Macular degeneration is a disease of the macula – a small area in the retina at the back of the eye. The macula allows you to see fine details clearly and do things such as read and drive.
When the macula does not work properly, your central vision can be blurry and have areas that are dark or distorted. Macular degeneration affects your ability to see near and far, and can make some activities — like threading a needle or reading — difficult or impossible.
In some patients macular degeneration may not affect your vision very much. In other cases, however, vision loss may be more rapid and severe. Macular degeneration is the most common cause of severe vision loss in people older than 50.
Even with advanced medical treatments it may be impossible to stop macular degeneration. However, with help from your eye doctor you can make the most of the vision you have. Schedule an exam today to screen for macular degeneration and find out what treatment options are best for you.
Causes
Many older people develop macular degeneration as part of the body’s natural aging process. There are different kinds of macular problems, but the most common is age-related macular degeneration (ARMD).
Oxidative stress is thought to play a major role in how ARMD develops. Many people (approximately 1 in 3 Caucasians) have genetic changes that make them more prone to this damage.
Major risk factors for ARMD include being more than 50 years old, having a family history of ARMD, and cigarette smoking. Another risk factor for developing ARMD may include having abnormal cholesterol levels.
Many people with ARMD have deposits under the retina called drusen. Drusen alone usually do not cause vision loss, but when they grow in size or number, there is an increased risk of developing advanced ARMD.
Types of ARMD
The two most common types of ARMD are dry (non-neovascular) and wet (neovascular).
Ninety percent of people with ARMD have the “dry” form. This condition is caused by damage (oxidative stress) and results in thinning of macular tissue. Vision loss is usually gradual. Many people with this form also have difficulty adjusting to changes in light. For example, they may find it takes them some time to adjust to seeing indoors when they come in from outside.
Ten percent of people who have ARMD have the “wet” form. Many of these people develop significant vision loss. Wet ARMD results when abnormal blood vessels form underneath the retina. These new blood vessels leak fluid or blood and blur central vision. Vision loss may be rapid and severe.
Treatments
Anti-VEGF Treatment
The most common treatment for wet ARMD involves injecting a drug into the eye that stops blood vessel growth and bleeding. These drugs, known as VEGF blockers or anti-VEGF treatments, target a specific chemical in your body that causes abnormal blood vessels to grow under the retina. That chemical is called vascular endothelial growth factor (VEGF). These anti-VEGF treatments improve vision in some people with wet ARMD.
Valeda Light Delivery System
The Valeda Light Delivery System is an FDA-approved multiwavelength photobiomodulation (PBM) device for treatment of nonexudative (dry) age-related macular degeneration (AMD). It received CE marking in 2018 and FDA approval in 2024. The device delivers three specific wavelengths of light — 590 nm (yellow), 660 nm (red), and 850 nm (near-infrared) — directly to the retina in a noninvasive, in-office treatment.
Treatment Protocol
Each treatment series consists of 9 sessions delivered 3 times per week over 3–5 weeks, repeated every 4 months on an ongoing basis.
Each session lasts approximately 4–5 minutes per eye.
Repeated treatments are necessary to maintain benefits.
Who Qualifies?
- Valeda is indicated for patients with nonexudative (dry) AMD, with the strongest evidence in intermediate dry AMD (AREDS categories 2–3).
- Key characteristics of ideal candidates based on trial inclusion criteria:
- Intermediate dry AMD with drusen but without foveal-involving geographic atrophy (GA)
- Better baseline visual acuity (>74 ETDRS letters) predicted stronger responses
- Patients with earlier disease stages showed more robust benefits
How Does Photobiomodulation Work?
- PBM targets multiple pathogenic mechanisms in AMD:
- Mitochondrial enhancement: Near-infrared light is absorbed by cytochrome C oxidase (COX), boosting ATP production and reducing oxidative stress and free radical damage
- Anti-inflammatory effects: Reduces gene expression of retinal stress and inflammatory mediators in the outer retina
- Complement modulation: Reduces complement propagation and increases phagocytosis
- Choriocapillaris perfusion: PBM has been shown to improve choroidal blood flow, correlating with functional improvement and drusen reduction
- Metabolic demand reduction: The 590 nm wavelength may act as a visual cycle modulator, reducing retinal hypoxia
What Can Patients Realistically Expect?
- Modest visual acuity improvement: Average gains of approximately roughly one line on an eye chart, not dramatic vision restoration
- Better responders tend to have earlier-stage disease and better baseline vision
- ~60% of treated eyes gain ≥5 letters; ~23% gain ≥10 letters at 21 months
- Drusen volume reduction and improved contrast sensitivity
- Potential slowing of progression to GA — the most clinically meaningful benefit, with a roughly 3.5-fold reduction in GA development
- Ongoing treatment required: Benefits diminish without repeated treatment series every 4 months
- Quality of life improvements reported on validated measures
Why Early Treatment Matters
- Irreversibility of GA: Once photoreceptors and RPE cells are lost in geographic atrophy, vision loss is permanent. Intervening at the intermediate stage — before GA develops — represents the critical therapeutic window.
- Stronger responses in earlier disease: LIGHTSITE I demonstrated that patients with earlier AMD stages and better baseline vision were more likely to be high responders.
- Disease modification potential: The significant reduction in GA incidence (6.8% vs. 24.0%) suggests PBM may alter the disease trajectory when initiated before irreversible structural damage occurs.
- Higher AREDS category associated with worse drusen outcomes: Higher baseline disease severity was associated with greater drusen volume increase over time, reinforcing the rationale for earlier intervention.
Nutritional Supplements
Antioxidant vitamins and zinc may reduce the impact of ARMD in some people. A large scientific study found that people at risk for developing advanced stages of ARMD lowered their risk by about 25 percent when treated with a high-dose combination of: vitamin C (500 mg); vitamin E (400 iu); beta carotene (15 mg); zinc (80 mg), and copper (2 mg). Another large study in women showed a benefit from taking folic acid and vitamins B6 and B12. And a large study evaluating the benefits of lutein and fish oil (omega-3) is ongoing.
Among those who either have no ARMD or very early ARMD, the supplements do not appear to be beneficial. Family members of patients with ARMD should check with their doctor before taking these vitamins themselves.