Diabetic retinopathy: an historical assessment.

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.