Editor—Lipid lowering treatment in diabetes has ophthalmic benefits.1 Diabetic maculopathy is a common cause of loss of sight in diabetic patients and is characterised by retinal oedema and lipid exudates. The use of atorvastatin in diabetic maculopathy has recently been shown in a randomised controlled trial to decrease visible lipid exudates and also to have a positive effect on the visual outcome of affected patients.2 This study also confirmed that exudates may reduce or resorb within weeks of starting statin treatment and even before or without the need for argon laser photocoagulation, and this has been our experience also. The Wisconsin epidemiologic study of diabetic retinopathy first identified an association between elevated serum cholesterol and hard exudates.3 This was confirmed in the early treatment diabetic retinopathy study,4 and the FIELD study showed a 30% reduction in laser interventions required in type 2 diabetic patients receiving fenofibrate versus the placebo group.5
We recently followed a case series of patients with type 2 diabetes in ophthalmic outpatients. We confirmed the dramatic anatomical resolution of retinal hard exudates that may result from modifying the lipid profile in patients with type 2 diabetes, although this may not necessarily be associated with an improvement in Snellen visual acuity, as Snellen acuity is a crude test of visual function.
Statin treatment, and lipid lowering in general, not only confers primary and secondary cardiovascular protection but is an emerging and exciting adjunctive treatment in gaining control in exudative diabetic maculopathy, for which argon laser treatment has traditionally been the only treatment option.
Competing interests: None declared.
References
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