Art and the eye





Vision is defined in Webster’s College Dictionary as “the act or power of sensing with the eyes; sight.” To an artist, vision is much more than simply seeing. It represents a marriage of eye and brain: an interpretation of color, light, line and form, clarity, tone, proportion, depth, and dimension. As sight diminishes, we see and record the world in a different light. A look at the works of many well-known artists raises a multitude of questions in the eyes of the astute observer. Did the painter deliberately change his style as he (or she) matured? Are the changes in color or technique related to changes in the way in which the artist was seeing things? If so, what was happening to his vision? Refractive error? Presbyopia? Cataracts? Diabetic retinopathy? Macular degeneration? Other pathology? Was he actually trying to depict the world as he saw it? Art history takes us behind the scenes. It explores evidence that helps to explain the theories that have been presented and leaves us with thoughts to contemplate when we have no way of obtaining documentation or proof. Let us examine some of these theories as we look into the lives and works of artists whose vision was dimmed by disease.


El Greco (1541–1614)


Art historians and ophthalmologists alike have studied the paintings of El Greco, born in 1541 on the Greek island of Crete, a possession, at that time, of the Republic of Venice. Although he trained in Italy, El Greco was most noted as a Spanish painter. It was to Spain, in 1570, that he brought his style of predominantly vertically elongated, isolated figures and mystical atmospheres, a style considered shocking at the time. Why were his figures so elongated? For almost a century, art connoisseurs and physicians alike have advanced theories attributing his elongations to an astigmatic refractive error. Patrick Trevor-Roper, a British ophthalmologist, stated that “in nearly all his paintings there is a vertical elongation but on a slightly oblique axis, so that all his characters seem to be in danger of falling off the bottom right-hand corner of the picture.” Astigmatism elongates along its axis and Trevor-Roper notes that the distortion can be neutralized by photographing the paintings through a cylindric lens, plano − 1.00 × 15.


When we place his paintings in the context of their times, however, we discover that a style of painting termed mannerism had developed and was popular in Europe from about 1520 to 1600. Mannerist paintings displayed great emotion and were characterized by figures that were distorted and deformed, stretched and exaggerated. X-rays of El Greco’s paintings show the elongations superimposed on his normally proportioned original sketches. More evidence pointing to the influence of style, rather than astigmatism, on his work can be observed in paintings, such as Saint Andrew ( Fig. 47.1 ), in which the fingers of the right hand are held horizontally and elongated; the fingers of the left hand point vertically and are also elongated. Could he have had one eye with hyperopic astigmatism that he used to see his subjects at a distance and the other with myopic astigmatism that he used at close range to see his canvas, one eye with with-the-rule astigmatism and one eye with against-the-rule astigmatism? As he grew older, his figures became more and more elongated, an unusual occurrence if the elongations were caused by astigmatism, because astigmatism tends to remain stable in adults. The answer to our questions will forever remain an enigma.




Fig. 47.1


El Greco: Saint Andrew .

(From Marmor MF, Ravin JG. The Eye of the Artist . St Louis: Mosby; 1997.)


The eyes of the Impressionists


A fast-forward to the latter half of the 19th century brings us to the era of Impressionism . In their day, Impressionist paintings were considered shocking, radical, and revolutionary. Brushstrokes were quick and spontaneous, coarse, thick, and sometimes broken; colors were often bold and daring and mixed directly on the canvas to be blended not by the painter but by the observer’s eye. The artists attempted to capture a fleeting moment, an impression , and chose subjects from everyday life, from nature, from the rapid changes that were transforming the Western world into an industrial society: locomotives, bridges, city scenes, and factories rather than paintings that portrayed historical, religious, or mythical subjects or taught moral lessons. They attempted to portray the real world and experimented with light, color, candid groupings, off-center focal points, deep perspectives, and spontaneity. To many, their work seemed crude and unfinished, but the Impressionists felt themselves liberated from the strict formats that had ruled technique and subject matter in the past.


Many of these new works of art seemed out of focus. Had these unique techniques originated because of defects in sight? Did the rough brushstrokes portray the subjects the way the artists actually saw them, or did they represent the attempt of the artist to capture an instant in time with rapid, incomplete movements of the hand that suggested motion: trains, parades, people at work, dancers, strollers, party-goers?


Because so many of the well-known Impressionist paintings appear misty and obscure, it has been written that most Impressionist painters were myopic and preferred to view their subjects without optical correction. Paul Cézanne was reported to be myopic (as well as affected with diabetic retinopathy) and, although glasses were available to correct his refractive error, he stated: “Take those vulgar things away.” His landscapes are hazy and indistinct; his still-life paintings, done at close range, show clarity and detail. Would he agree with the remark of Mr. Cross, the Vicar of Chew Magna in Somerset, England, who was purported to say, “The newly invented optic glasses are immoral because they pervert the natural sight and make things appear in an unnatural and false light” or an epitaph in the church of Santa Maria Maggiore in Florence, Italy, that reads “Here lies Salvino d’Armato, of the Armati of Florence, Inventor of spectacles: may God forgive him his sins. ad 1317.” Or, by painting through his myopic eyes, was he trying to portray a softer, gentler world?


Claude Monet (1840–1926)


The term Impressionism was coined in 1873 when Claude Monet was asked to name one of his paintings for an exhibition. He called it Impression: Sunrise and he and his contemporaries in the fledgling movement of innovative painters soon came to be known as Impressionists . Monet studied the subtleties of changing light and recorded these nuances with different versions of the same motif at different times of day and changing weather conditions, moving from one canvas to another to capture the sun and shadow as the world turned. He is said to have wished that he “had been born blind to experience sight suddenly: to see the world naively, as pure shape and color.” He actually did experience temporary blindness at the age of 27 years, which was attributed to worries about his wife, Camille, who was about to give birth to his son, Jean.


As he entered his 66th year, Monet became aware of changes in his vision, although bilateral cataracts were not diagnosed until 4 years later. He consulted with several ophthalmologists but was advised to defer surgery. Although the cataract in his right eye was almost mature and the eye virtually useless, he was deathly afraid of surgery. His close friend, the diplomat Georges Clemenceau, had been a physician and helped to provide both medical advice and a shoulder to lean on. Although Clemenceau assured Monet that his sight could be restored through surgery, Monet remained opposed to an operation. By 1918, then 78 years old, Monet reported:


I no longer perceived colors with the same intensity. I no longer painted light with the same accuracy. Reds appeared muddy to me, pinks insipid and the intermediate or lower tones escaped me….

At first I tried to be stubborn. How many times, near the little bridge where we are now, have I stayed for hours under the harshest sun, sitting on my campstool, in the shade of my parasol, forcing myself to resume my interrupted task and recapture the freshness that had disappeared from my palette! Wasted efforts. What I painted was more and more dark, more and more like an “old picture,” and when the attempt was over and I compared it to former works, I would be seized by a frantic rage and slash all my canvases with a penknife.


Subtle differences in color became difficult to distinguish, although vivid colors were still visible against a dark background, and the bright noonday sun forced him to abandon painting at midday. Aware of his problems differentiating colors, he arranged his paints according to their labels, in a set sequence, on his palette. Acknowledging that he was unable to select colors appropriately, he destroyed a number of canvases. By now, his cataracts had become brunescent and were affecting his color perception by filtering out blue, violet, and some shades of green. His paintings reflected his vision and became increasingly hazy and more red, yellow, and brown ( Figs. 47.2 and 47.3 ).




Fig. 47.2


Claude Monet: Water Lily Garden , 1900.

(From Marmor MF, Ravin JG. The Eye of the Artist . St Louis: Mosby; 1997. Mr. and Mrs. Larned Coburn Memorial Collection. Reproduction, The Art Institute of Chicago.)



Fig. 47.3


Claude Monet: Japanese Footbridge at Giverny , 1923.

(From Marmor MF, Ravin JG. The Eye of the Artist . St Louis: Mosby; 1997. Musée Marmottan, Paris. Bridgeman Art Library.)


Although Monet had agreed to produce 19 large water lily panels that the French government would place in the Orangerie Museum in Paris, he felt, by 1922, that he would be unable to complete the project. In a letter, he lamented:


I wished to profit from what little (remained of) my vision to bring certain of my decorations to completion. And I was gravely mistaken. For in the end, I had to admit that I was ruining them, that I was no longer capable of making something of beauty. And I destroyed several of my panels. Today I am almost blind and I have to renounce my work completely.


By September 1922, Monet’s vision had decreased to light perception with projection OD and 20/200 OS. Yet he continued to resist surgery. An attempt was made to enhance the vision in his left eye by dilating the pupil with eucatropine hydrochloride, a mydriatic used at that time, so he could see around the opacity. For a brief period of time, it seemed to help. Monet wrote to his ophthalmologist:


It is all simply marvelous. I have not seen so well for a long time.… The drops have permitted me to paint good things rather than the bad paintings which I had persisted in making when seeing nothing but fog.


Within a month, however, he realized the futility of his strategy to circumvent surgery and agonized over the inevitable procedure. He wrote to Clemenceau about his torment and nightmares. At the time, cataract surgery was a complex procedure. Monet knew of others, including the American Impressionist Mary Cassatt and the French caricaturist Honore Daumier, who had undergone unsuccessful cataract extractions and he became increasingly despondent. Finally, in January 1923, in response to the strong urging of Georges Clemenceau, who reminded him of his agreement with the French government to complete the water lily panels, Monet underwent an extracapsular cataract extraction, which had been preceded by an iridectomy the month before. The only anesthetic available was cocaine and the surgeon probably used no sutures or perhaps just one.


Monet found it difficult to adapt to the postsurgical regimen of lying in total darkness, both eyes bandaged shut, flat on his back (with no pillow), his head between sandbags to prevent movement and with no nourishment except bouillon and lime tea, for 10 days. The only time light entered his eyes during this period was when the bandages were removed from his right eye every hour or two to instill eyedrops. Monet had to be forcibly restrained from tearing off his bandages and expressed a preference for being blind rather than having his eyes covered. He was attended by a guardian at night, not only to make sure he did not move but also to engage in conversation because lack of contact with the outside world could cause delirium or psychotic behavior. Three weeks after surgery, he was given a pair of temporary cataract glasses and began his “adjustment” to the aphakic world.


As anticipated by his ophthalmologist, the posterior capsule opacified, necessitating still another surgical procedure. Severe depression set in. He wrote to his surgeon, Dr. Charles Coutela:


I am absolutely discouraged and as much as I read, not without effort, 15 to 20 pages per day, outdoors from a distance, I cannot see anything with or without glasses (with the right eye). And for 2 days, black spots have bothered me.

Remember that it has been 6 months since the first operation, 5 since I left the clinic and 4 that I have been wearing glasses. It has taken me 4 or 5 weeks to get used to my new vision. Six months that I would have been able to work if you had told me the truth.

It is to my chagrin that I regret having had this fatal operation. Pardon me for speaking so frankly and let me tell you that it is criminal to have put me in this situation.


Dr. Coutela noted Monet’s “profound discouragement and despair” and related that “Monet saw himself as blind forever and, completely demoralized, refused to leave his bed.” The secondary membrane was removed at Monet’s home in Giverny in July 1923, after which he was able to achieve vision of about 20/30 in his right eye with a prescription of + 10.00 + 4.00 × 90. Unfortunately, because he refused to have the cataract in his left eye removed, he was unable to use his eyes together. The brunescent cataract in his left eye caused him to experience a marked difference in color perception between the two eyes. The colors seen with his left eye were muddied by the cataract; with his right eye, the lost blues and violets returned with a vengeance. He painted his house, as seen from the rose garden, through the mature cataract in his left eye ( Fig. 47.4 ) and the aphakic (probably uncorrected) vision in his right ( Fig. 47.5 ).




Fig. 47.4


Claude Monet: The House Seen from the Rose Garden , 1923.

(From Marmor MF, Ravin JG. The Eye of the Artist . St Louis: Mosby; 1997. Musée Marmottan, Paris. Bridgeman Art Library.)



Fig. 47.5


Claude Monet: The Artist’s House Seen from the Rose Garden , 1923.

(From Marmor MF, Ravin JG. The Eye of the Artist . St Louis: Mosby; 1997. Musée Marmottan, Paris. Bridgeman Art Library.)


Monet found it difficult to adjust to aphakic spectacles. He was bothered by the abnormal curvature of objects caused by the high-plus astigmatic lens for his right eye and had difficulty walking with his glasses. He expressed his disappointment in a letter to Dr. Coutela:


I have just received them (new glasses) today but I am absolutely desolated for, in spite of all my good will, I feel that if I take a step, I will fall on the ground. For near and far everything is deformed, doubled and it has become intolerable to see. To persist seems dangerous to me.


And to Clemenceau, he wrote:


I’m doing exercises and can read easily but the distortion and exaggerated colors that I see are quite terrifying. As for going for a walk in these spectacles, it’s out of the question for the moment anyway and if I was condemned to see nature as I see it now, I’d prefer to be blind and keep my memories of the beauties I’ve always seen.


Clemenceau urged him to have surgery on the second eye but he responded:


I absolutely refuse, for the moment at least, to have the operation done to my left eye. … You can have no idea of the state I’m in as regards my sight and the alteration of colors…so unless I find a painter, of whatever kind, who’s had the operation and can tell me that he can see the same colors he did before, I won’t allow it.


Aphakic glasses, even today with corrected curve lenses, have a great deal of aberration; they create a ring scotoma that restricts the wearer’s peripheral vision and induce magnification of 1.5% to 2% per diopter of correction, making it impossible for patients who have had surgery in only one eye to use their eyes together. Monet had to block his unoperated left eye with a piece of paper or, in a later pair of glasses, what appears to be an occluder lens. He had separate glasses for near and distance rather than bifocals, and experienced far greater distortion, as well as spherical and chromatic aberration, than a wearer of contemporary aphakic spectacles would today. The high magnification and high astigmatic correction contributed to his depression and his refusal to have surgery on the contralateral eye. A pair of his aphakic spectacles on display at the Musée Marmottan in Paris reads: OD + 14.00 + 7.00 × 90; OS plano. He complained of overwhelming blue and yellow vision and expressed his desolation to Dr. Coutela:


For months I have worked with obstinacy, without achieving anything good. I am destroying everything that is mediocre. Is it my age? Is it defective vision? Both certainly, but vision particularly. You have given me back the sight of black on white, to read and write and I cannot be too grateful for that but I am certain that the vision of (this) painter…is lost and all is for nothing.

I am telling you this confidentially. I hide it as much as possible but I am terribly sad and discouraged. Life is a torture for me.


Eventually, Monet was fitted with a Zeiss aphakic spectacle lens, which had a wider field of vision. He continued to complain about colors:


I see blue; I no longer see red or yellow. This annoys me terribly because I know that these colors exist, because I know that on my palette there is some red, some yellow, a special green and a certain violet.…It’s filthy, it’s disgusting, I see nothing but blue. …


Relief was finally achieved and a more normal perception of blue obtained with glasses that were tinted yellow-green, allowing him to better adapt to his aphakic vision. He still experienced dramatic mood swings that are evidenced in letters he wrote in the final years of his life:


I am more certain than ever that a painter’s eyesight can never be recovered. When a singer loses his voice he retires; the painter who has undergone an operation of the cataract must renounce painting and this is what I have been incapable of.


But a few months later, in a letter to Dr. Coutela, he wrote:


I am very happy to inform you that I have recovered my true vision and that nearly at a single stroke. I am happily seeing everything again and I am working with ardor.


Monet continued to paint until his death, at age 86 years, from lung cancer and chronic obstructive pulmonary disease, retouching and completing his water lily series, which can be seen today at the Orangerie in Paris.


Vincent van Gogh (1853–1890)


Vincent Willem van Gogh was born into a Dutch family of preachers a year to the day after his stillborn brother and given the same name as the firstborn son. Although he studied for the ministry and tried his hand at teaching, he gradually drifted into a troubled and tragic life as an artist.


Many theories have been put forth in an attempt to explain his mental illness, bizarre behavior, and artistic technique. As an adult, particularly during the last 2 years of his life, he experienced periods during which he appeared to be perfectly normal and lucid, interspersed with episodes of severe mental disturbances. His mental illness has been attributed to epilepsy, bipolar illness, schizophrenia, Ménière disease, and chemical toxicity. More recently, the possibility of porphyria, a genetic disease caused by an enzyme deficiency and manifested by symptoms that include abdominal pain and neurologic and psychiatric disturbances, has been proposed as the cause of his bizarre behavior because others in his family also exhibited symptoms of insanity. However, dark urine is characteristic of porphyria, and scholars have found no references to this in his letters, nor has any other medical documentation been uncovered.


How can we envision van Gogh’s vision? Did his paintings reflect an abnormality of vision? Trevor-Roper hazards a guess that van Gogh was short-sighted, based on the fact that his paintings are best viewed within a short radius; the subjects in his paintings are placed at an unusually close range; and that he had a “childhood habit of walking with half-shut eyes, hunched shoulders, looking at his feet, and being a duffer (incompetent) at ball games.” Ravin and Marmor, however, report that in May of 1890, van Gogh’s vision was informally tested by Dr. Paul Ferdinand Gachet, a homeopathic physician, amateur artist, and rather eccentric individual himself. Gachet was entrusted with van Gogh’s care after van Gogh left the mental institution in Provence, where he had admitted himself after cutting off part of his left ear. Van Gogh was intrigued by an eye chart hanging on the wall of Gachet’s country home in Auvers-sur-Oise, north of Paris. On reading the letters on the chart and also being tested for color vision with the materials that Gachet used to test railroad workers, he was found to have excellent visual acuity and normal color vision. In spite of these findings, many questions have been raised about his style and use of color, particularly during the last 2 or 3 years of his life.


Van Gogh’s halos


The colored halos and swirls in the sky in Starry Night ( Fig. 47.6 ), perhaps van Gogh’s most well-known painting, and similar waviness and halos in some of his other works, have been the subject of much analysis. In Starry Night , the moon and sun are superimposed, stars magnified and surrounded by halos, and the sky filled with swirling nebulae. Some think that the painting resulted from a dramatic revelation that he experienced during a vivid hallucination. Others have entertained the possibility that the colored halos were indicative of an attack of angle-closure glaucoma, although there is no reference to the nausea, intense pain, and severe clouding of vision that accompany an angle-closure glaucoma attack in any of his letters, most of which have been preserved. Perhaps, as used by previous artists symbolically in religious paintings, the aura in the sky represented his “sentimental attachment to stars from his youth…when he felt a need for religion, he went out at night and painted them.”


Jun 26, 2022 | Posted by in OPHTHALMOLOGY | Comments Off on Art and the eye
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