There is substantial evidence that fenofibrate is beneficial in the treatment of diabetic retinopathy. The retina in a thin layer of nerve tissue that is sensitive to light and acts like the film in a camera. The retina “takes a picture” of what your eyes focus on. The fine blood vessels in the retina are especially sensitive to high blood sugar levels, which cause the vessels to leak and eventually become blocked. This damage is called diabetic retinopathy.
Fenofibrate is a medication commonly used to control blood lipid levels. Abnormal serum levels of lipid have been shown to increase the risk of hardening of the arteries (atherosclerosis), which may lead to stroke and heart attack. While the goal of controlling lipids in diabetes is important in itself, fenofibrate appears to offer an independent benefit to small blood vessels (capillaries) in the retina. Two large studies (ACCORD and FIELD) demonstrated that fewer laser treatments were needed in a group of patients on fenofibrate compared with other patients who were randomized not to receive treatment with this medication for abnormal serum lipid levels. Fenofibrate may be used along side other medications used for lipid control (such as statins). However, patients with severe kidney damage should not use fenofibrate. A common dose of fenofibrate is 160mg per day. However, fenofibrate 54mg is recommended for patients with glomerular filtration rate (GFR) between 30 and 50. No fenofibrate is recommended if the GFR is less than 30.
There are established treatments for diabetic retinopathy. The mainstay of treatment of vision-threatening diabetic retinopathy remains laser and anti-VEGF injections (Avastin, Lucentis, Vabysmo, and Eylea). In severe cases of diabetic retinal damage, vitrectomy surgery is needed to restore vision or prevent blindness. However, there are patients with diabetes who lose vision despite treatment and those who develop side-effects of treatment. Therefore, fenofibrate is a welcome addition to the medical treatment regimen.
Prevention of diabetic eye damage is far superior to treatment of diabetic retinopathy. Therefore, it is best to prevent diabetic damage to the eyes and other organs in the body through proper management of blood sugar, blood pressure, and blood lipids with the help of a medical doctor. In difficult cases of diabetes, the help of an endocrinologist is necessary. Finally, annual dilated eye exams with an eye doctor skilled in the management of diabetic retinopathy is key to identify retinal damage before vision is lost.
For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida.
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