The world of the uncorrected myope is an Impressionist painting: misty, muted and out-of-focus. In the late 19th century, traditional realism was challenged by a new breed of artists who quickly filled their canvases with splashes of color, crude brush strokes and fuzzy images. Most art historians surmised that these artists were merely trying to capture a fleeting moment, an impression; others believed that eyes dimmed by defects or disease explained the broken brush strokes, the lack of detail, and the brief glimpses of nature and of life that crossed their canvases.

Lets look at the lives and talents of some Impressionist artists and discover the visual problems that may have had profound effects on their techniques, their colors and their media.



 One artist who was myopic and painted without glasses was Paul Cezanne (1839-1906).1 Myopic spectacles were readily available in his time, but he refused to wear the glasses, saying, Take those vulgar things away.1 A look at his artwork shows that Cezannes close-ups are quite distinct, with fine details. His landscapes, on the other hand, were consistently hazy and out of focus. Why did he refuse vision correction? Did he prefer the softer, gentler world that he saw through his myopic eyes? Cezanne also had diabetes, but he lived before the discovery of insulin.1 Was his sight also dimmed by diabetic retinopathy?



Auguste Renoir (1841-1919) was erroneously described as a myope by the British author and ophthalmologist Patrick Trevor-Roper.1 Although his early paintings show great clarity, his later landscapes exhibit the haziness that Trevor-Roper attributed to myopia. Still, his son wrote about his fathers keen eyesight: He sometimes wore glasses for reading, but he did so chiefly to save his eyes. When he was in a hurry or when he mislaid his glasses, he managed quite well without them Often, he would point out to us on the horizon a bird of prey flying over the valley.2

Late in life, Renoir was badly crippled by arthritis and required a wheelchair.2 He was confined to his room for weeks at a time, had great difficulty holding his brushes and painted with far less detail. He also used different colorsmuch less blue and more warm tones. Were the changes in color usage due to cataracts, which filter out a disproportionate amount of violet, blue and green while leaving red and brown unaffected? Was the lack of detail in his later works due to presbyopia, or to his inability to hold his brushes properly anymore?


The term Impressionism was coined by Oscar-Claude Monet (1840-1926). In 1873, when asked to title a painting he entered in an exhibition, he named it Impression: Sunrise, never realizing that he and the others who adopted similar styles would come to be known as Impressionists.

While in Venice in 1908, Monet began to recognize problems with color perception; by 1912, at age 72, he was having a great deal of trouble with his vision. His right eye was virtually useless. He was diagnosed with bilateral cataracts, and several prominent ophthalmologists recommended surgery. But, in spite of the nearly mature brunescent cataract in his right eye, Monet refused surgery. In 1913, glasses were prescribed, with a plano lens O.D. and -1.75D lens O.S. A separate pair of reading glasses was also prescribed, with +1.50D lenses O.U.

As time passed, bright sunlight overwhelmed him, and he could no longer paint at mid-day. He had difficulty distinguishing between similar colors, and was forced to identify colors by reading the labels on his paint tubes. On his palette, he maintained the colors in a regular sequence in order to prevent mistakes. In a later interview, he said: 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 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.2

By 1922, the vision in Monets right eye had declined to light perception with projection; visual acuity O.S. was 20/200 through a dense yellow-brown opacity.2 He wrote, I wished to profit from whatever remained of my vision in order to bring certain of my decorations to completion ... 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 work completely.

Dilating drops were prescribed in an attempt to open up the pupil of Monets left eye and allow him to see around the opacity.

Initially, the response was good. Monet remarked, 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.

Their effect, however, was short-lived. Finally, in January 1923, George Clemenceau, a physician as well as a politician, convinced Monet to have surgery. A two-stage operation was scheduled: a preliminary iridectomy later that month, followed by an extracapsular cataract extraction. The surgery required 10 days of absolute rest, during which time both eyes were bandaged shut. He was compelled to lie flat on his back, with his head immobilized by sandbags. During this time, he could only sip lime tea or bouillon, and he had to be forcibly restrained from ripping off his bandages. Monet said that he preferred to be blind.

Post-recovery, his vision was correctible to 20/30 with +14.00D 4.00D x 180, but Monet had great difficulty adapting to his aphakic glasses. He could not use both eyes together and complained that objects curved abnormally. I feel that if I take a step, I will fall on the ground, he said. Near and far, everything is deformed, doubled, and it has become intolerable to see. To persist seems dangerous to me. As for going for a walk in these spectacles, its out of the question for the moment anyway, and if I was condemned to see nature as I see it now, Id prefer to be blind and keep my memories of the beauties Ive always seen.2 He blocked his left eye with a piece of paper when reading and preferred to walk around seeing through the dense yellow-brown nuclear cataract in his left eye.

Monet also complained about the marked difference in color perception between his eyes; saying that he saw nothing but blue with his aphakic eye.2 Two years after his surgery, he was still having difficulty adjusting to his glasses. As soon as I am in a better frame of mind, I will try to get used to them, though I am even more certain that a painters eyesight can never be returned. When a singer loses his voice, he retires; the painter who has undergone a cataract operation must give up painting; and this is what I have been incapable of doing.

Finally, glasses with a yellow-green tint were prescribed, which brought him out of his despair and enabled him to start painting again. He was able to continue painting almost until his death in December of 1926, from chronic obstructive pulmonary disease and lung cancer.


Van Gogh

The visual perception of Vincent van Gogh (1853-1890), whose short life was troubled by mental illness and bizarre behavior, is an enigma. Although the British ophthalmologist Patrick Trevor-Roper theorized that van Gogh was myopic, his vision was tested informally by a rather eccentric homeopathic physician, Dr. Paul Ferdinand Gachet, in May of 1890two months before van Gogh committed suicide.1 Dr. Gachet found his vision and color perception normal.2 But, why did van Gogh use so much yellow in his later paintingseven in the flesh tones of his portraits and self-portraits? Did he have xanthopsiaand, if so, was it caused by chemical toxicity or substance abuse?

Van Gogh probably had a seizure disorder. After release from a mental institution, his brother, Theo, placed him under the care of Dr. Gachet. At the time, digitalis, known today as a heart medication, was used to used to treat melancholic thoughts, hypochondria, mental illness, headache, nausea, vomiting, pain in the eyes, swelling of the eyelids, tearing, and
inflammation of the eyes.2 Van Goghs portrait of Dr. Gachet shows him seated with a sprig of foxglove, from which digitalis is extracted, in a glass on the table.

In toxic, but non-lethal doses, digitalis can cause yellow vision. Knowing Gachets eccentric nature, and the fact that the townspeople referred to him as Dr. Saffron because he dyed his hair yellow, one wonders whether van Gogh was mismanaged and deliberately overdosed with digitalis, causing him to develop xanthopsia.

Van Gogh also had some digestive problems, for which he may have taken santonin, a terpene, used at the time to treat and prevent intestinal parasites and known to cause yellow vision. He was presumed to have pica, which caused him to have abnormal cravings for other terpenes similar to santonin: thujone, turpentine, camphor and absinthe.

Perhaps most significant was absinthe, an emerald green, powerful alcoholic beverage (60% to 80% ethanol, with some methanol added occasionally) known as the green fairy, and derived from wormwood.

Wormwood (Artemisia absinthium), classified as a psychoactive convulsant, was used by many Impressionists, Post-Impressionists, and 19th and early 20th century writers. The hallucinogen was known to alter perceptions and act on ones consciousness to produce ideas that were not otherwise accessible. There was a 19th century saying that, Absinthe gives genius to those who do not have it and takes it away from those who do.

Van Gogh described how absinthe affected his vision: Instead of eating enough and at regular times, I was keeping myself going by coffee and alcohol. I admit all that, but it is true all the same that to attain the high yellow note that I attained last summer, I really had to be pretty well strung up.3

Eye-care practitioners with an interest in art have also taken note of the halos in some of van Goghs paintings, especially Starry Night and Starry Night Over the Rhone, and debated as to whether they could have been depicting halos that he saw during attacks of angle-closure glaucoma.2

There is no mention, however, in any of his letters or medical records of symptoms characteristic of glaucoma, such as intense pain, nausea or loss of vision. It is more likely that he used the halos religiously or symbolically, as did some of his contemporaries, to create a sense of atmosphere in his landscapes.4



Edgar Degas (1834-1917) is famous for his ethereal depictions of ballerinas, often with featureless faces. Yet, when he was younger, he painted with great detail.

Degas was a low myope, and he suffered from a chronic eye disease that caused progressive, irreversible vision loss.2 It was diagnosed at the time as chorio- retinitis, a term that, in the 19th century, encompassed many conditions that scarred the retinaincluding age-related macular degeneration.

He was extremely photophobic and felt that his eye problems were caused by sunlight and cold weather.2 In 1873, on a visit to relatives in New Orleans, Degas found that his cousin had a
progressive eye disease termed simply, ophthalmia, that caused her to lose all useful vision in her left eye by the time she was 25, and rendered her totally blind in both eyes by the age of 32.2

Degas feared that his visual loss would also be progressive and permanent. In a letter written in 1873, he lamented, I expect to remain in the ranks of the infirm until I pass into the ranks of the blind.

Early works of Degas show the finest details: eyebrows and lashes, details of musicians and their instruments; folds in the ballet costumes; and canvases filled from edge-to-edge.

As his condition worsened during the 1880s, he lost central vision. He described his painting as an exercise in avoiding the blind spot; his focal point shifted from the center to either the right or left side of his canvas. He had to ask his model to identify the colors of his pastels, and as time went by, his colors changed to harsh, strident tones.2

In 1892, Degas was given glasses with an occluder lens O.D. and a stenopeic slit that approximated his astigmatic axis O.S. In an 1873 letter, he wrote: You will see me with a comparatively ominous looking contraption over my eyes. They are trying to improve my vision by screening the right eye and allowing the left one to see through a small slit.2 The glasses were soon abandoned, as he found them embarrassing and not helpful.

Photographs taken between 1890 and 1900 show that Degas eyes were straight.2 He wore glasses and was apparently orthophoric, documenting that he must have retained some vision in his right eye, even late in life. Additionally, if his right eye was totally blind, why would he have needed an occluder lens in his stenopeic spectacles.

The late works of Degas show a predominance of red and a relative lack of blue. Central retinal disease can cause blue cone deficiency, and his difficulty in distinguishing colors supports the diagnosis of retinal disease.2 The etiology of his retinal disease was never established, but possibilities have included infection, degenerative disease or familial disease. As his sight diminished, he adjusted to its limitations by exploring other media: pastels instead of oil; photography; and sculpture, in which he could use his sense of touch to enhance his limited vision.



Camille Pissarro (1830-1903) has been called the Tearful Impressionist, since he suffered from chronic dacryocystitis of his right lacrimal sac with fistula formation during the last 15 years of his life.2

When Pissarro was young, he enjoyed painting landscapes with peasants in the then-rural le de France. In 1887, blaming traditional physicians for the death of his friend, the artist Edouard Manet, Pissarro sought treatment for an inflammation of the right lacrimal sac from a homeopathic ophthalmologist.2 Thus began a process of recurrent swelling, abscesses, probing of the right nasal lacrimal duct, discovery of a bony obstruction in the passages, injections of silver nitrate to close off abnormal passages created by the probing, and constant fear of cellulitis and further scarring.

Pissarro was advised to avoid wind and dust, [and] wash the eye with boric acid immediately if the eye became inflamed.2 Arum, a homeopathic remedy, was prescribed to promote healing of the tissues surrounding the bone. Each time an abscess formed, the eye was bandaged for several days, and Pissarro lived in constant fear that exposure to dust or wind would cause the dacryocystitis to recur.

Much the pragmatist, he wrote to his son, Lucien: I am getting used to the idea of having only one eye for working. This is much better than having none at all.2 He curtailed his travel plans and moved his easel and canvasses indoors. No longer able to paint scenes of landscapes with peasants, he created some of his finest paintings looking out of windows at the boulevards of Paris and the rooftops of Rouen.

But, Pissarros dacryocystitis persisted. Fearful of surgery, he consulted other ophthalmologists, receiving conflicting advice regarding the management of his condition. During Pissarros lifetime, the only methods available in France for treating dacryocystitis were probing or removal of the lacrimal sac. On the one hand, total destruction of the lacrimal sac was recommended, the result of which would be constant tearing; on the other, attempting to locate a passage through the bone to the nose via further probing, possibly causing more false passages, cellulitis and scarring.2 He never opted for either procedure.

Ironically, just a year after his death, the Italian surgeon Addeo Toti published his technique of dacryocystorhinostomy, ushering in the era of modern lacrimal surgery.



Mary Cassatt (1844-1926), considered to be the most famous American Impressionist, spent much of her life in France. Rather than painting landscapes like many of her contemporaries, she painted carefully composed scenes of mothers and children until her vision began to fail.2

Cassatts visual problems began at the age of 56, in 1900. She had diabetes, so she had to depend on dietary restrictions and bizarre methods of treatment, including radium therapy.

In a 1911 letter, she wrote: I am at the doctors taking inhalations of radium. This is the eighth day, and I am suffering very much, which it seems would prove that it is doing me good, that it will be a success, provided I can stand it.

Radium was the miracle treatment of the early 20th century. Although it is not known whether Cassatt was treated with radium for her cataracts as well as for her diabetes, a 1920 article in the American Journal of Ophthalmology, entitled Radium for Cataract, reported that: Of the 31 patients under observation, 84.3% showed a change for the better. In the cases that showed a marked improvement, the opacities were definitely thinned out; one of these, a very early nuclear cataract, disappeared entirely, leaving no trace of the opacities. Radium is of proven value in the treatment of incipient cataracts.2

Radium has since been proven to cause cataracts, rather than heal them.

In 1912, she was diagnosed with cataracts. By 1915, her vision had declined, and she was no longer able to paint. She switched from oils to pastels, which were more forgiving, and her smooth brush strokes became harsh and broken. Cassatt was no longer able to recreate the delicacy of her earlier paintings.2


Looking back on the lives of these artists, consider the words of Mr. Cross, the Vicar of Chew Magna in Somersetshire, England: The newly invented optick [sic] glasses are immoral ... They pervert the natural sight and make things appear in an unnatural and false light.1

Or, an epitaph in the church of Santa Maria Maggiore in Florence, Italy: Here lies Salvino dArmato, of the Armati of Florence, inventor of spectacles: May God forgive him [for] his sins. A.D. 1317.

Today, many of the conditions that affected the these artists can be treated and corrected, but we cannot help but wonder: Would they have reached the same heights if they had been able to perceive the world with perfect sight?

Phyllis Rakow, director of Contact Lens Services for the Princeton Eye Group, is a JCAHPO-certified ophthalmic medical technologist, NCLE advanced-level contact lens technician, and an honored fellow of the Contact Lens Society of America. She dedicates this article to Michael Marmor, M.D., and James Ravin, M.D., whose book, The Eye of the Artist, served as her principal resource and forever changed the way she looks at art.


1. Trevor-Roper P. The World Through Blunted Sight. London: Souvenir Press; 1997.

2. Marmor MF, Ravin JG. The Eye of the Artist. Saint Louis: Mosby; 1997.

3. The Letters of Vincent van Gogh. London: Constable & Robinson Ltd; 2003.

4. Mhlberger R. The Unseen van Gogh. Chesterfield MA: Chameleon Books, Inc; 1998.

5. Ravin JG. Ophthalmology and the arts: Pissarros lacrimal problems. Ophthalmic Forum. 1984;2(1).

Vol. No: 144:10Issue: 10/15/2007