Diabetic retinopathy is caused due to the damage of major cells in the retina like glia cells, vascular cells, neurons so before they got damaged these cells are activated. The activated cells alters the levels of growth factors, vasoactive agents, coagulation factors and adhesion molecules leading to increased blood flow, increased capillary permeability, proliferation of the extracellular matrix and thickening of basal membranes, altered cell turnover (apoptosis, proliferation, hypertrophy), procoagulant and proaggregant patterns and, finally, in angiogenesis and tissue remodeling.
Treatment Anti-VEGF Injection Therapy. Anti-VEGF drugs are injected into the vitreous gel to block a protein called vascular endothelial growth factor (VEGF), which can stimulate abnormal blood vessels to grow and leak fluid. Blocking VEGF can reverse abnormal blood vessel growth and decrease fluid in the retina. Available anti-VEGF drugs include Avastin (bevacizumab), Lucentis (ranibizumab), and Eylea (aflibercept). Lucentis and Eylea are approved by the U.S. Food and Drug Administration (FDA) for treating DME. Avastin was approved by the FDA to treat cancer, but is commonly used to treat eye conditions, including DME. The NEI-sponsored Diabetic Retinopathy Clinical Research Network compared Avastin, Lucentis, and Eylea in a clinical trial. The study found all three drugs to be safe and effective for treating most people with DME. Patients who started the trial with 20/40 or better vision experienced similar improvements in vision no matter which of the three drugs they were given. However, patients who started the trial with 20/50 or worse vision had greater improvements in vision with Eylea. Most people require monthly anti-VEGF injections for the first six months of treatment. Thereafter, injections are needed less often: typically three to four during the second six months of treatment, about four during the second year of treatment, two in the third year, one in the fourth year, and none in the fifth year.
Disease statistics Evidence suggests that approximately 55,000 German citizens die from diabetes each year (equal to 6 people per hour) (International Diabetes Federation (IDF) 2009). In terms of diabetes-related complications, more than 10% of patients with Type 2 diabetes suffer from coronary heart disease and 6.7% from stroke (Liebl et al. 2002); 16% suffer from retinopathy (Hesse et al. 2001), 8% suffer from nephropathy and 15% suffer from micro-albuminuria, which may lead to nephropathy (Bennett et al. 2001). In Germany, because of decentralized/regional governments‘ responsibilities in policies there is no legitimacy for ?national plans since 2008, which focuses on healthy lifestyle in general as primary prevention and is supported by the MoH (Bundesministerium für Gesundheit), or the the ?Gesundheitsziele programme from federal and regional ministries, focussing on healthy lifestyle in childhood, reducing tobacco consumption and detecting T2 diabetes early (Gesellschaft für Versicherungswissenschaft und -gestaltrun e.V). In addition, a number of D-DMP facilitating diabetes care have been in operation since 2002/04 by all health insurance funds, of which 40- 50% of Type 1 & 2 patients are members (and voluntary check-up for individuals aged upwards of 40 years). Both programmes (DMP and check-ups) were defined by law and implemented via guidelines issued by the Federal Joint Committee.