Blindness (2008)

If At First Sight is the Citizen Kane of ophthalmology movies, Blindness weighs in as The Battleship Potemkin. Mark Ruffalo portrays an ophthalmologist, and his wife, played by Julianne Moore, is the protagonist. The movie is based on Nobel prize-winner Jose Saramago's compelling (but puncutation-challenged) novel about epidemic blindness that suddenly sweeps through a large city.

Early scenes revolving around this mysterious affliction depict the ophthalmologist examining one of the patients with a slit lamp, and performing keratometry. The film treats the viewer with other scenes from the ophthalmologist's office, including refraction of an amblyopic boy, and administration of eyedrops to a young woman with bilateral conjunctivitis. Later in the movie, a Braille typewriter is used by a nefarious member of the tyrannical Ward 3. I'll try to avoid delivering too many spoilers, but obviously there are other numerous depictions of blindness and low vision throughout.

Like the movie At First Sight, an interesting premise and loads of eye-related content do not necessarily guarantee an enjoyable film. Pacing was erratic, and despite an excellent cast, much of the acting came off as overly theatrical. In addition, the intrusive and incongruous soundtrack proved distracting. As a bonus, however, the film did show a whippet on screen for three seconds as a blind person's companion dog. Including a beloved sighthound in your movie is a sure way to score points with this reviewer. Blindness gets a C + from me.

I would be interested in hearing other opinions about this movie, both from those who have read the novel and those who have not!

Master of the Flying Guillotine (1975)

Attempting to work the ophthalmology angle on the Kung Fu classic Master of the Flying Guillotine is a tall order, but I just had to direct some attention to this bizarrely entertaining movie. Some of you might remember my favorite TV show, Kung Fu Theater, where they would run these poorly dubbed martial arts movies after the Saturday morning cartoons finished up. I think I must have seen this movie repeat four times on Kung Fu Theater over the years.

The central character is a blind master whose weapon of choice is the flying guillotine. This thing looks like a small salad bowl with sharp knives lining the edge, attached to a chain. The blind guys throws the bowl over the heads of his victims, yanks on the chain, and the blades close up and decapitate him. He seeks revenge on the one-armed boxer who killed his two students, lopping off several heads along the way.

The movie features an amazingly hip soundtrack (apparently with nonlicensed use of songs), exceptionally poor and erratic dubbing, a weird fighting tournament showcasing various fighting styles, and crazy fake facial hair and eyebrows.

Ophthalmology-related content includes a scene of bilateral eye gouging during the fighting tournament, and of course, the blind title character. Accurately tossing the flying guillotine without being able to see would sharply limit its lethality for most, but the Master skillfully relies on his other heightened senses of hearing and smell. At one point, he tracks the injured one-armed boxer by "smell[ing] blood."

I tried running a quick PubMed search for articles on blindness and extrasensory recruitment, and glazed over at the murky hodgepodge of neuropsychology and developmental biology journals. I think the jury is still out, but it appears to be an area of active interest. Here's part of an abstract from a 2008 article from Beth Israel Deaconess Medical Center and Harvard Medical School:

The loss of vision has been associated with enhanced performance in non-visual tasks such as tactile discrimination and sound localization. Current evidence suggests that these functional gains are linked to the recruitment of the occipital visual cortex for non-visual processing, but the neurophysiological mechanisms underlying these crossmodal changes remain uncertain. One possible explanation is that visual deprivation is associated with an unmasking of non-visual input into visual cortex.

This kind of verbiage never fails to make me sleepy, and I believe you can get pretty much the exact same information by just watching the amazing abilities of the Master of the Flying Guillotine.

Get Smart (2008)

Although I can't say that Get Smart left me more fulfilled from a comedic or artistic standpoint, the ophthalmology content definitely taught me something new! In one scene, Maxwell Smart (Steve Carell) escapes a locked interrogation room by using his captor's ocular biometrics, holding up the beat-up bad guy's face to the eye scanner and lifting his eyelid.

You've probably seen this kind of scene before- remember Demolition Man (1993) with Wesley Snipes and Sylvester Stallone, or how about Tom Cruise getting an eye transplant in Minority Report (2002) to mask his identity?

What you might not realize, as I didn't, is that ocular biometrics actually does exist in many forms right now. There are two main technologies: iris recognition, which images the detailed surface of the irides of an individual's eyes; and retinal scanning, which utilizes infrared light to map the unique vascular pattern of a person's retina.

Apparently these scanners no longer exist just in science fiction movies. Retinal scanners have been used by the FBI, CIA, and NASA. Iris recognition seems to enjoy more widespread applications, notably in the UK Iris Recognition Immigration System, several US and Canadian airports, and in Pakistan for a refugee repatriation project. An interesting iris registration fact from Wikipedia:

The iris has a fine texture that – like fingerprints – is determined randomly during embryonic gestation. Even genetically identical individuals have completely independent iris textures, whereas DNA (genetic "fingerprinting") is not unique for the about 1.5% of the human population who have a genetically identical monozygotic twin.

Hey, I must have missed the ultra-cool ocular biometrics lecture somewhere along the way! I don't really recommend Get Smart ( C - ) based on the eye-related content alone, but maybe if you were totally into the old TV show, the cameos and references to it might make it a worthwhile pursuit. A plane, train, and SUV make for an impressive stunt-filled finale, too.

Here are some parting images of an iris and a retina. Enjoy!

Bolt (2008)

We all know and love the standard Disney formula: independent hero(ine) strays far from home and family, struggles to journey back with assistance from scrappy sidekicks, and along the way learns a little something about their true self. Bolt sticks to the tried-and-true, borrowing more than a few plot points from Toy Story, but ultimately delivers an enjoyable and technically astonishing experience.

As an added bonus, there are a few ophthalmology related features to address.

First, an animal control worker gets maced in the second half of the movie, resulting in toxic conjunctivitis. Nothing new here- these scenes seem to be a dime a dozen! Interesting mace tidbit from Wikipedia:

Due to the current brand-name use of the term "Mace" to refer to pepper sprays and the fact that mace is illegal in most Western countries, it is very difficult to find information on traditional mace. "Mace" and "Pepper Spray" are frequently used interchangeably.

Also, we saw the version of Bolt in 3-D, which I highly recommend. As you may have read in the reviews, Disney Digital 3-D is a huge technological leap from the old red-and-blue 3-D glasses. The animators really skillfully avoided 3-D cliches here, and used the added technology to complement the story-telling. How does it work? We got circular polarized 3-D glasses, and the movie frame rate is jacked up to 144 frames per second. The digital projector has a polarizing screen that matches the right and left filters in the glasses. The alternating left-right projected perspectives are then perceived by the viewer as a three dimensional image!

Finally, the villain in the movie, Dr. Calico (voiced by Malcolm McDowell of A Clockwork Orange) exhibits two ophthalmic features of note. He is occasionally referred to as "The Green-Eyed Man" by Bolt.

This blurry screen capture of Dr. Calico demonstrates iris heterochromia (different colored irides), and also corectopia (displacement of the pupil from its normal central position).

Iris heterochromia may occur as a congentital condition (usually inherited as an autosomal dominant trait), or it may be acquired as a result of retained intraocular foreign body, topical medications, iris neoplasm, ICE syndrome, Fuchs' heterochromic iridocyclitis, Horner's syndrome, chronic iritis, juvenile xanthogranuloma, leukemia, or lymphoma.

The differential diagnosis for corectopia includes trauma, prior anterior segment surgery, ICE syndrome, iris coloboma, iris tumor, prior inflammatory change, iris stromal hypoplasia, posterior embryotoxon, Peter's anomaly, and ectopia lentis et pupillae.

Wonderful ophthalmology teaching points, Bolt! This movie gets a B + from me, and if you are considering watching it, I highly recommend seeking out one of the 3-D theaters to enhance the experience.

Made of Honor (2008)

Within the first few minutes of the horrifically bad Made of Honor, fans of eyes in film are treated to a scene of womanizer Tom Bailey (Patrick Dempsey) getting sprayed in face with perfume by Hannah (Michelle Monaghan). This episode happens after tipsy Tom inadvertently stumbles into the bed of his intended partner's roommate, Hannah. As ridiculous as this opening premise sounds, I actually know someone who had the same thing happen to them (minus the mace-ing)!

Toxic conjunctivitis occurs with airborne irritants or a direct splash of liquid or powder to the eye. Patrick Dempsey admirably portrays a victim of this condition, and also later demonstrates proper treatment with copious irrigation of both eyes, making good use of the Cornell dorm drinking fountain.

If you are simply looking for a cinematic depiction of toxic conjunctivitis, take a look at Will Ferrell in Semi-Pro (2008), or better yet, Jean-Claude Van Damme in the legendary Bloodsport (1988). Made of Honor fails miserably as a When Harry Met Sally wannabe, lacking the requisite chemistry or animated dialogue of a passable romantic comedy. Plus, doesn't the basic premise of all these infidelity-themed "romances" (My Best Friend's Wedding, Waitress, Bridges of Madison County) just start you off on the wrong foot? Made of Honor scores a wretched D from this reviewer.

Smart People (2008)

When pompous Carnegie Mellon literature professor Lawrence Wetherhold (Dennis Quaid) suffers head trauma, multiple medical follow-up exam scenes follow. These interspersed hospital scenes inexplicably depict an ongoing physician-patient relationship between the protagonist and his emergency room doc (Sarah Jessica Parker).

Equally baffling is a scene of a neurologist (Daivd Denman, who plays Pam's former fiance on NBC's The Office) using a slit lamp to perform an evaluation. While I applaud any screen-time that our tool of the trade gets, seeing a neurologist handling it made me kind of queasy.

Smart People features a quirkier-than-thou cast of misfits and the occasionally engaging dig at academia. I liked the sense of place and much of the acting. Ultimately, the forced eccentricity (Gilmore Girls, anyone?) doomed this movie for me. I give it a C + .

A couple of quick Ophthalmology in Film tidbits:

• Blindness, starring Julianne Moore, had its release date pushed back to next week, September 26th. I'm trying to finish up the novel of the same name by Nobel-laureate Jose Saramago before it opens, and the extra week will definitely help out. If the movie version contains even a quarter of the eye-related content of the book, this one may prove to be the Citizen Kane of ophthalmology movies.
• Derailed (2005), starring Jennifer Aniston and Clive Owen, depicts a character with corneal scarring secondary to gunshot wounds. I kind of liked this thriller despite its cliched elements, but it really got panned on Rotten Tomatoes (20%). There are also some great shots of Chicago. I give this one a B .
  

Never Back Down (2008)

No attack is frowned upon more by mixed martial artists and ophthalmologists alike than eye gouging. This act of pressing on or tearing the eye, usually with the fingers, can cause extensive ocular and periorbital trauma.

Without giving too much away, Never Back Down, a sort of Karate Kid for the You Tube generation, depicts a rather realistic scene of eye gouging. There are also assorted instances of facial blows with subsequent eyelid swelling and superficial trauma.

Despite a ridiculously cliche script and ADHD-style directing, I found myself laughing right along with this movie. The training scenes and the brutality of street fighting were fairly well-rendered. Never Back Down gets a solid C + from this reviewer.

Up next: an actual eye exam performed in Smart People (2008), starring Ellen Page.