• my response to an article in JAMA Ophthalmology

Ophthalmology and Art: Simulation of Monet’s Cataracts and Degas’ Retinal Disease”

I found an article about Degas and Monet that tries to illustrate what they might have been able to see by showing their inspiration or their later work and then using Photoshop to try to simulate their kind and degree of vision loss. Their intent is to show how their painting might have looked to them as they worked. It is a fascinating premise. I am here to tell you that, at least for Degas, the simulation misses the mark, based on my personal experience.  Having also experienced cataracts and had them corrected, I think the Monet examples are reasonably well represented, although mine were not permitted to “ripen” to the extent that he experienced in his lifetime. See the article here.

I have been pretty quiet about it, but I have been dealing with age-related macular degeneration (“dry” kind, also known as geographic atrophy)  for a few years now.  It is really difficult to describe how it is to have vision loss generally in the center of the visual field and still have great clarity on either side of the compromised area. The loss is partial, and is different in each eye. Of course we use both eyes together to see, so it can create some odd visual effects at times.

The impact on making marks is also hard to describe. I can no longer place my marking implement exactly where I want to place it. It might be as much as 1/4″ off. Part of the difficulty may be that our habit of using our eyes for reading and writing – and drawing – is to look directly at the spot where we want to focus our attention. In “dry” macular degeneration, that central part of vision is what is diminished. It’s not blurry, more like covered in a fog or simply blank, depending on the lighting.

Imagine you are presented with a form for filling our your social security number.  The form has a little box for each individual digit.  Now imagine that, when you look at the first box, it disappears – simply winks out of existence, along with the tip of the pen you were aiming at the box.  You can see the boxes next to it, and you can see the shaft of the pen – just not the tip.  If you shift your eyes left or right, the box is back – but when you try to write, lifelong habit draws your eye back to the exact spot where you wish to write and the box disappears again

My solutions so far are, get as close as I can using peripheral vision and make the mark from habit without the immediate visual feedback of seeing the line developing from contact between pen and paper.  With many tasks, like signing a check, this is sufficient.  For filling in those boxes – or for drawing and painting – it can be frustrating to be unable to see the mark you are making as you make it. Maybe the closest experience most people would have to this would be dirty glasses – if you cleaned your glasses really well and then put a thick blot of vaseline on each lens – just a fingertip’s size – just to the left of center on the left lens and just to the right of center on the right lens. Then you might gain some idea of the impact of AMD.

The article does not account for this ability to see some of the visual field clearly even though the center of vision is impaired. It says “ The striking finding is that Degas’ blurred vision smoothed out much of the graphic coarseness of his shading and outlines. One might even say that the works appear “better” through his abnormal vision than through our normal vision.” I doubt this very much . I suspect that he could see, with the peripheral vision that remained, that his strokes were less refined than earlier, but that he could no longer guide his hand and pastel to the precise spot where he wanted to mark the page.

If you take figure 2 (from the article on Degas and Monet), and imagine selecting an irregular oval shape from the center of figure 2f and placing that in the corresponding area of figure 2c, you might have more sense of what Degas could see of his work. (Understand that the spot would move with the movement of the gaze over the piece, so that the center of focus would be altered but the areas around it would likely be perceived clearly.) I suspect that he had to come to grips with making art differently, not that he imagined he was still making art in the same style and with the same refined qualities of his younger years. He had to develop a new language for his expression. But he did’t just quit – should he have?

Gradually as the cells that receive visual input die off, it creates an area I can best describe as a fog.  It is neither black, nor white, nor even blank, really, or not usually.  Blurry is not accurate either, although sometimes things look like they have had bites taken our of them. I say central vision, but it is slightly off-center, and of course it is progressive so constantly changing as it progresses.  In the left eye, the loss is slightly ot the left of center and encroaching on the center at this point.  In the right eye, it is slightly to the right of center, and a little bit lower, almost in a backwards C shape.  This means that, when using both eyes together, and especially if I move them a lot and have strong light, I almost feel as though I can see pretty well.  Each eye is still picking up information from the area the other eye has lost.  But there are conditions in which the loss seems more profound. When looking at faces in anything but bright sunlight, I have trouble distinguishing features, and expressions, because it seems the face are in deep shadow without enough contrast to discern the usual visual cues. In case of a crowd at a reception, this means I may not recognize people that I have known for years unless other things about them – stature, hairstyle, gait, sound of voice – give me enough cues.

Because some of the eye perceives with crystal clarity (as long as there is bright light) and some of it does not, AT THE SAME TIME, a simulation done by compute that treats an entire image as altered does isn’t even close to replicating the experience.  Another curious thing is that the brain fills in the gaps with what it imagines should be there.  A very startling example of this is evident in my room, where a white paper sculpture made by my granddaughter hangs from white “popcorn” acoustic ceiling. It is like a folded flower pattern with dramatic lights and shadows. If I  gaze at this sculpture at a certain angle, it will vanish.  But my brain fills in the blank with the pebbly pattern of the ceiling so that I “see” a perfectly uninterrupted acoustic ceiling. Shifting my eyes just a little – up, down, or to either side, the sculpture comes back into view in whole or in part.  It’s my new magic trick – I can make things appear and disappear..

The change of color perception from one part of the visual field to another is also a factor – the rods and cones are atrophying, and it produces strange and changing effects.  I first noticed this about a year ago when I was trying to use a yellow highlighter on some paperwork.  After a couple of swipes of the highlighter, I decided it must have dried out and I threw it in the trash.  A moment later, though, when I glanced at a different part of the page, the bright yellow highlight was visible in the periphery of my vision.  Sure enough, when I looked back at the spot, the yellow completely vanished. At that point, I could still read the word I had highlighted, I just could not perceive the yellow.  This does make me wonder how my color perception is being affected when I paint. 

In at least one work in the past year, I have found a bright blue showing up where I intended to use a dark shade, but that blue is not visible in my central vision – only if I look to the side.   In nature, I noticed a similar loss of blue in the case of a flowering bush that appeared to be all green until I caught it out of the corner on my eye – where I could see it had clusters of blue flowers.  Shifting my gaze back and forth, it was like blue lights winking on and off. I don’t know how much this altered  perception of certain blue and yellow hues affects my perception of color overall. Most colors appear more vivid in my peripheral vision now. It doesn’t mean that color is gone or flat in my center of vision, just somewhat less vivid and apparently less accurate.

The cataract simulations of Monet’s work seem accurate – I’ve had that experience too, and had the return of accurate color perception following the surgery (that he never had). My cataracts were not allowed to develop for as long as Monet’s did,  so I did not experience the deeper darkness he must have had in later years. such as is seen in Figure 3d. Figure 3c, approximating the yellow cast and general dimming of what he might have seen seems true to my experience. Because the surgery was performed on each eye on different days, there was a period of time in which I could compare “before and after” by closing one eye and then the other and comparing how I saw. It turns out that my neighbor’s new “green” vehicle was actually blue!

I remember being very curious about how I would feel about the work I had done while under the visual influence of cataracts, but surprisingly (to me) – they were fine.  Their colors were relative to the image and made a cohesive painting – somehow,  I was still choosing the colors that matched the colors in my references well enough so that removing the orange “filter” of cataracts did not make me want to “re-do” those pieces at all.  I am afraid macular degeneration is going to affect it a great deal more over time, but there is no do-over for this condition. Yet. Maybe science will get there.

For now, I am coming to terms with the idea that my art may become ever more expressive and less defined. Ironically I have often thought I “should loosen up” – be careful what you ask for!  I see that my new pieces looks rougher – or shall we say looser? – than my previous work, and I no longer have the visual acuity to refine it as I would love to do. As I struggle with  accepting the need for a new visual language, I guess I have to trust the impulse to create still has value, as it did for others who have gone before me. I hope that viewers of my work still find it engaging and meaningful and maybe even beautiful. Degas and Monet didn’t quit – should they have? I haven’t quit – should I?