By Rajnish Mago, MD (bio)
Bright light therapy is an important treatment modality in mental health but is underutilized. To help clinicians with using bright light therapy appropriately, on other pages on this website, we have discussed exactly how bright light therapy should be done (see Related Pages below).
We have also discussed in detail on other pages (see Related Pages below) the criteria for deciding which bright light devices to recommend and have made specific recommendations about both larger and smaller light boxes.
What about visor devices for bright light therapy?
It is somewhat inconvenient for the patient to have to sit in front of a light box for 30 minutes or more. That is why attempts have been made since the early 1990s to create bright light therapy devices that are attached to a visor (shade) worn on the head with the light coming from the visor directly into the patient’s eyes. The obvious advantage of such devices would be that patients wear the device on their heads and walk around doing what they have to do while also getting bright light therapy.
Question from a Member: What do you think of the Luminette visor — patients can move about!
What did controlled clinical trials find?
If these devices were as effective as light boxes, that would be fantastic, wouldn’t it? But, are they?
Several controlled clinical trials done in the 1990s that evaluated bright light therapy using visor devices did NOT find them to be more efficacious than the control (“placebo”) intervention. But, these studies had several limitations and I don’t consider them conclusive.
Study no. 1 (Rosenthal et al., 1993)
– 55 subjects
– Randomized to receive light of either 400 or 6000 lux intensity from a light visor device.
– Duration of treatment: one week.
– Results: No statistically significant difference between the two groups. In fact, there was a trend for patients in the control group (dim light or “placebo”) to be more (sic) likely to be responders than those who received the brighter light.
Study no. 2 (Joffe et al., 1993)
– 105 subjects
– Randomized to three groups that received light of 60 lux, 600 lux, or 3500 lux intensity using a light visor device.
– Duration of treatment: two weeks.
– Results: No statistically significant difference between the three groups.
Study no. 3 (Teicher et al., 1995)
– 57 subjects
– Randomized to receive either dim (30 lux) red light or white light of 600 lux (sic) intensity. It was that using red light in the control group made the intervention at that group even less likely to be efficacious.
– Duration of treatment: 2 weeks
– Results: No statistically significant difference between the two groups.
The clinical trials mentioned above did not find bright light therapy visor devices to be efficacious but, in my opinion, they don’t convincingly show that they don’t work either. I have several methodological concerns with these studies, but my main concern is that the duration of treatment—one or two weeks–was much too short.
Optional to read: Clinical trials that are not being considered in this article include:
Stewart et al. (1990): 11 patients, compared a head-mounted device to a conventional light box and not to a sham head-mounted device. Also, the same patients were crossed over to the other treatment (head mounted device or conventional light box).
Visor devices using LED lights
Since then, the technology of visor devices has changed—LED lights are now being used in the visors. These visor devices provide light of much greater intensity than those used in the earlier clinical trials in the 1990s. A systematic evaluation of bright light therapy devices evaluated three visor devices and found them to deliver light of 5900, 8900, and 13800 lux intensity.
As of December 2019, not a single randomized clinical trial of an LED visor device with a parallel sham (“placebo”) group in patients with major depressive disorder or bipolar depression has been published.
There are ongoing clinical trials of bright light therapy visor devices, so we hope to have better data on them in the future. For example, there is an ongoing, small, controlled clinical trial of a visor device that is expected to be completed in February 2021 (https://clinicaltrials.gov/ct2/show/NCT03685942)
As of December 2019, visor devices for bright light therapy have not been shown in controlled clinical trials to be efficacious. So, for now, I do not recommend their use.
But, what if a patient who may benefit from bright light therapy absolutely refuses to use one of the light boxes that I recommended on another page (see Bright light therapy: Exactly which devices to recommend)? Is it better to use a visor light therapy device than to not use bright light therapy at all?
If a visor device is used, here are two visor devices whose physical characteristics were evaluated in a systematic study (Oldham et al., 2019).
1. Feel Bright light (www.feelbrightlight.com)
This comes in three different models that are available on Amazon.com at the links below:
2. SolarMax Light Visor (www.biobrite.com)
Available on Amazon.com at the following link: BioBrite SolarMax Light Visor $149
Tip: It has been suggested that if a patient is using a visor device for bright light therapy, we should tell the patient to check in a mirror that the visor has been positioned correctly on the head because, otherwise, patients “are likely to” try to reduce glare from the visor device by positioning it inappropriately (Oldham et al., 2019).
Disclosure: The links above to Amazon.com are affiliate links. Amazon.com offers websites that link to any product sold by them a small commission at no extra cost to the customer.
Controlled clinical trials of visor devices
Joffe RT, Moul DE, Lam RW, Levitt AJ, Teicher MH, Lebegue B, Oren DA, Buchanan A, Glod CA, Murray MG, et al. Light visor treatment for seasonal affective disorder: a multicenter study. Psychiatry Res. 1993 Jan;46(1):29-39. PubMed PMID: 8464953.
Levitt AJ, Wesson VA, Joffe RT, Maunder RG, King EF. A controlled comparison of light box and head-mounted units in the treatment of seasonal depression. J Clin Psychiatry. 1996 Mar;57(3):105-10. PubMed PMID: 8617693.
Raymackers JM, Andrade M, Baey E, Vanneste M, Evrard F. Bright light therapy with a head-mounted device for anxiety, depression, sleepiness and fatigue in patients with Parkinson’s disease. Acta Neurol Belg. 2019 Dec;119(4):607-613. doi: 10.1007/s13760-019-01214-3. Epub 2019 Sep 30. PubMed PMID: 31571135. Crossover design, no difference between the groups.
Stewart KT, Gaddy JR, Benson DM, Byrne B, Doghramji K, Brainard GC. Treatment of winter depression with a portable, head-mounted phototherapy device. Prog Neuropsychopharmacol Biol Psychiatry. 1990;14(4):569-78. PubMed PMID: 2236584.
Rosenthal NE, Moul DE, Hellekson CJ, Oren DA, Frank A, Brainard GC, Murray MG, Wehr TA. A multicenter study of the light visor for seasonal affective disorder: no difference in efficacy found between two different intensities. Neuropsychopharmacology. 1993 Feb;8(2):151-60. PubMed PMID: 8471127.
Teicher MH, Glod CA, Oren DA, Schwartz PJ, Luetke C, Brown C, Rosenthal NE. The phototherapy light visor: more to it than meets the eye. Am J Psychiatry. 1995 Aug;152(8):1197-202. PubMed PMID: 7625470.
Oldham MA, Oldham MB, Desan PH. Commercially Available Phototherapy Devices for Treatment of Depression: Physical Characteristics of Emitted Light. Psych Res Clin Pract 2019;1(2):49-57.
Meesters Y, Beersma DG, Bouhuys AL, van den Hoofdakker RH. Prophylactic treatment of seasonal affective disorder (SAD) by using light visors: bright white or infrared light? Biol Psychiatry. 1999 Jul 15;46(2):239-46. PubMed PMID: 10418699.
Clark C, Schocket LS, Turner EH, Rosenthal NE. Light visor maintenance of light box response. Am J Psychiatry. 1997 Aug;154(8):1172. PubMed PMID: 9247417.
Wallace G. Effectiveness of the light visor. Am J Psychiatry. 1996 Aug;153(8):1110-1. Erratum in: Am J Psychiatry 1996 Oct;153(10):1374. PubMed PMID: 8678188.
Disclosure: The links above to Amazon.com are affiliate links. Amazon.com offers websites that link to any product sold by them to receive a small commission at no extra cost to the customer.
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