Valeda Light Therapy for Dry Age-Related Macular Degeneration by: Adam AufderHeide, MD, PhD, FASRS
For most of my career as a retina specialist, there has been very little we could actively do for patients with early and intermediate dry age-related macular degeneration (AMD). We could recommend AREDS2 vitamins when appropriate, discuss lifestyle changes, monitor the retina closely, and watch carefully for progression.
With Valeda® Light Delivery Therapy, we now have another option to discuss.
Valeda at a Glance
What is Valeda?
Valeda is a non-invasive light therapy for certain patients with dry age-related macular degeneration.
It uses photobiomodulation (PBM)—specific wavelengths of light delivered to the retina.
There are no injections, incisions, or anesthesia.
Valeda received FDA authorization for treatment of certain patients with dry AMD.
It is not a cure for macular degeneration, and results vary from patient to patient.
What is it used for?
Valeda is primarily intended for appropriately selected patients with dry AMD who still have functioning retinal tissue that we are trying to preserve.
The goal is to improve or maintain visual function, not to restore retinal cells that have already been permanently lost.
Valeda does not replace treatment for wet AMD or other retinal diseases.
What does a treatment series look like?
One treatment course consists of 9 sessions.
Treatments are generally given 2–3 times per week over 3–5 weeks.
Each treatment is brief—approximately 5 minutes per eye.
There are no injections, no anesthesia, and no surgical recovery.
Patients can return to their usual activities after treatment.
Additional treatment courses may be recommended based on the treatment protocol and the patient's individual response.
Who may be a candidate?
Patients with certain stages of dry AMD
Patients who still have meaningful central retinal function to preserve
Patients whose examination and retinal imaging indicate that PBM may be appropriate
Some patients with more advanced dry AMD or wet AMD may be considered for off-label treatment, but that requires a separate discussion about the evidence, expectations, alternatives, and cost
What about insurance?
Coverage for Valeda is evolving and varies by insurance plan, diagnosis, stage of disease, and medical necessity.
Our office will determine whether we can bill a patient's insurance for treatment when appropriate.
If Valeda is not covered—or if treatment is being recommended outside the FDA-authorized indication—patients may have the option to receive treatment on a private-pay basis.
We will discuss anticipated financial responsibility before beginning treatment.
What Is Dry Age-Related Macular Degeneration?
The macula is the central portion of the retina responsible for the detailed vision we use to read, recognize faces, drive, and perform fine visual tasks.
In dry AMD, the tissues supporting the macula gradually become less healthy. One of the characteristic findings we see is the accumulation of deposits called drusen beneath the retina.
Dry AMD often progresses slowly. Some patients maintain useful vision for many years, while others gradually notice difficulty reading, decreased contrast, distortion, trouble seeing fine details, or difficulty adapting to changes in lighting.
In some patients, dry AMD eventually progresses to geographic atrophy, in which areas of retinal cells are permanently lost. Dry AMD can also convert to wet AMD, where abnormal blood vessels develop beneath the retina and leak fluid or blood.
Once retinal cells are permanently lost, our ability to restore them is extremely limited.
That is why I am interested in treatments aimed at supporting retinal function before significant, irreversible damage occurs.
What Is Valeda?
Valeda uses photobiomodulation, or PBM.
Despite the complicated name, the treatment itself is fairly straightforward. Valeda delivers specific wavelengths of yellow, red, and near-infrared light to the retina.
This is not the type of laser we use to cut, burn, or destroy tissue.
The science behind photobiomodulation involves, in part, the mitochondria—the structures inside our cells responsible for producing much of the energy those cells need to function.
The retina is one of the most metabolically active tissues in the body. Retinal cells require an extraordinary amount of energy throughout a person's lifetime. In AMD, mitochondrial dysfunction, oxidative stress, inflammation, and other age-related cellular changes are believed to contribute to declining retinal function.
Valeda's specific wavelengths of light are intended to influence cellular activity and support mitochondrial function.
The way I explain it to patients is this:
We are trying to help stressed retinal cells function more efficiently while those cells are still alive and capable of functioning.
Valeda cannot bring back retinal cells that have already been permanently lost. That distinction is important.
Why Am I Offering Valeda?
New technology comes into ophthalmology all the time. I don't believe that something is better simply because it is new.
Before bringing a treatment into my practice, I want to understand the science behind it, the evidence supporting it, its risks, and whether the potential benefit justifies the burden we are asking a patient to take on.
What interested me about Valeda was the combination of its clinical trial results and its non-invasive safety profile.
The LIGHTSITE clinical studies evaluated photobiomodulation in patients with dry AMD. In the LIGHTSITE III study, treated patients demonstrated improvements in visual acuity compared with sham-treated patients, and many patients maintained or improved their measured vision during follow-up. You can read the full study here: LIGHTSITE Research Study
That is noteworthy because, historically, our approach to early and intermediate dry AMD has largely been to try to reduce risk and monitor for vision loss, rather than actively treat retinal function.
But I also want to be careful about what those results mean.
Valeda is not a cure. I cannot promise that it will improve your vision.
Some patients in the studies gained letters on the eye chart. Others maintained their vision. Some continued to lose vision despite treatment.
There are also questions that remain about the magnitude and durability of the benefit and which patients are most likely to respond.
For me, that doesn't mean we ignore the treatment. It means we select patients thoughtfully, establish realistic expectations, and monitor their response objectively.
Who Is a Good Candidate?
This is where seeing a retina specialist matters.
"Dry macular degeneration" describes a broad spectrum of disease. Two patients can both have dry AMD but have very different amounts of drusen, retinal damage, geographic atrophy, visual acuity, and risk for progression.
Determining whether Valeda is appropriate requires looking at the actual retina, not simply the diagnosis listed in the chart.
I evaluate the retinal examination, visual acuity, OCT imaging, and other retinal imaging when appropriate. I also consider the patient's medical and ocular history, medications, stage of AMD, and what we are realistically trying to accomplish with treatment.
For patients who fall within Valeda's FDA-authorized indication, the decision is relatively straightforward if the examination supports treatment.
For patients with advanced dry AMD, geographic atrophy, or wet AMD, the discussion is different.
There may be circumstances where I believe PBM is reasonable to consider outside the FDA-authorized indication. That is considered off-label use.
If I recommend Valeda off-label, I will tell the patient that directly. We will discuss why I think it may be reasonable, the limitations of the evidence, alternatives, expected costs, and the fact that insurance is unlikely to cover treatment provided outside its authorized indication.
For patients with wet AMD, Valeda would not replace anti-VEGF injections or other treatment necessary to control active wet macular degeneration.
What Should I Expect From Treatment?
My goal is not to convince every patient with AMD to have Valeda.
My goal is to identify the patients for whom I believe the treatment is medically reasonable, explain what we know and what we don't know, and allow them to make an informed decision.
If we proceed, we can follow objective measures over time. We can check visual acuity. We can image the retina. We can ask what the patient is noticing in everyday life.
Some patients may notice an improvement. For others, success may mean maintaining functional vision longer than they otherwise would have.
And some patients may not respond.
That is the reality of nearly every treatment I use in retina, and I think patients deserve to hear that before treatment—not afterward.
Billing, Insurance & Private-Pay Treatment
We recognize that cost is part of the decision.
Insurance coverage for newer treatments can be complicated and may depend on the patient's diagnosis, clinical findings, insurance carrier, and the indication for which treatment is being provided.
When appropriate, Retina Care Center will evaluate insurance coverage and billing options before treatment begins.
If treatment is not covered by insurance, patients may elect to receive Valeda on a private-pay basis. Private-pay options may also be available for patients for whom I recommend Valeda off-label after an appropriate discussion and informed consent.
Before a patient commits to treatment, our staff will explain the anticipated cost and whether we expect treatment to be billed to insurance or paid privately.
I do not want financial surprises to be part of someone's medical care.
Why We Brought Valeda to Southern Oregon
Retina Care Center has served Southern Oregon since 2000. As a retina-only practice, macular degeneration isn't one service among many for us—it is a major part of what we do every day.
I want our patients to have access to meaningful advances in retinal care here at home.
That doesn't mean adopting every new machine or treatment that comes along. It means evaluating new technology carefully and offering it when I believe the evidence, safety profile, and potential benefit make it reasonable for my patients.
That is why we have brought Valeda to both our Medford and Grants Pass locations.
For years, when a patient with dry AMD asked me, "What can we do?" the answer was often focused on vitamins, lifestyle, and careful observation.
Those things remain important.
But now, for appropriately selected patients, we have another option to discuss.
If you have dry macular degeneration and would like to know whether Valeda may be appropriate for you, I would be happy to review your retinal findings and have that conversation with you.
Adam AufderHeide, MD, PhD, FASRS
Retina Specialist
Retina Care Center