PBM for AMD now in NZ

Age-related macular degeneration (AMD) patients in Wellington will be some of the first in the country to receive photobiomodulation (PBM) treatment to treat this progressive eye disease.

Wellington-based ophthalmologist Dr James Leong, principal of Wellington’s newest private eye surgery The Eye Clinic, recently purchased an Eye-light PBM-therapy device after learning it had received European accreditation (the CE mark) for AMD. Specialising in medical retina and uveitis, Dr Leong said there’s been little to treat dry-AMD patients previously but recent studies, especially the Lightsite III study¹, have shown some exciting outcomes for PBM for dry-AMD patients. “I see quite a few patients who have seen the impact of AMD on their parents and have now started showing early to intermediate signs of dry AMD. These patients are very motivated to try to avoid the outcomes their parents had.”

Better known for treating dry eye disease, PBM, or low-level light therapy (LLLT), is a non-invasive treatment using low levels of multiple wavelengths of light to stimulate retinal cells. “It targets mitochondria, aiming to improve cell function, reduce inflammation and decrease oxidative stress – all key factors in AMD progression,” said Dr Leong. The Lightsite III prospective, randomised, controlled trial showed significant improvements in clinical and anatomical outcomes in intermediate dry AMD following PBM therapy with the Valeda Light Delivery System. This included more than 50% of treated eyes showing improved visual acuity (gaining ≥5 letters); slower progression to geographic atrophy compared to the control group; and improvements in contrast sensitivity and reading speed, leading to FDA approval for the Valeda device at the end of 2024.

Eye-light is a more cost-effective option that has produced comparable results in similar clinical trials, said Dr Leong. “Both options are painless, taking around 10 minutes per session delivered mostly through closed eyelids.” Valeda PBM is delivered in a three-week block of three treatments per week, while Eye-light PBM is delivered in a four-week block of two treatments per week with the manufacturers’ recommending this is repeated at least twice more after a gap of four to six months, he added.

Lightsite III Study Figure — A significant reduction in macular drusen volume, without photoreceptor or retinal pigment epithelium loss, plus a four-letter increase in BCVA, was observed (75 to 79 letters) at month 13 following four PBM treatments. Source: LIGHTSITE III study (Creative Commons 4.0 CCBY-NC-ND)¹

Dr Leong said he has several patients lined up for the new treatment, including some referrals from other Wellington-based ophthalmologists. Though it’s too early to know what the results will be, unlike laser or injections there’s practically no risk of significant complications with PBM treatment, he said, adding it will be most useful for patients with intermediate AMD or early geographic atrophy. “I do not expect that it will be suitable on its own for patients with oedema or who require ongoing injection treatments but as an adjunctive or add-on treatment.”

He also sees PBM as a useful adjunct to cataract surgery for his AMD patients. “We always warn that cataract surgery could possibly exacerbate their AMD. But now we have the option of a post-op treatment to see if we can get a little bit of further improvement in visual acuity and potentially prevent any exacerbation as well.”

Boyer D et al. LIGHTSITE III: 13-Month Efficacy and Safety Evaluation of Multiwavelength Photobiomodulation in Nonexudative (Dry) Age-Related Macular Degeneration Using the Lumithera Valeda Light Delivery System. Retina. 2024 Mar 1;44(3):487-497.