographs. Surgeons can use any of the excellent commercial systems available, such as those from Appasamy Associates or Haag-Streit. The videos can also be made very inexpensively using a slit-lamp adapter and a smartphone camera.

CAMERA Many of the new higher-end microscopes have built-in cameras and the output can be recorded on an HD recorder. Alternately, an external camera may be connected to the beam splitter using a C-mount. High-quality 3-chip HD-cameras (e.g., Sony MCC-500MD) give excellent output but do add to cost. New and simple attachments are also available that can be connected both to the video output port of the microscope and to a smart phone camera for surgeries to be recorded, shared, and even streamed live.

EDITING There are many editing software programmes available—e.g., Pinnacle, iMovie, Wondershare Filmora®—which are user-friendly and easy to learn. For those who like to add an extra finish to their videos, there are more sophisticated software programmes such as Final Cut Pro and Adobe Premiere.

Software such as Adobe Photoshop, MS Paint, PowerPoint, and even many smartphone apps are available to create still graphics for the video.

Adding a voiceover helps greatly. Make sure to give clear and crisp narration. Adding some background music also adds to the video’s appeal; however, it should not be overpowering or drown the narration.

Finally, the entire video should be crisp and to the point so as not to waste the viewer’s time or lose attention. Once done, the output can be saved in many formats depending on the intended use. When sharing on messaging apps, there is generally an upper limit to the file size accepted. In addition, when viewing is intended for a small screen such as a mobile phone or requires downloading before watching, a smaller size, lower resolution video is desirable. If uploading to YouTube, higher resolution keeps the image clear, irrespective of the screen size. SHARING As mentioned earlier, videos may be shared on many platforms, including YouTube, Vimeo, Facebook, WhatsApp, and LinkedIn. YouTube has many advantages. It is free, and if one has a Google account, is quite easy and intuitive to begin with. It is a good idea to share the link, short URL, or QR code (for example, the QR code shared in this EuroTimes article!) with the intended audience through social media handles and direct messaging. Adding a description and keywords and encouraging viewers to subscribe helps spread the video faster and makes it more searchable.

Remember that educational ophthalmic videos need not always be surgical. There are excellent opportunities for making nonsurgical teaching videos with the cases seen in the clinic daily. Videos can also be a combination of clinical and surgical tips. Use the format for scientific articles such as reviewing literature, discussing a new technique, showing results with the new technique—adding a discussion that includes advantages and disadvantages—and ending with a conclusion.

Discussion with peers on current topics of interest both clinical and non-clinical such as balancing work-life, starting a new practice, navigating through the COVID crisis, educational videos for patients or staff—all make for interesting viewing and can have a far-reaching audience.

There are many video types and formats, making it possible for anyone to create videos. So, don’t wait any longer! Whatever you may be doing, whatever it is that you are passionate about—now is a wonderful time to grab a camera and start making videos.

178x130 AAFF.pdf 3 26/07/2021 8:53:05 Dr Soosan Jacob is Director and Chief of Dr Agarwal’s Refractive and Cornea Foundation at Dr Agarwal’s Eye Hospital, Chennai, India. dr_soosanj@hotmail.com