The Case of the Affluent Artist With Rapidly Deteriorating Vision

Albert Lowenfels, MD; Patrick Maisonneuve, Eng

Disclosures

August 10, 2010

Brief Biography

Joshua Reynolds (1723-1792) was born in the United Kingdom and exhibited early artistic talent (Figure 2). He was still a young man when his parents, impressed by his ability, arranged for him to be apprenticed to Thomas Hudson, a successful British painter, to learn the rudiments of portrait painting. When Reynolds was 26 years old, he had already sold several portraits, raising sufficient funds to travel to Rome and support himself there for 2 years, where he studied Italian masterpieces. Upon his return to England, he quickly became the country's most sought-after portrait painter. In 1769, when Reynolds was 46 years old, King George III awarded Reynolds a knighthood in recognition of his ability.

Figure 2. Joshua Reynolds, self portrait painted during middle age. From http://www.gutenberg.org/etext/19009.

When the Royal Academy of Art was formed in 1768, Reynolds was the natural choice to head this prestigious new institution. He remained its president for the next 20 years, resigning only because of ill health near the end of his life.[2]

During his most successful years, his estimated earnings amounted to 6000 guineas, equivalent to a current annual income of approximately 1 million dollars. Few artists have ever achieved such monetary success during their lifetime.

Ophthalmology in the 18th Century

Ophthalmology has a rich history dating back to the beginning of recorded civilization. Egyptian physicians could partially restore the vision of a patient with cataract by using a needle to push the opacified lens back into the vitreous humor. However, the Code of Hammurabi stipulated that if the surgeon blinded the patient or if the patient died, the surgeon would have his hands cut off -- an early and startlingly severe example of quality control that must have caused all but the boldest surgeon to hesitate before performing this type of surgery.[3]

At the time Reynolds developed his visual problems, examination of only the external portion of the eye was possible. A tumor within the eye would have been invisible, because ophthalmoscopes become available only about 50 years later, after Helmholtz developed a primitive ophthalmoscope allowing physicians for the first time to inspect the interior of the eye. With this new instrument, physicians were soon able to classify the pathologic findings related to many previously mysterious eye diseases.

Spectacles, although expensive, had been available for several centuries, and from his numerous self-portraits, Reynolds is known to have worn them. He may have even used a type of bifocal lens so that he could examine his sitters and his painting by using different focal lengths.

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