Hektoen International

A Journal of Medical Humanities

Medicean optics: An analysis of Raffaello’s Portrait of Pope Leo X and Two Cardinals

Vincent P. de Luise 
New Haven, Connecticut, United States

Portrait of Pope Leo X and two cardinals
Portrait of Pope Leo X (Giovanni di Lorenzo de’ Medici) and his cousins, the cardinals Giulio de’ Medici and Luigi de’ Rossi. Raffaello Sanzio (Raphael). ​O​il on panel, 154 cm x 119 cm (​61 in. ​x 4​9​ ​in​). 1518-1519. Galleria degli ​Uffizi​, ​Firenze. Via Wikimedia.

Myopia, or nearsightedness, is the most common global eye disorder of refractive error, with significant global public health consequences.1 Along with cataract, macular degeneration, infectious disease, and vitamin A deficiency, myopia is one of the most important causes of visual impairment worldwide.1 In the United States, approximately twenty-five percent of the population is myopic.

High myopia, defined as myopia over six diopters, can lead to visual loss from retinal detachment, myopic maculopathy, secondary glaucoma, and cataract.2 Genetic and environmental factors contribute to the development of myopia. The genetics of myopia is complex, and most cases are not inherited. However, high myopia is often found to be transmitted through families in Mendelian patterns, including autosomal dominant, autosomal recessive, and X-linked recessive inheritance.

One of the most famous families with myopia was the de’ Medici of the Florentine Renaissance. The de’ Medici produced a long line of bankers, statesmen, and cardinals, as well as four popes: Leo X, Clement VII, Pius IV, and Leo XI. One of these popes, Leo X (born Giovanni di Lorenzo de’ Medici, December 11, 1475–December 1, 1521), is of particular interest because of the famous painting by Raffaello Pope Leo X and Two Cardinals at the Uffizi, that provides a visual example of high myopia.

Portrait of Pope Leo X and Two Cardinals by Raffaello Sanzio (Raphael) is one of the masterpieces in the Uffizi (Figure 1). It is one of Raffaello’s last works, and one of the few he himself designed and painted in his last years.3 The Pope is seated magisterially in the center of the painting. The cardinal on the left of the painting is Giulio di Giuliano de’ Medici, who would become the future Pope Clement VII. The other cardinal has been identified as Luigi de’ Rossi, who was a maternal cousin to both Pope Leo X and Cardinal Giulio di Giuliano.

The realism and monumentality in which Raffaello depicts Pope Leo X is extraordinary, and one of the artist’s greatest achievements.3 Raffaello uses a dramatic black background to amplify the spotlight on the Pope and his cardinals, an early example of tenebroso (tenebrism) technique. Tenebroso would also be used by El Greco and Tintoretto later in the Cinquecento before Caravaggio deployed it in many of his works in the 1600s. On the table are an opened illuminated prayer book as well as an ornately carved bell, aspects of the exquisite taste of the Pope who was an active patron of the arts.3 The pommel on top of the Pope’s chair evokes the symbolic abacus balls of the Medici family, while the illuminated Bible open on the table has been identified as the Hamilton Bible.4

Detail of Portrait of Pope Leo X and two cardinals
Detail of the handheld lens in Portrait of Pope Leo X and Two Cardinals. Raffaello Sanzio (Raphael). Oil on panel, 1518–1519. Galleria degli Uffizi, Firenze. Via Wikimedia.

The de’ Medici were a learned and bookish family, in which myopia was prevalent.5,6 The founder of the de’ Medici dynasty, Giovanni de Bicci de’ Medici (1360-1428), was said to have had “remarkable eyes” and to have “read greatly up to an advanced age.”5,6 His son, Cosimo de’ Medici, was said to “have the habit of half-closing his eyes” to see sharply. Half-closing one’s eyes works as a stenopaic slit, reducing stray and aberrant light rays. Cosimo’s son, Piero (“the Gouty”), was said to have “the eyes of the family and to have read up to the end of his life without glasses.”6

Lorenzo de’ Medici (“the Magnificent”), Pope Leo’s father, and Giuliano de’ Medici, Pope Leo’s uncle, were said to be shortsighted, another term for myopia. It was written that Lorenzo had “prominent” eyes and that his “sight was weak.”6 There are three versions of a portrait of Giuliano de’ Medici by Botticelli, all of which show him with prominent globes and half-closed lids.

Pope Leo X, Giuliano’s second son, was said to “always read letters close to his nose.”6 However, the most compelling proof of Pope Leo’s myopia is evidenced by Raffaello’s realistic portrait and the concave lens the Pope is holding in his left hand (Figure 2).

While it might appear that what Pope Leo is holding is a magnifying lens, it is not. Magnifying lenses are convex in shape and create an enlargement of images behind them. There is no enlargement of Leo’s thumb beneath it; in fact, the tip of the thumb is actually slightly smaller than it is in reality. This minification is characteristic of lenses for myopia. The Pope’s handheld lens still exists, and is displayed in the Museo di Galileo (formerly the Museo Storia della Scienza di Firenze). The lens has been measured at -12 diopters (minus signs before diopter numbers represent myopia, plus signs represent hyperopia or presbyopia), proof that Pope Leo X was myopic, indeed highly myopic.6,7 


  1. Terri Young, Molecular genetics of myopia. Optom Vis Sci Jan 2009 86: E8-22
  2. Jiali Li, and Qingjiong Zhang, Insight into the molecular genetics of myopia. Mol Vis 2017: 23: 1048-1080
  3. Raphael’s Pope Leo X and Two Cardinals web gallery of art https://www.wga.hu/frames-e.html?/html/r/raphael/5roma/5/09leo_x.html
  4. Bernice F. Davidson, Raphael’s Bible. Penn State Univ. Press, 1990. pg.12.
  5. Louis Alaerts. La myopie héréditaire des Médicis. Bruxelles (Brussels). Laboratoires Cusi. 1958
  6. Sir Patrick Trevor-Roper, The World Through Blunted Sight, Penguin Press. 1988. pp. 28-30. 7)
  7. Catholic Encyclopedia entry: Leo X: https://www.newadvent.org/cathen/09162a.htm

VINCENT P. DE LUISE, MD, FACS, is an assistant clinical professor of ophthalmology at Yale University School of Medicine, a distinguished visiting scholar at Stony Brook University School of Medicine in the department of bioethics and medical humanities, and on the adjunct faculty at Weill Cornell Medical College where he serves on the humanities and medicine committee and the Music and Medicine Initiative advisory board. Dr. de Luise is a senior honor recipient of the American Academy of Ophthalmology and physician program co-chair of the Connecticut Society of Eye Physicians. He is the cultural ambassador of the Waterbury Symphony Orchestra and president of the Connecticut Summer Opera Foundation. Dr. de Luise lectures frequently on music and the arts and their relationship to humanism and compassion.  

Highlighted in Frontispiece Volume 13, Issue 2 – Spring 2021

Fall 2020




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