RETINA PIONEER

Theodor von Leber

1840 - 1917

Contributed by Niyaz Uddin, MD (cand)

With each beat of the heart, blood is pumped through the ophthalmic and central retinal arteries, supplying essential oxygen and nutrients to the eyes. Though well-known today, back in 1863 mapping the blood circulation to the eye was a ground-breaking discovery by a father of ophthalmic research, Dr. Theodor von Leber.[1]

Theodor von Leber was born in Karlsruhe, Germany on February 29, 1840.[2] His mother died when he was young, and von Leber was raised by his father, a professor of romance languages who valued the education of his children.[1] He moved their family to Heidelberg where von Leber finished school and studied medicine at Heidelberg University in 1856.[3]

The creation of the ophthalmoscope in 1851 by Hermann von Helmholtz led to a boom in the field of ophthalmology.[4] Theodor decided to delve into the fast-growing study after graduating, and in 1862 began clinical work at the first ophthalmic hospital at Heidelberg University.[3]

Leber later took an interest in physiology which led him to Vienna as an assistant to physiologist Karl Ludwig. Ludwig developed a technique to map out vasculature using an injection of glycerin and alcian blue, which von Leber applied to the eye.[3] Theodor’s subsequent findings regarding ocular blood circulation were presented in 1864 at the Heidelberg Ophthalmology Conference, which drew the interests of major ophthalmologists including von Graefe, Liebreich, Donders, and Helmholtz.[1] His next adventure led him to work in Paris under Richard Leibreich.3[]

This was just the beginning. Dr. von Leber contributions to the field include the first histological report on retinitis pigmentosa via ophthalmoscope that described a disorder known as Leber’s congenital amaurosis.[3] He also wrote the first clinical description of Leber’s hereditary optic neuropathy (LHON), noting the atypical inheritance pattern of the disease that later was found to be a mitochondrial disorder.[1] In his years as a professor at Gottingen University he studied the origin and mediators of ocular inflammation and published a paper on the clinical presentation of Lymphangiectasia haemorrhagica conjunctivae.[3] In 1890 he took the position as the head of the Department of Ophthalmology at Heidelberg University.[3] In 1896 Dr. Leber received the Graefe medal, the most prestigious ophthalmology award in Germany. In 1910, von Leber retired.[3] Von Leber continued to publish new work even after retiring including a description of a disorder involving multiple retinal aneurysms and an uncommon finding of unilateral optic disc swelling, loss of vision, and a macular star, he called Leber’s stellate neuroretinitis.[1]

The final written work von Leber left behind was an obituary for Richard Liebrich who died in January 1917. Dr. von Leber passed shortly after in Heidelberg, Germany on April 7, 1917, his own obituary was published alongside Liebrich's in Klinische Monatsblaetter, a German journal of ophthalmology.[2] The student's and teachers’ combined and individual accomplishments were memorialized alongside each other post-mortem.

highlights

1863-1864

Mapped out blood circulation in the eye through color injections into ocular vessels

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1864

Lectured on the ocular blood supply to the Ophthalmological Society in Heidelberg

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1868

First histological report of Leber’s Congenital Amaurosis by Dr. von Leber

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1871

The first clinical description of Leber hereditary optic neuropathy(LHON), a genetic mitochondrial disease, by Dr. von Leber

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1892

Gave the Bowman Lecture “On the Present Position of our Knowledge of Inflammation with Special Reference to the Eye”

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1896

Awarded the von Graefe Medal at the Congress of German Ophthalmological Society

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Work History

1862

  • Clinical work with Hermann Knapp in the Eye Clinic of Heidelberg University under the supervision of Hermann von Helmholtz

1863

  • Worked under physiologist Karl Ludwig in Vienna

1864-1866

  • Assistant to Richard Liebreich in Paris

1867-1870

  • Assistant to Albrecht von Graefe in Berlin

1870-1890

  • Director of University Eye Clinic and Professor of Ophthalmology in Gottingen

1890 - 1910

  • Chair of Ophthalmology at Heidelberg University Eye Clinic

Education & Training

Medical Doctorate: University of Heidelberg, 1862

Photo Gallery

Leber's drawings of optic circulation: (a) Circulation of the globe. (b) Blood vessels in the anterior of the eye: the sclera, limbus, conjunctiva, ciliary body, and iris. (c) Anterior segment of the choroid seen from the inner side. (d) Posterior part of the choroid close to the optic nerve. (e) Posterior segment of the sclera, including the optic nerve head[6]

References

  1. Sen M, Honavar SG. Theodor Karl Gustav von Leber: The Sultan of Selten. Indian J Ophthalmol. 2022;70(7):2218-2220. doi:10.4103/ijo.IJO_1379_22.
  2. Blum M, Tetz M, Völcker H. Theodor Leber 1840-1917 - stationen eines beruflichen werdegangs. Klinische Monatsblätter für Augenheilkunde. 1992;201(07):51-54. doi:10.1055/s-2008-1045869.
  3. Blum M, Hykin PG, Sanders M, Völcker HE. Theodor Leber: a founder of ophthalmic research. Surv Ophthalmol. 1992;37(1):63-68. doi:10.1016/0039-6257(92)90006-f.
  4. Jaeger W. Theodor Leber und die Begründung der Experimentellen Ophthalmologie. Semper Apertus Sechshundert Jahre Ruprecht-Karls-Universität Heidelberg 1386–1986. 1985:875-885. doi:10.1007/978-3-642-70477-2_30.
  5. Langbein F. Theodor Karl Gustav Leber, Augenarzt, 1890–1910 Professor in Heidelberg.; 1901. https://prometheus.uni-koeln.de/de/image/heidicon_gs-efdb9dbb4624cefcdf5e5621a851bd513192de8d. Accessed October 5, 2022.
  6. Leber T, Ludwig C. Anatomische Untersuchungen über Die blutgefässe Des Menschlichen Auges. Aus der Kaiserlich-Königliche Hof- und Staatsdruckerei; 1865.