Diabetic retinopathy (DR) remains a leading cause of vision loss in working-age adults despite advances in glycemic and blood pressure management. Interest has increased in whether lipid-lowering therapies may provide additional retinal benefit beyond cardiovascular risk reduction. A narrative review published in Clinical Diabetology evaluated evidence on statins and fenofibrate in DR onset and progression.

The review included clinical studies and evidence syntheses identified through PubMed, Web of Science, and Scopus searches covering publications from January 2020 through January 2025. The analysis evaluated diabetic retinopathy outcomes associated with statins, fenofibrate, and combination lipid-lowering therapy.

Findings

• Fenofibrate use was associated with lower DR progression risk (RR 0.21; 95% CI 0.06-0.71) and reduced need for laser therapy (RR 0.70; 95% CI 0.58-0.85).
• Lower risk of proliferative diabetic retinopathy was also reported with fenofibrate use (HR 0.76; 95% CI 0.64-0.90), with stronger associations observed in advanced disease.
• Evidence for diabetic macular edema remained limited and less consistent across studies.
• Statin-related findings were heterogeneous. Some observational studies reported higher DR risk, whereas others suggested possible benefit in selected groups, including older women with hypercholesterolemia.
• Combined fenofibrate–statin therapy was associated with lower rates of ocular interventions in selected cohorts.

The review findings suggested that fenofibrate may offer favorable microvascular outcomes in patients with diabetic retinopathy, particularly in established disease. The ophthalmic impact of statins remained inconclusive across currently available studies.