Diabetic retinopathy: An historical assessment

Abstract

Diabetic retinopathy is a microvascular complication of diabetes mellitus and is a significant cause of new-onset blindness. Diabetic macular changes in the form of yellowish spots and full or partial thickness extravasations through the retina were observed for the first time by Eduard Jäger. In 1855, he published "Beiträge zur Pathologie des Auges" where he included his fundus paintings. Jaeger's findings were controversial until 1872, when Edward Nettleship published his seminal paper on "Oedema or cystic disease of the retina", providing the first histopathological proof of "cystoid degeneration of the macula" in patients with diabetes. In 1876, Wilhelm Manz described the proliferative changes occurring in diabetic retinopathy and the importance of tractional retinal detachments and vitreous haemorrhages. However, it was not until 1943 that the work of Arthur James Ballantyne provided evidence that diabetic retinopathy represents a unique form of vascular disease. A number of multi-centred clinical trials during the last ten years have contributed substantially to the understanding of the natural history of diabetic retinopathy and have established the value of intensive glycaemic control in reducing both the risk of onset and the progression of diabetic retinopathy.

Diabetic retinopathy: Breaking the barrier

“…Later, around 500 BC, the presence of sugar in the urine and its occurrence in obese individuals was linked. Aretaeus of Cappadocia, a renowned physician of the Pneumatic School who lived in Alexandria and Rome during the 2 nd century AD [28], was the first to introduce the term diabetes. The term ‘diabetes’, which meant siphon, was started by Apollonius of Memphis, and is consistent with the polyuria associated with diabetes.…”

“…Apollinaire Bouchardat, a French ophthalmologist in Paris, reported the progress of visual loss in the absence of cataracts in diabetics in 1846 [29, 30]. This was reported as reversible, and most complications were eliminated with the control of diabetes through diet and exercise [28]. In 1855, the ophthalmologist Eduard Jäger in Austria built an ophthalmoscope that for the first time enabled him to observe diabetic macular changes that he recorded in fine detail in his now famous paintings [31].…”

“…An article by Henry Noyes (1869) supported the link between diabetes and maculopathy (the damage of the macula) [32], and was confirmed by another paper by Edward Nettleship (1872) in London. Nettleship’s paper described details of diabetes-induced pathological retinal changes [28]. …”

Association of Diabetic Retinopathy in Type II Diabetes Mellitus with Hba1c Levels: A Study

“…1 Diabetes is the commonest metabolic abnormality in the humans. 2 Type 2 diabetes is the commonest form of diabetes constituting nearly 90% of the diabetic population. 3 India with largest number of diabetic subjects earned the title Diabetes capital of the world.…”

Detection of Blood Vessels and Measurement of Vessel width for Diabetic Retinopathy

“…In 1950s, a number of clinical trials have characterized the natural history of DR and the efficacy and safety of DR treatment strategies [2]. DR is an apparent breakdown of the blood-retinal barrier (Cunha Vaz 1976, Krupinet al 1978, Klemen et al 1980) [4]. Normally the circulating blood is separated from the extravascular compartment of the retina by tight encircling functional complexes between contiguous endothelial cells in the case of the intra retinal vessels (inner blood-retinal barrier) and between cells of the retinal pigment epithelium (outer blood-retinal barrier) [5].…”