Diagnosis and treatment of diabetic retinopathy — Historical overview

Abstract

Before the discovery of insulin, diabetes had been a fatal disease. Insulin extended lifespan of diabetic patients, yet it also gave rise to a number of chronic vascular complications, including diabetic retinopathy. Ophthalmic lesions were first observed in 1798 by John Rollo. Precise assessment of the eye fundus became possible following the construction of ophthalmoscope, which later made it possible to propose a classification of diabetic eye disease. The history of diabetic retinopathy encompasses not only the discovery of diagnostic methods such as fluorescein angiography, ultrasound examination or optical coherence tomography, but also the history of its treatment. Both initially as well as at present, clinical nutrition constitutes the most important aspect of treatment. DCCT and UKPDS have shown that good metabolic balance plays a significant role in preventing and treating DR. Further studies proved that pharmacological treatment based on fibrates and angiotensin-converting-enzyme inhibitors. A turning point in the history of DR treatment appeared when laser photocoagulation was introduced in 1959. The discovery of epidermal growth factor in 1982 led to the use of anti-VEGF medications in treating maculopathy. Surgical treatment of DR primarily consisted of vitrectomy whose procedures are continually improved.