Introducing Valeda, A New Treatment for Dry AMD, to Moscow & Pullman

There is a conversation I have had hundreds of times in my career, and until recently, I dreaded every one of them.

A patient comes in, usually in their late sixties or seventies, sometimes a farmer from out near Genesee, sometimes a retired WSU professor, sometimes someone’s grandmother who noticed that the crossword puzzle is blurrier than it used to be. We do the exam. We look at the back of the eye, and I see what I’ve been afraid I was going to see: the scattered yellow deposits called drusen. Early-to-intermediate dry age-related macular degeneration.

And then the patient asks me the question every patient asks.

“So what can we do about it?”

For most of my career, the honest answer was: not much. Eat well. Take your AREDS2 vitamins. Don’t smoke. Come back in six months so we can watch it.

If your disease eventually progressed to advanced geographic atrophy, there were newer injectable drugs (Syfovre and Izervay) that could 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 I was having most of these conversations, the answer was still essentially: not much.

Now, for the first time in my career, that conversation has changed.

What dry macular degeneration actually is

Before I get to the new treatment, let me back up and explain what we are talking about, because most of my patients have heard the words macular degeneration for years but have never had anyone sit down and explain it in plain English.

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. The macula is the precision instrument.

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. The tissue thins. 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.
• 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. Because there are no retina-specialist practices here on the Palouse, our general ophthalmology practice has built up a meaningful patient population on anti-VEGF injections, a surprising number for a practice our size, and a significant part of what we do on the medical eye care side.

For dry AMD (the common one, the slow one), we have, until very recently, had essentially nothing.

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. Globally, an estimated 196 million people had AMD in 2020, and that number is projected to grow to 288 million by 2040 as populations age.

Here on the Palouse, that means thousands of our friends, loved ones, neighbors, grandparents, and in my case, hundreds of patients.

The good news (and I always make sure patients hear this part) is that most people with dry AMD never go completely blind. AMD affects central vision, not peripheral. But central vision is the vision that lets you live independently. It is the vision that matters for nearly everything we care about after sixty-five.

Why I tend to be skeptical of new eye technology

I should tell you something about how I think.

I am a skeptical doctor. Not in the sense that I resist new technology: when a genuinely better tool comes along, I am happy to adopt it, and my patients are better for it.

I am skeptical in the sense that I have seen a lot of “revolutionary” devices come through the exhibit halls at big ophthalmology meetings, and I have learned the hard way that not every new device actually benefits the patient in my chair.

Some of them do. Some of them mostly benefit the stockholders of the company that made them.

Not every new machine is actually better medicine. A handful are genuinely transformative. Part of my job is to tell the difference on behalf of the patients in my chair. I work hard to earn their trust, so it’s my job to make sure I’m recommending treatments and technologies I actually believe in.

So when I first started hearing about photobiomodulation for dry AMD several years ago, my initial reaction was a polite version of let’s see. Light therapy. For the retina. To slow or reverse damage from a disease we have spent my entire career unable to treat. I wanted to believe it. I also wanted to see real data.

What changed my mind

Three things changed my mind over the last two years.

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.

(If you enjoy reading scientific papers, you can dive into the original LIGHTSITE research in Retina.)

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. That is not a number I thought I would see in my career.

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, the way they would look into one of the imaging machines or an autorefractor during a normal eye exam.

When I evaluate any new treatment, I run a simple mental test: what would I do if this were my own mother? For Valeda, the answer is easy. If my mother walked into my office today with signs of early/intermediate dry AMD, I would walk her into the next room for her first Valeda session.

Third, the colleagues I trust. Over the past year, several retina specialists and ophthalmologists whose judgment I have respected for a long time (people who are not easily impressed, people who would tell me bluntly if a device were a dud) invested in Valeda systems and began treating patients. I started hearing the same kinds of stories I had read in the trial. Patients reading letters they could not read before. Grandparents noticing that the granddaughter’s face was more visible again.

That is when I stopped waiting.

Why we brought Valeda to Moscow & Pullman

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Earlier this year, Moscow & Pullman Family Eye Care became one of the first practices in the Inland Northwest to acquire a Valeda Light Delivery System. At the time of writing, the only other Valeda within a reasonable drive is in Spokane. Beyond that, patients were being referred to Utah for treatment.

My patients with Dry AMD, as a rule, are not the kind of people who make a casual day trip to Salt Lake City. Even Spokane is a 3-hour round trip. Many of them are in their seventies and eighties. Many of them live on farms or in small towns.

And here’s the thing 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 courses over two years.

If your eye doctor’s office is right around the corner, stopping by for a treatment a few times a week for a few weeks of your life is manageable. If it’s a three-hour round trip to Spokane (or a flight to a retina specialist in Salt Lake City), 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 Moscow meant bringing it within reach of the people who actually need it. That is why we did it.

I love living in a small town. It’s where I grew up. It’s where I’ve chosen to raise my kids. And sometimes, it’s OK to make a trip to a bigger city for specialty medical care. But my goal is, whenever I can, to make Moscow & Pullman Family Eye Care a place where you get the same standard of care you would get at a major academic center, without the parking garage, and without being treated like a chart number. Adding Valeda was a straightforward extension of that goal. It is not a gadget (though it is pretty slick). It is a genuinely useful tool that was previously only available hundreds of miles from here.

How Valeda works

I’ll explain it the way I explain it to patients in the exam room.

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 slightly 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, and the mitochondria run on a molecule called ATP, the basic energy currency of the body.

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 called cytochrome c oxidase, which is essentially the last gatekeeper in the chain of reactions that produces ATP. Stimulating it does three things we care about: it increases ATP 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.

What a course of treatment looks like

One of the things my patients appreciate is how gentle the patient experience is.

A course of Valeda consists of nine sessions, spread across three to five weeks, typically two or three sessions per week. Each session takes about five minutes per eye. No dilation. No drops. No injection. No anesthesia. No patches. You sit in a chair, rest your chin in a soft cushion, and look into a device while it delivers the programmed sequence of wavelengths. Then you go home.

The full FDA-authorized protocol is four courses over two years, for a total of fifty-four sessions. In practical terms, that means one course roughly every four months.

This is not what patients expect when we say “new retina treatment.” They come in braced for injections. They leave wondering if we are sure that was all.

Who is a good candidate, and who isn’t

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 (larger than 63 microns), or any large drusen (larger than 125 microns), or non-central geographic atrophy
• Best-corrected visual acuity between 20/32 and 20/70
• Absence of wet AMD and absence of central-involving geographic atrophy

The most reliable way to find out whether you’re a candidate is to ask your ophthalmologist. We can look at your retina, take the necessary imaging, and tell you exactly where you stand and whether Valeda is appropriate for you.

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. That is a change in how we think about dry AMD in general. For decades, the diagnosis of intermediate dry AMD was something to monitor. It is now something we can actively treat.

If you or someone in your family has been told you have drusen or early dry AMD, I would genuinely encourage you to schedule an exam with us. The patients who do best are the ones we see before the disease takes meaningful central vision.

What I am seeing in my own patients

I want to be careful here. A handful of patients treated in a single practice is not a clinical trial, and I am not going to pretend otherwise. The clinical trial data is the clinical trial data. My anecdotal observations sit on top of that, not in place of it.

That said: what I have seen so far in our patients matches what the studies describe. Modest but real improvements in the ability to read smaller print. Patients noticing that the numbers on the gas pump or the faces on the television are a little sharper.

One of our patients came in measuring 20/60 in their affected eye. In Idaho, that’s under the threshold for an unrestricted driver’s license, so they were already facing the conversation about whether they could keep driving. After just two Valeda sessions (18 appointments), that same patient was measuring 20/40. That is the difference between losing their license and keeping it a bit longer.

That’s one patient. Not every patient gains that much that fast, and some patients gain less. But that kind of result (which was essentially unthinkable in dry AMD a few years ago) is now something I see in our practice.

I am not telling you Valeda is a cure. It is not. Nothing we have is a cure for AMD. What Valeda appears to do, both in trials and in our early experience, is buy patients a meaningful amount of functional vision over a meaningful amount of time. For a disease whose natural history is a slow, irreversible erosion of the vision that lets you live your life, that is a significant step forward.

A Word of Caution: Some Smart Ophthalmologists Are Skeptical

I want to be transparent: not every ophthalmologist is as enthusiastic about Valeda as I am, and my patients deserve to hear that. Some of my colleagues, whose judgment I respect deeply, 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.
• The anatomical evidence is weaker than the functional evidence. Valeda hasn’t clearly shown it shrinks drusen or prevents progression to advanced disease.

If you want to read the original arguments, Retinal Physician ran a thoughtful pro-and-con piece, and Grisanti and colleagues published a detailed methodological critique, also in Retina. I don’t dismiss any of these concerns.

Let me be clear about one more thing, whether you end up sharing the skeptics’ view or mine: 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. Every body is different. Cataract surgery, anti-VEGF injections, nearly every treatment I offer works beautifully for most patients and less well for some. Valeda will be no different. I cannot promise you an outcome. What I can promise is that I will watch your progress carefully and tell you honestly what I am seeing.

Here is where I come out: every serious concern about Valeda is a concern about how much it helps, not whether it’s safe. Across three LIGHTSITE studies there have been zero reports of phototoxicity, no serious adverse events, no injections, and no incisions. For early-to-intermediate dry AMD, we have had nothing to offer for decades. For most of my candidates, a 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. Honestly, that was another reason I was hesitant to bring Valeda into our practice. A great many of my AMD patients are retired and on fixed incomes: Social Security, a pension, maybe a modest amount of savings. The last thing I wanted was to create a two-tier experience in our office, where patients who could afford to pay out of pocket got access to a meaningful treatment for their AMD, and patients who couldn’t had to sit in the same waiting room and watch their vision decline knowing the treatment existed just down the hall.

That changed this past year. Valeda is now covered by Medicare, treated much like any other medical eye care service. Coupled with the clinical results, the decision to bring it to the Palouse became an easy one. 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

I am a skeptical doctor by nature, and I have watched a lot of shiny new things come and go in this field. Valeda doesn’t seem to be one of them. The safety profile is excellent. The patient experience is genuinely gentle. And for the first time in my career, I get to have a different conversation with patients who come in with early-to-intermediate dry AMD.

I get to tell them we have something to offer.

If you have been told you 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 come in. Me or one of my colleagues would be happy to examine your eyes, and see if you’re a candidate for Valeda.

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To schedule a Valeda consultation, call 208-882-3434 or book an appointment online.

Frequently Asked Questions

Is Valeda FDA approved?

Yes. The Valeda Light Delivery System (Valeda PBM) received FDA authorization as the first and only treatment for early-to-intermediate dry age-related macular degeneration. It is cleared to improve and maintain vision for up to two years in appropriately selected patients.

How long does Valeda treatment take?

A single session takes approximately five minutes per eye. A full course is nine sessions over three to five weeks. The complete FDA-authorized protocol is four courses over two years, for a total of fifty-four sessions.

Does Valeda hurt?

No. More than 97 percent of patients in the clinical trials reported no eye pain. There is no dilation, no anesthesia, no device propping the eye open, and no injection. Most patients describe the sessions as easy.

Is Valeda covered by Medicare?

Yes. Valeda is now covered by Medicare. Coverage specifics vary by plan and medical necessity documentation, so we verify benefits for each patient before scheduling.

Can Valeda reverse macular degeneration?

Valeda is not a cure for AMD. In the LIGHTSITE III pivotal trial, 84 percent of treated patients improved or maintained their vision at approximately two years, and more than 60 percent gained at least one line of vision on the eye chart, a meaningful change in a disease where progression was previously considered inevitable.

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 ophthalmologist will review your full history before recommending treatment.

What is the difference between wet and dry macular degeneration?

Dry AMD is the more common, slowly progressive form of macular degeneration, affecting 80 to 90 percent of patients. It is characterized by thinning of the macula and buildup of drusen. Wet AMD is less common but more aggressive, characterized by abnormal blood vessel growth under the retina. Wet AMD is treated with anti-VEGF injections. Valeda is authorized for dry AMD only.

Where can I get Valeda near me?

Valeda is currently offered at Moscow & Pullman Family Eye Care, the first Valeda system in the region. At the time of writing, the only other Valeda within a reasonable drive is in Spokane; beyond that, the next-closest systems are in Salt Lake City. Patients travel to us from across the Palouse, including Pullman, Lewiston, Colfax, and Coeur d’Alene.