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.
Question from a Member: What do you think of the [particular brand] visor — patients can move about!
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 “wearable”. At first, these devices consisted of 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.
Why consider wearable devices?
As of November 2020, wearable (e.g., visor) devices for bright light therapy have not been shown in controlled clinical trials to be efficacious. So, over the years, I have been telling patients that I do not recommend their use. Even now, using a large light box is the best approach. So, why are we discussing wearable devices on this page?
1. Sometimes a patient who may benefit from bright light therapy is unable or unwilling to use one of the light boxes that we have recommended (see Bright light therapy: Exactly which devices to recommend). In such situations, maybe it would be better to use a wearable bright light therapy device than to not use bright light therapy at all? Of course, we should tell the patient that using a wearable device is not the first-line recommendation and not yet proven to work in research.
2. Also, a wearable bright light therapy devices may be useful as supplements to conventional light boxes. For example, they could be used while the patient was traveling and unable to take the large light box along.
3. Lastly, once the patient has had a good response to bright light therapy using a conventional light box, the patient may not less willing to continue the light therapy. In such cases, a trial of a wearable device may be considered to maintain the response (Clark et al., 1007) could be maintained by using a wearable device, though it has not been shown in an adequate controlled clinical trial as of November 2020.
Do wearable bright light therapy devices work?
Older clinical trials
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, 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.
Newer wearable devices that use LED lights
Since then, the technology of wearable devices has changed—LED lights are now being used in the visors. These wearable devices provide light of much greater intensity than those used in the earlier clinical trials in the 1990s. For example, 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 (Oldham et al., 2019).
As of November 2020, 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.
But, there are several small studies that found that wearable light therapy devices suppress melatonin, lead to phase shift, etc, etc. These can be taken as indirect evidence that at least some wearable bright light therapy devices can do what larger light boxes can do.
Also, 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)
For which wearable bright light therapy devices may be considered, please see the following article on this website:
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).
Optional to read: Clinical trials using older visor devices
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.
Clinical trials that were not 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).
Clark C, Schocket LS, Turner EH, Rosenthal NE. Light visor maintenance of light box response. Am J Psychiatry. 1997 Aug;154(8):1172. doi: 10.1176/ajp.154.8.1172a. PMID: 9247417. Crossover design, small sample size.
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.
Swanson LM, Burgess HJ, Zollars J, Todd Arnedt J. An open-label pilot study of a home wearable light therapy device for postpartum depression. Arch Womens Ment Health. 2018 Oct;21(5):583-586. doi: 10.1007/s00737-018-0836-z. Epub 2018 Mar 30. PMID: 29603017; PMCID: PMC6234841.
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.
Zalta AK, Bravo K, Valdespino-Hayden Z, Pollack MH, Burgess HJ. A placebo-controlled pilot study of a wearable morning bright light treatment for probable PTSD. Depress Anxiety. 2019 Jul;36(7):617-624. doi: 10.1002/da.22897. Epub 2019 Apr 17. PMID: 30995350; PMCID: PMC6721597.
Center for Environmental Therapeutics. Are light visors effective in treating SAD? Last accessed November 4, 2020.
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.
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.
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.
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.
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