Lipids, hyperreflective crystalline deposits and diabetic retinopathy: potential systemic and retinal-specific effect of lipid-lowering therapies – published online 11/02/2022

Alicia J. Jenkins, Maria B. Grant, Julia V. Busik

 The highly metabolically active retina obtains essential lipids through both endogenous biosynthesis and via the systemic circulation. Both quantitative and qualitative changes in lipids have been associated with diabetic retinopathy. Whilst the role of lipids and lipid-modifying drugs in cardiovascular disease in people with diabetes is well-studied, their roles in diabetic retinopathy are currently less well known. In this issue, Jenkins et al (https://doi.org/10.1007/s00125-022-05655-z) review the potential role of lipids and lipid-lowering drugs in diabetic retinopathy, examining results from retinal tissue analyses, clinical observational studies, clinical trials and meta-analyses. The authors discuss several statin and fibrate trials that were designed to predominantly address cardiovascular outcomes, but which have also reported potential retinal benefits. They outline the many challenges in this clinically important field, but also highlight that ongoing research in this area. This includes several in-progress trials of lipid drugs that have diabetic retinopathy-related primary endpoints, which may further elucidate the potential mechanisms by which lipid-modifying therapies could impact diabetic retinopathy. The figures from this review are available as a downloadable slideset.

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