Introducing Valeda, A New Treatment for Dry AMD, to Valley Vision Eyecare

Valeda is the first FDA-authorized treatment for early-to-intermediate dry age-related macular degeneration (dry AMD).
It’s a non-invasive light therapy. No injections, no dilation, no anesthesia. Treatment consists of nine painless sessions consisting of 4-5 minutes/eye completed over 3 to 5 weeks, with maintenance treatments repeated every 4 to 6 months over a two year period. During treatment visits, the vision remains unchanged immediately afterward allowing patients to drive themselves to and from appointments.
In the LIGHTSITE III study, 84% of treated patients improved or maintained their vision over two years, and more than 60% gained at least one line on the eye chart.
Safety profile is excellent: zero reports of phototoxicity across three clinical studies.
Now covered by Medicare and available at Valley Vision Eyecare, the first Valeda Light Deliver System in the Upper Valley.
Not a cure, and it won’t work for everyone. For a disease we’ve had nothing to offer for decades, it’s a real option worth a conversation.

There is a conversation we have had hundreds of times in our career, and until recently, we dreaded every one of them. A patient comes in, usually in their late sixties or seventies, sometimes a farmer, sometimes a retired Dartmouth professor, sometimes someone’s grandmother who noticed that things aren’t as clear as they used to be. We do the exam, look into the eye, and we see what we’ve been afraid we were going to see: the scattered yellow deposits called drusen. Early-to-intermediate dry age-related macular degeneration. And then the patient asks the question every patient asks. “So what can we do about it?” For most of our careers, the honest answer was: not much. Eat well. Take your AREDS2 vitamins. Don’t smoke. Come back in six months to a year so we can monitor it.

If your disease eventually progressed to advanced geographic atrophy, there were newer injectable drugs (Syfovre and Izervay) that could potentially slow the damage, but not reverse it, and only for the small fraction of patients who had already reached that late stage. For early and intermediate dry AMD, where we were having most of these conversations, the answer was still essentially: not much.

Now, for the first time in our careers, that conversation has changed.

What dry macular degeneration actually is

The macula is the small, central part of your retina, the part that handles sharp, detailed, straight-ahead vision. Reading, driving, recognizing faces, threading a needle. The rest of your retina handles peripheral vision, motion, low-light vision. Age-related macular degeneration is what happens when the support cells underneath the macula start to break down over time. It comes in two forms:

Dry AMD is by far the more common form, roughly 80 to 90 percent of cases. It progresses slowly. Yellowish protein and lipid deposits called drusen accumulate. The cells underneath the retina struggle to do their job, which is essentially to keep the photoreceptors alive. Until recently, there has been no treatment.
Wet AMD is the less common form, but it progresses faster and more aggressively: abnormal blood vessels grow underneath and into the retina and leak. We’ve had effective treatment for wet AMD for about two decades now: anti-VEGF injections, now most commonly Avastin, Vabysmo, Eylea, and Eylea HD. They work. But they are injections, in the eye, indefinitely.

AMD is the leading cause of severe central vision loss in Americans over the age of fifty-five. The numbers are sobering. About one in eight Americans over seventy has some form of AMD. The good news is that most people with dry AMD never go completely blind. AMD affects central vision, not peripheral. But central vision is what helps you live independently.

Why we’re recommending Valeda Light Therapy

First, the research. The LIGHTSITE studies have followed Valeda patients across several years and hundreds of eyes, and the findings have been consistent. In the pivotal LIGHTSITE III work (a two-year study of 98 patients with early-to-intermediate dry AMD), the patients who received Valeda treatments could read, on average, about six additional letters on the eye chart after 21 months compared to the patients who received a fake treatment. That gain held up at the two-year mark. Eighty-four percent of treated patients improved or maintained their vision compared to where they started. More than 60 percent gained at least one full line of vision on the chart. For context on what that means: in a disease where we have historically been pleased just to slow the erosion of vision, these patients were actually reading more letters on the eye chart after two years than before they started treatment.

Second, the safety profile. Across all three LIGHTSITE studies, there have been zero reports of phototoxicity, meaning no light-related damage to the retina. More than 97 percent of patients reported no eye pain during treatment. No dilating drops, no anesthesia, no device propping your eye open, no injection. The patient sits in a chair and looks into a device.

Third, the specialists we trust. Over the past year, several optometrists, retina specialists and ophthalmologists whose judgment we respect, invested in Valeda systems and began treating patients. We started hearing the same kinds of stories we had read about in the trial. Patients reading letters they could not read before or noticing that faces were easier to see.

Why we brought Valeda to Valley Vision Eyecare

Valley Vision Eyecare became the first practice in the Upper Valley to acquire a Valeda Light Delivery System. At the time of writing, the next closest Valeda is in Manchester, NH. Our patients with Dry AMD, as a rule, are not the kind of people who make a casual day trip to Manchester.

And here’s the downside about the Valeda protocol: each individual treatment session requires a short office visit, but a full course is nine treatment sessions spread across three to five weeks, and the full FDA-authorized regimen is four to six courses over two years.

If your eye doctor’s office is right down the road, stopping by for a treatment a few times a week for a few weeks of your life is manageable. If it’s a two and a half hour round trip to Manchester, repeated nine times in a month, and then repeated again every few months for two years, it becomes effectively impossible. The idea of asking an eighty-year-old with failing central vision to make that trip was, for most of them, the same as saying “this treatment is not available to you.” Bringing Valeda to Lebanon and the Upper Valley meant bringing it within reach of the people who actually needed it.

How Valeda works

Here’s the short version: we are giving your retinal cells a targeted energy boost, over and over, so their power plants have the resources to keep working.

Here’s the much longer version: Your retinal cells are enormously energy-hungry. Photoreceptors, in particular, have to convert light into electrical signals continuously, all day long, for decades. The power plants inside each of those cells are called mitochondria. A growing body of evidence tells us that in dry AMD, the mitochondria in the retinal cells underneath the macula begin to falter. Energy production drops. Waste accumulates. Inflammation rises. Cells that should be supporting the photoreceptors cannot quite keep up, and over years, the photoreceptors themselves begin to starve.

Valeda delivers three specific wavelengths of light through the front of the eye: yellow (590 nm), red (660 nm), and near-infrared (850 nm). Those wavelengths are absorbed by a molecule inside the mitochondria that stimulates it and does three things we care about: it increases energy production, it reduces inflammation, and it improves local blood flow and oxygen delivery to the retina.

This is not a laser. It is not cutting anything. It is not burning anything. It is a specific, well-studied, low-intensity pulse of light in wavelengths that penetrate eye tissue harmlessly. The mechanism of photobiomodulation has been studied in other tissues (wound healing, neurology, musculoskeletal medicine) for over two decades. What is new is applying it to the retina with a device precisely engineered for the eye.

Who is a good candidate for Valeda

Valeda is FDA-authorized for patients with:

Dry age-related macular degeneration (not wet)
Intermediate stage disease, meaning the presence of at least three medium drusen, or any large drusen, or non-central geographic atrophy
Best-corrected visual acuity between 20/32 and 20/70, although it can still be done even if someone has 20/20 vision
Absence of wet AMD and absence of central-involving geographic atrophy

The summary is this: Valeda works best, and is most clearly indicated, for patients who are caught early, when there is still meaningful central vision to preserve. For decades, the diagnosis of intermediate dry AMD was something to monitor. It is now something we can actively treat. The patients who do best are the ones we see before the disease takes meaningful central vision.

Who is not a candidate for Valeda?

Valeda is not appropriate for patients with wet AMD, for patients with central-involving geographic atrophy, for patients with certain photosensitive conditions such as some forms of epilepsy or migraine, or for patients currently taking photosensitizing medications (a 30-day wait after stopping is required). Your optometrist or ophthalmologist will review your full history before recommending treatment.

Be Aware of Legitimate Reservations

Some eye doctors have legitimate reservations. In short:

The effect size is modest. A gain of about six letters on an eye chart is within the range vision can naturally fluctuate between visits.
The trials have been small. Around two hundred eyes total, when rigorous analysis suggests closer to five hundred would be needed for full confidence.
Visual acuity may be the wrong yardstick. More sensitive measures of early dry AMD haven’t shown the benefit as clearly.
The studies were run with the manufacturer’s involvement. Independent academic replication hasn’t happened yet.

Valeda will not work for everyone.

Even in the favorable LIGHTSITE III results, roughly 16 percent of treated patients still lost some vision over two years, and close to 40 percent did not gain a full line of improvement on the eye chart. Everybody is different. However, for most candidates, a safe, gentle, non-invasive treatment that might meaningfully preserve vision is a reasonable bet worth taking.

Cost and insurance

Until recently, Valeda was available only as a cash-pay treatment, which put it out of reach for many of the patients who needed it. A great many of our AMD patients are retired and on fixed incomes. The last thing we wanted was to create a two-tier experience in our office, where only patients who could afford to pay out of pocket got access to a meaningful treatment for their AMD. That changed this past year. Valeda is now covered by Medicare, treated much like any other medical eye care service. Coverage details still vary by plan and by medical necessity documentation, so we verify benefits for each patient before we schedule. Our office handles the paperwork and will work to give you a clear picture of what (if anything) you will owe out of pocket before we begin treatment.

The bottom line

We finally have something to offer for AMD that is safe, gentle, and may preserve vision. If you, or someone you know have been told they have drusen, or early or intermediate dry AMD, or if you have a family history of macular degeneration and want to know where you stand, please discuss it with your eye doctor or schedule a consultation to see if you’re a candidate for Valeda.