Metformin in Diabetic Retinopathy: Mechanisms, Therapeutic Potential, and Barriers

The primary aim of diabetic retinopathy (DR) management is to prevent or slow the decline of vision loss. While current treatments for DR are effective in the advanced stages, they may not be as effective in the early phases of the disease. Metformin is among the most widely used antidiabetic medications and has recently shown promising outcomes in DR, as it has been found to affect several pathological mechanisms involved in DR, including oxidative stress, angiogenesis, and inflammation. Multiple clinical and preclinical studies demonstrated its potential role in reducing DR development and progression. However, the potential adverse effects, safety concerns, especially in patients with renal impairment, and the lack of large-scale studies supporting this evidence remain a barrier. This review explores the mechanisms through which metformin may exert its therapeutic effects in DR, discusses the clinical evidence, and identifies the limitations of metformin's potential use in DR treatment.