The Crash Reel (2013)

 

What E.T. the Extra-Terrestrial (1982) lacked in ophthalmology content, it made up for in emotional punch, choking up this then eleven year old viewer with empathy.  The Crash Reel, a new HBO documentary, hits home with incredible portrayals of tragedy and heroism, and prominently features ophthalmology to deliver the total package.

 

Kevin Pearce, world-class snowboarder, suffers a horrifying crash during a half-pipe training run in Park City, UT in 2009. The documentary chronicles Pearce's rise to fame, his recovery, and the subsequent challenges faced by him and his impressive family.

 

 

 Unfortunately, the type of injuries suffered by Pearce are not unfamiliar territory for practicing ophthalmologists. He sustains left orbital fractures (facial CT scans shown in the movie), intracranial hemorrhage and traumatic brain injury, a described but not shown traumatic mydriasis, acquired nystagmus, and a cranial nerve palsy which leaves him with persistent diplopia (double vision). The diplopia treatments shown run the whole gamut, and include occlusion filters, Fresnel prisms, prism glasses, vision therapy, and eventual strabismus (eye muscle) surgery. Pearce's ophthalmologist is shown reviewing some aspects of the informed consent process, and footage from inside the operating room and later in the post-op recovery area (see below) documents the first major film to feature strabismus surgery that this reviewer has ever seen.

 

 

Since The Crash Reel was released two weeks ago on HBO, I do not want to get into too many of the specific non-ophthalmic details of Lucy Walker's riveting and multi-faceted documentary. Ophthalmologists and non-ophthalmologists alike will be thrilled and challenged by what may very well be the best movie I have seen so far this year. A .

I Love You, Beth Cooper

With the one-two punch of the Thanksgiving-Christmas holiday combo rapidly approaching, the high school comedy I Love You, Beth Cooper serves up a timely eye safety message.

The movie opens up with the class valedictorian, Denis, delivering a graduation speech professing his secret love for the popular cheerleader, Beth Cooper.  Wouldn't you know that wacky antics ensue, and that, against all odds, these two crazy kids manage to get together?  I'd put a spoiler alert warning before this brief recap, but I think you'd be justifiably insulted by it!

The above-mentioned antics kick off with a cork flying out of a champagne bottle and toward Denis' right eye.  Incidentally, the bottle is provided with parental approval, and the father of Denis is acted by that guy who played Cameron, the friend in Ferris Bueller's Day Off.  Champagne cork injuries to the eye are actually somewhat common, and can be devastating.  From the British Journal of Ophthalmology 2004:

Among [eye injuries from] bottle tops, the champagne bottle cork remains the main culprit. A 750 ml champagne bottle contains 4.125 litres of carbon dioxide with a pressure of 6.2 bar—almost three times higher than a typical car tyre’s (Champagne France Information Bureau, 2002); this can shoot the 30 g cork up to 13 metres. The blinking reflex offers no help: from the typical opening distance of 60 cm, the cork needs less than 0.05 seconds to reach the eye.

Fortunately for Denis, the cork impacts his right orbital rim, rather than the globe, and he escapes serious ocular injury.  Unfortunately for the viewer, this means that the movie continues its absurd storyline, rather than perhaps a more interesting plot involving a trip to the emergency room, and an engaging consult with a friendly ophthalmologist.

Most champagne bottles in the US apparently "carry conspicuous warning labels explaining the dangers to the eye and showing the correct way of bottle opening."  I can't verify this at the moment, but I'll check on it the next time we open a bottle.  From a press release by the American Academy of Ophthalmology, here are some tips on opening a bottle of champagne properly:

• Make sure sparkling wine is chilled to at least 45 degrees Fahrenheit before opening. The cork of a warm bottle is more likely to pop unexpectedly.


• Don’t shake the bottle. Shaking increases your chances of eye injury.


• To open the bottle safely, hold down the cork with the palm of your hand while removing the wire hood. Point the bottle at a 45-degree angle away from yourself and from any bystanders.


• Place a towel over the entire top of the bottle and grasp the cork. 


• Keep the bottle at a 45-degree angle as you slowly and firmly twist the bottle while holding the cork to break the seal. Continue to hold the cork while twisting the bottle. Continue until the cork is almost out of the neck. Counter the force of the cork using slight downward pressure just as the cork breaks free from the bottle.


• Never use a corkscrew to open a bottle of champagne or sparkling wine.

Other than its vivid demonstration of the potential ocular hazards associated with champagne corks, I cannot find a lot to recommend about I Love You, Beth Cooper.  I sort of liked the first scene when Denis gave his speech, and I think the two buddy actors share a few funny moments, but almost everything else about the movie seems forced and awkward.  Further, what might pass as harmless merriment in another high school comedy setting comes off as lurid and irresponsible here.  Maybe I'm just getting older or something.  For a much better movie about the tired theme of "seize the day", check out Jim Carrey's Yes Man.  For a better high school comedy, just cover your eyes and pick any DVD out of the 80s bargain bin.  I Love You, Beth Cooper gets a D .

The Expendables (2010)

You don't stroll into Applebee's seeking out a culinary epiphany, right? Similarly, The Expendables will almost certainly deliver the expected goods to its target audience, satiating ones appetite for automatic weapons, knife-throwing, beheadings, and flimsy plots of government corruption by ex-military personnel. But can the eye-content hungry movie-goer find a morsel of ophthalmology in The Expendables? Read on!

Early in this mercenary flick, Jet Li delivers a ferocious kick with a steel-toed boot to Dolph Lundgren's left upper eyelid, causing a superficial laceration. Dolph's character even comments on the injury, stating that it will probably require sutures, and he expresses his dislike for sutures.

Later in the movie, the viewer notes that his laceration has been repaired with simple Steri-Strips, thin adhesive strips produced by 3M. They are applied across the laceration in a manner which pulls the skin on either side of the wound together. Their purported benefits compared to sutures include less scarring, easier care and application, and enhanced patient comfort. A major drawback is the loss of integrity when wet, something that a badass New Orleans-based soldier of fortune might want to take into consideration.

I won't go into a long treatise on the relative benefits of wound closure by suture versus Steri-Strips versus Dermabond, but suffice it to say that like with many areas of medicine, this issue is surrounded by heavy dogmatic declarations. ER doctors (read "I'm never going to see this patient again in follow up") will have a greater preference for quick and easy wound closure, whereas plastic surgeons (read "I'm not the one knee-deep in an ER swamped with drunkards and screaming kids at 3 AM") will pride themselves on meticulous suture closure with a grateful, well-insured, and sober clientele.

It's hard to judge The Expendables, because you get exactly what you signed up for. It's still pretty tough to overlook the banal plot and shabby dialogue. There should also be a law against movies where people run, out in the open, away from an army of people firing machine guns from less than 20 feet, escaping any serious injury. The whole theme of Jet Li repeatedly getting his ass kicked by a shady white person and then getting rescued by a noble white person got a bit old for this Asian-American male reviewer, too. Where is the Chuck Norris-spanking Bruce Lee from Enter the Dragon when we need him?

I'm going to give The Expendables a C - , which pains me, because I went to high school with one of the executive producers (see if you can guess which guy in the picture!) Sorry, Jason. Let's see if we can get just a little more ophthalmology content in the sequel, OK?

Unfaithful (2002)

Other than a brief scene of chemical keratoconjunctivitis in Kickass (hairspray in the eyes), there has been a dearth of eye-related movie content on DVD and in theaters lately.  Since we've covered the tired theme of chemical irritation several times (Bolt, Made of Honor, Did You Hear About the Morgans?), I had to resort to HBO to come through with Unfaithful from 2002, starring Diane Lane, and directed by Adrian Lyne.  Lyne also directed Flashdance, Fatal Attraction, and Indecent Proposal.

I guess marital infidelity flicks are Mr. Lyne's specialty, and Unfaithful depicts a tragic family implosion sparked by adultery.  What appears to be an ideal and secure home life proves stifling for suburban housewife Connie Sumner, and her New England manor and even-keel husband can't compete with the exciting, care-free city life offered by French book dealer, Paul Martel.  You can almost connect the dots here with a standard story about the bored housewife, intriguing foreigner, suspicious husband, private investigator, etc, etc.  There's a shift at the end of the second act that steers the plot in a different direction than I was expecting, and for as standard as the rest of the movie is, the power of the directing and acting ultimately produces something more intriguing than it should be.

The downtown loft-dwelling home wrecker, Paul Martel, has more in his bored-housewife seducing toolbox than just a French accent, toned abs (see photo), and inappropriate public displays of affection.  Among the piles of books in his apartment, there is a copy of a book in Braille in the kitchen, and one of his pick-up techniques involves taking Connie's hands in his and drawing them over the pages as he "reads" the words.  From Wikipedia:

The Braille system is a method that is widely used by blind people to read and write. Braille was devised in 1821 by Louis Braille, a blind Frenchman. Each Braille character or cell is made up of six dot positions, arranged in a rectangle containing two columns of three dots each. A dot may be raised at any of the six positions to form sixty-four (2⁶) possible subsets, including the arrangement in which no dots are raised.

The Braille system was based on a method of communication originally developed by Charles Barbier in response to Napoleon's demand for a code that soldiers could use to communicate silently and without light at night called night writing. Barbier's system was too complex for soldiers to learn, and was rejected by the military. In 1821 he visited the National Institute for the Blind in Paris, France, where he met Louis Braille. Braille identified the major failing of the code, which was that the human finger could not encompass the whole symbol without moving, and so could not move rapidly from one symbol to another. His modification was to use a 6 dot cell — the Braille system — which revolutionized written communication for the blind.

Interestingly, Braille literacy statistics show that 50% of legally blind people were able to read Braille in 1960, and this has dropped to around 10% today.  Technological advances and budgetary constraints have been cited as some possible reasons.  I have never met a visually impaired person who could actually read Braille.  This lack of Braille fluency is kind of reflected in the movie, since Paul Martel (who is not visually impaired, by the way) just makes up what he is "reading" with Connie.

Unfaithful is a well-acted and produced movie, with occasionally nuanced moments that rescue it from a movie-of-the-week descent.  A few scenes of peculiar pacing and heavy-handed directing are balanced by a restrained exploration of motive.  It will remind you of "The Stranger" in a movie form.  Let's give Unfaithful a big Braille B .

Blindsided (2006)

Unlike the similarly titled The Blind Side starring Sandra Bullock, Blindsided is a documentary film full of ophthalmology content.  This 65 minute documentary chronicles 12 year-old Jared Hara's experience with a particularly cruel disease known as Leber's hereditary optic neuropathy, a rare form of vision loss which typically develops in a person's teens or twenties.  From the National Institutes of Health:

These vision problems may begin in one eye or simultaneously in both eyes; if vision loss starts in one eye, the other eye is usually affected within several weeks or months. Over time, vision in both eyes worsens with a severe loss of sharpness (visual acuity) and color vision. This condition mainly affects central vision, which is needed for detailed tasks such as reading, driving, and recognizing faces. Vision loss results from the death of cells in the nerve that relays visual information from the eyes to the brain (the optic nerve). Although central vision gradually improves in a small percentage of cases, in most cases the vision loss is profound and permanent.

In the movie, we see Jared's ophthalmologists,  re-enactments of his exams, and witness his personal struggles with his progressive disorder.  The movie's strength lies in its rendering of how disease affects not only the individual, but also their family and friends.  Leber's hereditary optic neuropathy's basis on mutations in maternally inherited mitochondrial DNA also elicits complex feelings of guilt, blame, and unpredictability within the family.

In many ways, Blindsided (and movies like it) should be required viewing for  medical students.  Not every doctor (or even ophthalmologist) will encounter Leber's hereditary optic neuropathy in their career.  These personalized accounts of illness bring textbook descriptions alive, making obscure and intangible diseases very real.  And of course, feelings of helplessness and desperation in the patient and their family when dealing with medical conditions are something important for every practitioner to remember, even when rushing from one exam room to the next.


Blindsided won Best Documentary at the Idaho International Film Festival in 2006.  It has been showing lately on HBO, and is available on DVD.  As a movie, it relies heavily on Ken Burns-style pan and zooming, with an occasionally distracting soundtrack and some awkward sequence editing.  None of this takes too much away from the power of the story, and its illuminating portrayal of a tenacious victim of optic neuropathy.  Compared to that cloying Sandra Bullock football movie, Blindsided has a hell of a lot more ophthalmology content, and a far more nuanced representation of family dynamics and heroism.  B  .

Hachi: A Dog's Story (2009)

The famous true story of Hachiko, the loyal Japanese dog who awaited his master's return every day at the Shibuya train station, gets a modern makeover starring Richard Gere and Joan Allen.  Sony Pictures Entertainment booted this movie straight to a DVD release (just like the last movie re-make I reviewed, Ice Castles), so you'd expect that it would be pretty bad.  But after watching this one, I was surprised it never got a proper theatrical release.

Is there some rule that dog-centric movies must culminate in ultimate sadness?  Entertainment Weekly's review cites Marley and Me and I Am Legend  as recent examples of this man-dog bond motif.  Gere plays a music professor who stumbles upon the lost puppy, Hachi.  The movie bounces between scenes at the university, the professor's home, and the community of merchants around the commuter train station.  I'll try not to give away anything from this story based on events from the 1920s. but you can bet every effort to squeeze tears from the viewer is exhausted here.

The ophthalmology content involves scenes from Hachi's point of view, and show obvious color perception derangement.  This begs the question: Are dogs really color-blind?  My research took me to Paul Miller's (from University of Wisconsin-Madison's School of Veterinary Medicine) excellent review article Vision in Dogs.  Some selected excerpts:

Color vision in domestic mammals has been the subject of numerous studies with conflicting results.  More recent, well-controlled studies suggest that most domestic mammals possess, and use, color vision... cones constitute less than 10% of the visual streak in the dog, whereas they occupy almost 100% of the human fovea.  Additionally, instead of the three types of cones found in humans with normal color vision, dogs have only two functional cone types.

The article goes on to state that dogs lack or do not use "green" cones, and confuse red and green colors.  The canine visible spectrum is divided in the violet and greenish-yellow ranges.  Additionally, dog discrimination of closely related shades of grey is thought to be superior to that of a human.

Despite its manipulative tear-jerking stunts, Hachi tells a compelling story with likable characters and strong actors.  The train station scenes and season changes are very appealing and capture a strong sense of place.  The dog point-of-view scenes accurately reflect current thinking in canine veterinary ophthalmology, depicting a desaturated and altered color spectrum, but not a total lack of color perception.  I think this movie could have enjoyed modest success at the box office, and I reward this dog DVD with a solid B .

Ice Castles (2010)

Following occipital lobe trauma from an ice-skating mishap, figure skater Lexi Winston suffers cortical visual impairment.  You might think this sort of devastating injury would be career-ending, but Lexi and her plucky hockey-star boyfriend Nick set out to prove us wrong.

Normally I might include a bunch of "Spoiler Alert" tags on the plot summary, but this Ice Castles is actually a re-make of the Ice Castles from 1978.  C'mon, you remember tearing up hearing that Academy Award winning song "Theme from Ice Castles (Through the Eyes of Love)", don't you?  The 2010 movie serves up the modern, requisite syncopated re-make of the song, with hyper-stylized vocals.

Transient post-concussive visual disturbance is commonly encountered, but Lexi's type of prolonged/permanent vision loss from head trauma is not as common as you might think.  After the accident, we see her imaging evaluation in an older model General Electric MRI scanner (I think).  While standing in the radiology control room, the matter-of-fact physician counsels Lexi's father about the poor prognosis, advising him to take her home and prepare her for the difficult transition to a life of low vision.

These types of consultations are not normally done while standing in a control room, and in fact, the radiologists and technicians usually don't like it when non-radiologists hang out in there, let alone the family member of a patient.  Also, the doctor's assessment of Lexi's vision as "light perception" is clearly inaccurate, since Lexi's point-of-view shots suggest her ability to discriminate some shapes and movement.

Ice Castles didn't get a theatrical release, instead going straight to DVD with its release timed for the winter Olympics.  Despite some likable personalities and good skating cinematography, there is some seriously wobbly acting and an overall dingy look to the movie.  This one gets a C - , but worth a look if you have a special interest in figure skating, traumatic brain injury, or if you are a 13 year old girl.