More than seven decades have passed since the discovery of retinal changes in Bright's disease. In this interval a belief in their ominous prognostic significance has become established, and for this reason many internists have learned to use the ophthalmoscope. A great deal of experience has been gained, and much knowledge has been obtained, but ignorance on some important points remains.
It is rapidly being accepted that the retinal changes do not occur in renal disease unless hypertension is present, no matter how gravely the function and structure of the kidney is damaged.
Decided changes in the eyeground unquestionably mean danger to life, but it has become possible and important to place very different prognostic values on the different appearances of the fundus.
Necessary to the understanding of this expanding problem is some knowledge of the changes in the eyeground during life, of the retinal lesionsafter death, and of the