John Gustaf Lindberg (22 June 1884 – 23 November 1973) was a Finnish ophthalmologist who was the first to describe exfoliation syndrome, an age-related degenerative disease of the eye that often complicates glaucoma and cataract surgery, in his doctoral thesis that he wrote in St. Petersburg and defended in March 1917 in Helsinki, Finland, at that time a Grand Duchy in the Russian Empire.
Early years John Gustaf Lindberg was born to Gustaf Robert Lindberg (1844–1929), a Finnish engineer working in St. Petersburg, Russia, as a department manager in St. Petersburg Metalworks supervising the construction of boilers for steam engines and of metal bridges, and Anna Heloise Rautelin. Lindberg was the second of three boys in the family. St. Petersburg thus became his hometown, a fact that was to influence his career. The family moved to Helsinki, Grand Duchy of Finland in the early 1890s after his father had been offered a position as the Director of Technology in a recently founded company Kone ja Silta Oy (literally, Machine & Bridge, today Wärtsilä Corporation). In 1903, at the age of 19, Lindberg matriculated from the Swedish speaking Real Lyceum in Helsinki. After preparatory studies for three years in botany, zoology, physics and chemistry in the Imperial Alexander University in Finland, he passed the medicophile examination, a mandatory step before applying to the Faculty of Medicine. He graduated in 1914 as Licentiate of Medicine. By that time, he had made up his mind to become an ophthalmologist after having frequently assisted during his university years in a private eye hospital in Helsinki, run by Johannes Silfvast (1867–1932).
Specialization Lindberg spent the rest of 1914 working as an intern at the Department of Surgery in Maria Municipal Hospital, Helsinki, and as a voluntary unpaid resident in the Helsinki University Eye Hospital. After mastering the basics, he enrolled in 1915 to the Imperial Ophthalmic Hospital in St. Petersburg. He also worked as a general practitioner. All professors in the Imperial Ophthalmic Hospital before the Russian Revolution of 1917 were of German origin. During Lindberg's residency, the chair was Ernst Friedrich Blessig (1859–1940). The main research interests of Blessig were glaucoma and eye injuries. He proposed that Lindberg would explore the theory put forward two years earlier by Karl Theodor Paul Polykarpus Axenfeld (1867–1930) in Freiburg, Germany, according to which pigmentation of the iris would decrease and its transparency increase with the development of cataract. Lindberg started his research in 1915. Lindberg needed a slit lamp but this instrument was not yet commercially available. The theory behind a slit lamp had been presented by Nobel laureate Allvar Gullstrand (1862–1930) 4 years earlier. Lindberg consulted publications of Gullstrand, got hold of an old Zeiss microscope, and built his own slit lamp. The material of the thesis consisted of 202 patients older than 55 years from the Imperial Ophthalmic Hospital, although some control patients were enrolled from the Kivelä Municipal Hospital and Oulunkylä Old People's Home, both in Helsinki, Finland. Lindberg made detailed drawings of the iris and lens as no photographic technique was yet available. While examining his patients, he found that many of them had small whitish flakes on the lens and the pupillary border of the iris. He grew interested in this unexpected observation. Eventually, such white flakes could be seen in one half of his glaucoma patients and they also were frequent in eyes with cataract. He noted an association with advancing age. Lindberg wrote his doctoral thesis in Swedish and entitled it (as translated to English) "Clinical Investigations on Depigmentation of the Pupillary Border and the Translucency of the Iris in Cases of Senile Cataract and in Normal Eyes of Elderly Persons". He defended it on May 30, 2017. Because the thesis was written in the Imperial Ophthalmic Hospital, his opponent was Väinö Grönholm (1868–1939) from the Imperial Alexander University in Finland where the thesis also was defended. The thesis fulfilled the academic requirements for the title of Doctor in Medical Sciences.
Escape from Russian Revolution The increasing tumult of World War I (1914–1917) brought the young family to Helsinki in 1917 after the February Revolution broke out following significant military setbacks for the Russian Army. On 6 December 1917, Finland separated from Russia and declared independence as a Republic. Lindberg first briefly practiced in the Eye Clinic of the Deaconess’ Hospital in Vyborg, Eastern Finland. He then took a voluntary appointment as Resident ophthalmologist in the University Eye Hospital in Helsinki and held this position until 1920. He already was a licensed specialist in Ophthalmology but considered the appointment useful to get a comprehensive training in every subspecialty of ophthalmology. Although travelling abroad in the 1920s was expensive, slow and tedious, Lindberg visited in 1920 to the University of Freiburg, Germany, where he practiced science at its Department of Ophthalmology for one year and took part in clinical work under the guidance of Axenfeld. He returned later to Freiburg in 1923 to pursue studies in naphthalene cataract. He also became a regular participant in the annual meeting of the Deutsche Ophthalmologische Gesellschaft (German Ophthalmological Society) in Heidelberg. While in Germany, Lindberg met Alfred Vogt (1879–1943) from the University of Basel in Switzerland and gave him a copy of his thesis. In 1923, Vogt published about exfoliation syndrome without mentioning Lindberg. Vogt proposed that exfoliation was a consequence of prior surgery for glaucoma, but this was an error. After becoming Professor in Ophthalmology in the University of Zürich, Vogt undertook original research in exfoliation syndrome and became widely known in the United States, so that exfoliation syndrome was known there as Vogt's syndrome even decades later. In 1921, Lindberg attended for the first time the Nordic Congress of Ophthalmology in Stockholm, Sweden, and met Birger Malling (1884–1989) from Tromsø, Norway, who also was briefed about the thesis. Malling also published about exfoliation syndrome in 1923 without mentioning Lindberg. He erred in concluding that exfoliation resulted from iridocyclitis.
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