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John G. Lindberg, a young Finnish ophthalmology resident, started a research project in 1914 aiming at an academic dissertation. His plan was to elucidate Axenfeld's observations on iris changes in senile eyes. Axenfeld had described two types of degeneration of the iris: a hyaline degeneration of the iris pupillary zone causing poor pupillary dilatation with mydriatics and an atrophy of the iris pigment epithelium at the pupillary border. For his research Lindberg had to construct a slit-lamp biomicroscope by studying Gullstrand's monograph on the matter; slit-lamp biomicroscopes were not commercially available at that time. A Sach's lamp was used for transillumination of the iris. While conducting his research Lindberg paid attention to greyish flakes and fringes at the pupillary border. He also noted how this strange material formed a membrane on the anterior lens surface. Documentation was made by skilful hand drawings. The new phenomenon was found to be as common in cataract patients as in non-cataractous controls older than 55 years. The phenomenon was observed in 50% of glaucoma patients. Age was the decisive factor; the phenomenon was more prevalent with advancing age. Lindberg published his results as a thesis at the University of Helsinki in 1917. When attending a Nordic Congress of Ophthalmology in 1921, Lindberg met Norwegian ophthalmologist, Birger Malling, and gave him his thesis and explained the new findings. In 1920–21 Lindberg worked at Axenfeld's clinic in Freiburg, Germany. During this period he met in Basel, Switzerland, a Swiss ophthalmologist, Alfred Vogt. He told Vogt about his research and provided him with copies of his thesis. Both Malling and Vogt published papers on exfoliation in 1923 without referring to Lindberg's work. Lindberg did not, however, interfere with these papers. Thus Lindberg was forgotten by his contemporaries as a scientist. However, his main conclusions on exfoliation are still valid today. The... [ABSTRACT FROM AUTHOR]

Exfoliation syndrome (XFS) is a systemic disease with significant ocular manifestations, including glaucoma and cataract. The disease impacts close to 70 million people globally and is now recognised as the most common identifiable cause of open-angle glaucoma. Since the discovery of XFS 100 years ago by Dr John G. Lindberg, there has been considerable advancement in understanding its pathogenesis and resulting clinical implications. The purpose of this paper is to summarise information regarding the epidemiology, pathophysiology, ocular manifestations and systemic associations of XFS with the objective of sharing clinical pearls to assist in early detection and enhanced management of patients., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)