Diabetes Can Lead to Leaky Retinal Blood Vessels, Sudden Blindness

September 11, 2020

The American Diabetes Association and other groups are mounting a public health campaign to encourage people with diabetes to get annual eye exams. ADA Chief Scientific and Medical Officer Robert Gabbay, MD, PhD, FACP, explains "leaky blood vessels" and diabetic retinopathy in this first of a four-part video series.

They say the eyes are windows into the soul. But at more prosaic level, they can also offer a first glimpse into what may be a sign of diabetes.

“One interesting fact is that many people are diagnosed with diabetes when they go to see the eye doctor. Based on what the eye doctor sees, they say, “Oh you should be tested for diabetes,” Robert Gabbay, M.D., Ph.D., FACP, the chief scientific and medical officer of the American Diabetes Association (ADA), said in a video interview this week with Managed Healthcare Executive®. “There are pathognomonic changes that one sees in the retina that really suggest that his person has diabetes.” 

Related: Diabetes Drugs and Retinopathy: So Far, It's All About Lowering A1C Level

The diabetes association; VSP vision care, a vision insurance company, and Regeneron are cooperating on a public health campaign to encourage people with diabetes to get annual eye exams that include an examination of the retina. As Gabbay explained, poorly controlled diabetes can result in the blood vessels in the retina becoming leaky and an increased risk of bleeds into the eye that cause blindness.

Eye disease caused by diabetes “is still the leading cause of blindness among working-age adults. We have a lot of work to do,” said Gabbay, who prior to taking his current position with the ADA was chief medical officer and senior vice president at the Joslin Diabetes Center in Boston. 

Gabbay, an associate professor at Harvard Medical School, said people with diabetes may experience blurry vision but often the underlying pathology occurs without causing any symptoms till a bleed and vision loss.

“It can really happen quite suddenly but the [underlying] process is slow and insidious,” he said.

That process, he explained, begins with leaky blood vessels in the retina, a manifestation in the eye of the damage to the microvasculature that diabetes can cause throughout the body.

“As they become leaky,” Gabbay continued, “they cause the surrounding tissue to not get enough oxygen. That tissue produces a growth factor that leads to the formation of new blood vessels. The problem is that they are not good blood vessels — they are very friable and when they break there is a bleed into the eye and sudden loss of vision.”

Gabbay noted that Blacks and Latinos are 50% more likely to have diabetes than the rest of the population and that a disproportionate number of Blacks and Latinos with diabetes have poor blood glucose control, partly because of barriers to health care. “And we know that poor glucose control leads a higher risk of eye disease.”