Tag Archives: Cataracts

Mon-ayyy I can see!

I’ve worn glasses ever since I was in second grade. Yes, I was unfortunately THAT Asian girl who wore her hair in a middle part, high ponytail every day and had blue plastic glasses. Ever since I got glasses, naturally, my vision has gotten worse and I currently stand at a -9.00 prescription for my contacts. As someone who has had bad vision for two-thirds of her life, I was particularly intrigued by our vision module during our “Arts on the Brain” class. We began to explore the world of sight and learned that many famous artists had some sort of visual impairment. Claude Monet, a French impressionist painter, had cataracts which are speculated to have aided him in trailblazing the Impressionist art style. Our class wrapped lab goggles in plastic wrap to mimic the effects of cataracts, and we were able to see the beautiful gardens in Giverny through Monet’s eyes. This led me to research more about the cognitive effects of having visual impairments, specifically cataracts, and what Monet’s cognitive state might have been like.

Left to Right: original photo, drawing, drawing with cataract glasses

First, what exactly are cataracts? A cataract is a clouding of the lens in the eye, which lies behind the iris and the pupil. Our lens is analogous to a camera lens, hence the name, and it refracts light rays to help focus on image on the retina. A clear lens lets us see a clear picture. The lens is made of water and protein that is arranged in a precise way to keep the lens clear and let light pass through it. However, as we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract. Over time, the cataract may grow larger and cloud more of the lens, making it even harder to see (NEI, 2015). Usually, aging is the most commons cause for cataracts, but traumatic injuries, UV exposure, and certain medical problems can also lead to the development of cataracts (Boyd, 2018).

Normal eye vs. Eye with cataract

Monet was diagnosed with cataracts in both eyes in 1912 at the age of 72, which aligns with what we would expect for age-induced cataracts. Monet was very reluctant to go through cataract surgery, and in the end, he only had restorative surgery in one eye. His left eye, clouded by a dense yellow cataract, could not see violets and blues, but his right eye could see these colors clearly. This distortion in color perception and acuity had an impact on his work where tones became muddier and darker and forms became less distinct. Monet apparently complained that “colors no longer had the same intensity for me” and that “reds had begun to look muddy”, and that “my painting was getting more and more darkened” (Gruener, 2015). Monet was audibly upset about his impairment, but I wonder if his mood or cognitive state would have been improved if he had gotten the surgery in both of his eyes.

Monet’s paintings of water lilies are impacted (Left 1889 vs. Right 1915)

Some studies have been conducted that look at the impact of cataract surgery on cognitive function in an aging population. A study by Jefferis et al. looked at the effect of cataract surgery on cognition, mood, and visual hallucinations in older adults who had bilateral cataracts. Participants, who were all 75 years of age or older, were assessed pre and post-operatively. The investigators measured visual acuity through logMAR, Addenbrooke’s Cognitive Examination (ACE-R), the 15-item Geriatric Depression Scale (GDS-15), and the North East Visual Hallucinations Inventory (NEVHI) (Jefferis et al., 2015). ACE-R evaluated six cognitive domains: orientation, attention, memory, verbal fluency, language, and visuospatial ability (Mioshi et al., 2006). Small but significant benefits in cognitive scores were seen 1 year after surgery, but there was no statistically significant difference in mood or hallucinations.

A different study by Fukuoka et al. in 2016 found that cataract surgery could improve cognition, although there was insufficient evidence for a definite conclusion (Fukuoka et al., 2016). A follow-up study in 2018 found that cataract surgery may play a role in reducing the risk of developing mild cognitive impairments independently of visual acuity, but not for dementia (Miyata et al., 2018). A loss of vision can be associated with loss of cognition. It is interesting to see how when the sensory input of sight is disturbed, there are cognitive effects that occur. The relationship between vision and cognition have not been explored extensively, but there are specific visual disorders that have been shown to share common pathogenic pathways with Alzheimer’s disease (Rogers & Langa, 2010). Some speculate that individuals with visual impairment allocate more attention resources to processing sensory information, leaving fewer resources for cognitive tasks (Lindenberger & Baltes, 1994). Additionally, there is a common factor to vision and cognition and that is the degeneration of central nervous function (Christensen et al., 2001. These studies provide great insight into how Monet or even people like our grandparents might be affected by declining vision.

Cute elderly couple with glasses

Cataracts and cognitive impairment are both age-related diseases. Especially with how the proportion of older adults are increasing in the world, it is important to see how we can improve their quality of life as they get older. These studies allowed us to gain more insight into how vision or sight for older populations may have an additional benefit of cognitive improvement.


Boyd K (2018) What Are Cataracts? American Academy of Ophthalmology https://www.aao.org/eye-health/diseases/what-are-cataracts

Fukuoka H, Sutu C, & Afshari NA (2016) The impact of cataract surgery on cognitive function in an aging population. Current Opinion in Ophthalmology 27:3-8

Gruener A (2015) The effect of cataracts and cataract surgery on Claude Monet. British Journal of General Practice 65:254-255

Jefferis JM, Clarke MP, & Taylor JP (2015) Effect of cataract surgery on cognition, mood, and visual hallucinations in older adults. J Cataract Refract Surg 41:1241-1247

Lindenberger U, Baltes PB. Sensory functioning and intelligence in old age: a strong connectionPsychol Aging 1994; 9:339–355

Miyata K, Yoshikawa T, Morikawa M, Mine M, Okamoto N, Kurumatani N, Ogata N (2018) Effect of cataract surgery on cognitive function in elderly: Results of Fujiwara-kyo Eye Study. PLoS One 13

National Eye Institute (2015) About Cataracts. National Eye Institute https://nei.nih.gov/health/cataract/cataract_facts

Rogers MA & Langa KM (2010) Untreated poor vision: a contributing factor to late-life dementia. Am J Epidemiol 171:728-235

Tay T, Wang JJ, Kifley A, et al. Sensory and cognitive association in older persons: findings from an older Australian populationGerontology 2006; 52:386–394


At Giverny: My own

Cataracts: https://nei.nih.gov/health/cataract/cataract_facts

Monet, Bridge over a Pond of Water Lilies (1889): https://www.metmuseum.org/art/collection/search/437127

Monet, Water Lilies (1915):


Old people with glasses: https://www.aoa.org/patients-and-public/good-vision-throughout-life/adult-vision-19-to-40-years-of-age/adult-vision-over-60-years-of-age

A Glimpse Through Monet’s Eyes

Standing in Monet’s Garden in Giverny, I donned a pair of scratched, plastic-covered, yellowed glasses and watched the once-breathtaking view in front of me melt into a muddied and obscured version of its former beauty. As a class, we had taken a day-trip to explore the place that Monet painted his famous water lilies. Monet is thought to have had worsening cataracts as he aged, which

Monet’s garden (Personal image)

impacted his vision and therefore his artwork. To simulate his experience, in class we had made “cataract glasses” by altering a pair of safety glasses, and we wore them for part of our time in the garden. I sketched the scene, noting how the vibrant, defined foliage lost its form and beauty. Certainly, this distortion altered my perception and gave me a unique perspective. However, at the time, I did not consider my final product a very appealing result.

My Monet-inspired glasses, meant to imitate vision with cataracts (Personal image)

But, this representation of the scene wasn’t inherently bad, and being impaired didn’t necessarily make my depiction worse for its lack of accuracy! It may even be that “impairments” enhance creative ability: even with the failing functionality of his own vision, Monet was able to transform any scene into a masterpiece.

My sketch of the same scene without (left) and with (right) the glasses (Personal Image)

In other realms as well, what may be deemed an impairment may turn out to be neutral or even beneficial to an individual’s creativity or artistry! Perhaps surprisingly, recent research suggests that this may be the case for some dementia patients.

One study by Midorikawa et al. (2016) involved analyzing new or increased positive abilities that appeared in patients with behavior-variant frontotemporal lobe dementia (bvFTD) or Alzheimer’s Disease (AD). These types of dementia are the ones in which enhanced abilities—such as new or improved drawing, singing, or painting skills—are most commonly reported after disease onset, leading to an apparent boost in creativity or artistry.

First, to briefly introduce the diseases of interest: FTD and AD are both types of

The different brain regions affected by FTD and AD. (Image from ElderlyCareAssistance.info)

dementias, diseases in which brain cells begin to die. FTD is a rather rare type of dementia that begins early in life. Cells die in parts of the brain that deal with social skills, decision-making, and emotion—especially the front and the side (What is Frontotemporal Dementia?). The specific type called behavior-variant FTD (bvFTD) is characterized by changes in personality such as disinhibition, inappropriate behavior, and loss of empathy. (Kurz et al., 2014). AD, which is one of the most common types of dementia, usually begins later in life. A lot of the initial cell death happens in the hippocampus, a structure associated with memory, so memory problems are often some of first symptoms (Miller and Hou, 2004).

Some of the items from the questionnaire (Image from Midorikawa et al., 2016)

In this study, caregivers of people with FTD and AD filled out a questionnaire, ranking the patients on a variety of positive behaviors in three different categories: sensory processing, cognitive skills, and social/emotional processing. On a four-point scale, caregivers indicated the frequency of the listed behaviors in each category for their patient “before the illness” and “at the present time.” Prior to the study, each patient was also diagnosed by a neurologist and assigned a clinical dementia rating, or CDR. (Higher CDR numbers indicate a more advanced or severe stage of disease.) This would allow the researchers to see if there were differences in ability between various stages and types of dementia.

Study results: y-axis indicates the average score. X-axis indicates clinical dementia rating (CDR) for Alzheimer’s Disease or frontotemporal dementia. (Image from Midorikawa et al., 2016)

Subtracting the “before” score from the “present” score, the researchers obtained a representative value, where a positive number indicates more of the behavior since diagnosis. Averaging these values for each diagnostic rating, Midorikawa et al. (2016) performed a statistical test to assess the magnitude of change in that behavior. What they found was that some of these positive behaviors significantly increased after disease onset! In particular, they found that (as can be seen in the graphs below) both AD and bvFTD patients actually exhibited more language-related activities–meaning creativity in self-expression through language–in the earliest stages of the disease. Additionally, a small portion of patients of both dementias experienced an increase in visuospatial activities, which includes things like being able to depict scenes through painting or drawing!

Although patients at later stages of the disease experienced decreases in these behaviors, it is a very intriguing finding that patients’ creative expression actually increased after disease onset. Moreover, there have also been many case reports documenting increased artistic output following neurological damage due to other causes, such as traumatic brain injury, Parkinson’s Disease, and semantic dementia (Midorikawa and Kawamura, 2015; Canesi et al., 2016; Hamauchi et al., 2019). Just like with Monet, it appears that what appears to be a deficit may in reality not be quite so detrimental to the creative process!

One strength of this study was how all patients underwent a comprehensive neurological evaluation by the same experienced neurologist. This was effective to confirm the diagnoses of the patients using consistent parameters and to assess disease severity. However, being survey-based, these measures were quite subjective and may not be entirely accurate. What it contributes to the field, though, is that it is one of the first studies to systematically analyze these changes in artistic ability: others have primarily been case studies of individuals. The study also offers a unique perspective: most work on dementia serves to analyze the deficits that occur due to cell death. This study, however, highlights

Painting by one AD patient without previous artistic training or ability before disease onset (Image from Schott, 2012).

some positive aspects of the disease, contributing to a rather new initiative that is working to change the dynamic around mental impairments. Rather than viewing perceptual differences as incorrect or indicative of pathology, maybe we should allow ourselves to appreciate the creativity.

In sum, even though I felt a bit ridiculous in the moment, wearing my cataract glasses in Monet’s garden taught me a powerful lesson: A change in perspective is not necessarily bad, even when the conventionally beautiful scene undergoes some alterations in the process. Perhaps if more people would be willing to look a bit silly and try on some Monet cataract glasses, we could all come to appreciate those with neurological damage and perceptual differences a little bit more, valuing them for the unique perspectives they bring to the world.



Canesi, M., Rusconi, M.L., Moroni, F., Ranghetti, A., Cereda, E., Pezzoli, G. (2016). Creative Thinking, Professional Artists, and Parkinson’s Disease. J Parkinsons Dis. 6:239-246. doi: 10.3233/JPD-150681.

Frontotemporal Dementia- Signs and Symptoms. (n.d.). Retrieved from https://www.ucsfhealth.org/conditions/frontotemporal_dementia/signs_and_symptoms.html

Hamauchi, A., Hidaki, Y., Kitamura, I., Yatabe, Y., Hashimoto, M., Yonehara, T., Fukuhara, R., Ikeda, M. (2019). Emergence of artistic talent in progressive nonfluent aphasia: a case report. Psychogeriatrics. 10.1111/psyg.12437.

Kurz, A., Kurz, C., Ellis, K., Lautenschlager, N.T. (2014). What is frontotemporal dementia? Maturitas. 79:216-219. doi: 10.1016/j.maturitas.2014.07.001.

Midorikawa, A., Cristian, L.E., Foxe, D., Landin-Romero, R., Hodges, J. R., Piguet, O. (2016). All is not lost: positive behaviors in Alzheimer’s Disease and Behavioral-Variant Frontotemporal Dementia with disease severity. Journal of Alzheimer’s Disease. 54:549-558. doi: 10.3233/JAD-160440.

Midorikawa, A., Kawamura, M. (2015). The emergence of artistic ability following traumatic brain injury. Neurocase. 21:90-94. doi: 10.1080/13554794.2013.873058.

Miller BL, Hou CE. (2004). Portraits of Artists: Emergence of Visual Creativity in Dementia. Arch Neurol. 61:842–844. doi:10.1001/archneur.61.6.842.

Schott, G. D. (2012). Pictures as a neurological tool: lessons from enhanced and emergent artistry in brain disease. Brain. 135:1947-1963. doi: 10.1093/brain/awr314.






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