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Blume C, Münch M. Effects of light on biological functions and human sleep. HANDBOOK OF CLINICAL NEUROLOGY 2025; 206:3-16. [PMID: 39864930 DOI: 10.1016/b978-0-323-90918-1.00008-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2025]
Abstract
The nonvisual effects of light in humans are mainly conveyed by a subset of retinal ganglion cells that contain the pigment melanopsin which renders them intrinsically photosensitive (= intrinsically photosensitive retinal ganglion cells, ipRGCs). They have direct connections to the main circadian clock in the suprachiasmatic nuclei (SCN) of the hypothalamus and modulate a variety of physiological processes, pineal melatonin secretion, autonomic functions, cognitive processes such as attention, and behavior, including sleep and wakefulness. This is because efferent projections from the SCN reach other hypothalamic nuclei, the pineal gland, thalamus, basal forebrain, and the brainstem. The ipRGCs also directly impact the prefrontal cortex and the perihabenular nucleus (mood). In particular, light suppresses the secretion of melatonin in a dose-dependent manner, mainly depending on irradiance and spectral composition of light. There is evidence that exposure to light-emitting devices from luminaires and screens before bedtime can impact on sleep onset latency, sleep duration, and sleep quality. Likewise, light exposure during daytime modulates sleep architecture, duration, and sleep quality during the subsequent night. Therefore, the integration of acute, circadian, and long-term effects of light together influence sleep-wake quality and behavior in healthy individuals, as well as in patients with psychiatric or medical disorders.
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Affiliation(s)
- Christine Blume
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland; Research Cluster Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland; Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Mirjam Münch
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland; Research Cluster Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland; Department of Biomedicine, University of Basel, Basel, Switzerland
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2
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van der Linden RTM, van der Aa HPA, van Nispen RMA. The Role of Season, Sunlight, and Light Sensitivity in Self-Reported Depressive Symptoms by Adults With Visual Impairment. Transl Vis Sci Technol 2024; 13:2. [PMID: 39352713 PMCID: PMC11451827 DOI: 10.1167/tvst.13.10.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/07/2024] [Indexed: 10/06/2024] Open
Abstract
Purpose Depression is common in people with visual impairment, and the onset may be influenced by aspects related to light. The aim was to explore the associations of season, sunlight, and light sensitivity with depressive symptoms in this population. Methods Data regarding self-reported depressive symptoms from seven cross-sectional studies conducted between 2009 and 2018 were combined with information concerning sensitivity to light, season on the date of self-report, and potential sunlight exposure in the 2 weeks prior to self-report. The latter was calculated by summing up the daily sunlight hours detected by the weather station nearest to the residence of each participant. Logistic regression analyses were performed to investigate the associations. Results Participants (N = 1925) experienced clinically significant depressive symptoms most often in winter (32.8%), followed by summer (27.4%), spring (26.2%), and fall (24.2%). The odds of experiencing depression in fall were significantly lower compared with winter (odds ratio [OR] = 0.67, P = 0.007). An increase in the hours of sunlight in the participant's environment was associated with lower odds to experience depressive symptoms (OR = 0.995, P = 0.011). People who were sensitive to bright light had higher odds of experiencing depressive symptoms (OR = 1.80, P < 0.001). Other differences found between subgroups were not consistent. Conclusions It seems likely that season, sunlight, and light sensitivity play a role in depression among people with visual impairment. Further research is needed, exploring the experiences in this population, the actual sunlight exposure using objective measures, and treatment options. Translational Relevance Clinicians should consider these factors when treating visually impaired patients with depressive symptoms.
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Affiliation(s)
- Rob T M van der Linden
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Aging and Later Life, Amsterdam, the Netherlands
| | - Hilde P A van der Aa
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Aging and Later Life, Amsterdam, the Netherlands
| | - Ruth M A van Nispen
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Aging and Later Life, Amsterdam, the Netherlands
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3
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Philibert M, Milea D. Basics, benefits, and pitfalls of pupillometers assessing visual function. Eye (Lond) 2024; 38:2415-2421. [PMID: 38802485 PMCID: PMC11306737 DOI: 10.1038/s41433-024-03151-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/22/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024] Open
Abstract
Numerous commercially and non-commercially available pupillometers are nowadays able to assess various biological functions in humans, by evaluating pupils' dynamics in response to specific stimuli. However, the use of pupillometers for ophthalmic afferent evaluations (i.e., photoreceptoral responses) in real-world settings is relatively limited. Recent scientific and technological advances, coupled with artificial intelligence methods have improved the performance of such devices to objectively detect, quantify, and classify functional disturbances of the retina and the optic nerve. This review aims to summarize the scientific principles, indications, outcomes, and current limitations of pupillometry used for evaluation of afferent pathways in ophthalmic clinical settings.
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Affiliation(s)
| | - Dan Milea
- Rothschild Foundation Hospital, Paris, France.
- Copenhagen University Hospital, Copenhagen, Denmark.
- Singapore National Eye Centre, Singapore, Singapore.
- Angers University Hospital, Angers, France.
- Duke-NUS Medical School, Singapore, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
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Romagnoli M, Amore G, Avanzini P, Carelli V, La Morgia C. Chromatic pupillometry for evaluating melanopsin retinal ganglion cell function in Alzheimer's disease and other neurodegenerative disorders: a review. Front Psychol 2024; 14:1295129. [PMID: 38259552 PMCID: PMC10801184 DOI: 10.3389/fpsyg.2023.1295129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
The evaluation of pupillary light reflex (PLR) by chromatic pupillometry may provide a unique insight into specific photoreceptor functions. Chromatic pupillometry refers to evaluating PLR to different wavelengths and intensities of light in order to differentiate outer/inner retinal photoreceptor contributions to the PLR. Different protocols have been tested and are now established to assess in-vivo PLR contribution mediated by melanopsin retinal ganglion cells (mRGCs). These intrinsically photosensitive photoreceptors modulate the non-image-forming functions of the eye, which are mainly the circadian photoentrainment and PLR, via projections to the hypothalamic suprachiasmatic and olivary pretectal nucleus, respectively. In this context, chromatic pupillometry has been used as an alternative and non-invasive tool to evaluate the mRGC system in several clinical settings, including hereditary optic neuropathies, glaucoma, and neurodegenerative disorders such as Parkinson's disease (PD), idiopathic/isolated rapid eye movement sleep behavior disorder (iRBD), and Alzheimer's disease (AD). The purpose of this article is to review the key steps of chromatic pupillometry protocols for studying in-vivo mRGC-system functionality and provide the main findings of this technique in the research setting on neurodegeneration. mRGC-dependent pupillary responses are short-wavelength sensitive, have a higher threshold of activation, and are much slower and sustained compared with rod- and cone-mediated responses, driving the tonic component of the PLR during exposure to high-irradiance and continuous light stimulus. Thus, mRGCs contribute mainly to the tonic component of the post-illumination pupil response (PIPR) to bright blue light flash that persists after light stimulation is switched off. Given the role of mRGCs in circadian photoentrainment, the use of chromatic pupillometry to perform a functional evaluation of mRGcs may be proposed as an early biomarker of mRGC-dysfunction in neurodegenerative disorders characterized by circadian and/or sleep dysfunction such as AD, PD, and its prodromal phase iRBD. The evaluation by chromatic pupillometry of mRGC-system functionality may lay the groundwork for a new, easily accessible biomarker that can be exploited also as the starting point for future longitudinal cohort studies aimed at stratifying the risk of conversion in these disorders.
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Affiliation(s)
- Martina Romagnoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma di Neurogenetica, Bologna, Italy
| | - Giulia Amore
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | | | - Valerio Carelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma di Neurogenetica, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Chiara La Morgia
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
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Schöllhorn I, Stefani O, Blume C, Cajochen C. Seasonal Variation in the Responsiveness of the Melanopsin System to Evening Light: Why We Should Report Season When Collecting Data in Human Sleep and Circadian Studies. Clocks Sleep 2023; 5:651-666. [PMID: 37987395 PMCID: PMC10660855 DOI: 10.3390/clockssleep5040044] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/07/2023] [Accepted: 10/09/2023] [Indexed: 11/22/2023] Open
Abstract
It is well known that variations in light exposure during the day affect light sensitivity in the evening. More daylight reduces sensitivity, and less daylight increases it. On average days, we spend less time outdoors in winter and receive far less light than in summer. Therefore, it could be relevant when collecting research data on the non-image forming (NIF) effects of light on circadian rhythms and sleep. In fact, studies conducted only in winter may result in more pronounced NIF effects than in summer. Here, we systematically collected information on the extent to which studies on the NIF effects of evening light include information on season and/or light history. We found that more studies were conducted in winter than in summer and that reporting when a study was conducted or measuring individual light history is not currently a standard in sleep and circadian research. In addition, we sought to evaluate seasonal variations in a previously published dataset of 72 participants investigating circadian and sleep effects of evening light exposure in a laboratory protocol where daytime light history was not controlled. In this study, we selectively modulated melanopic irradiance at four different light levels (<90 lx). Here, we aimed to retrospectively evaluate seasonal variations in the responsiveness of the melanopsin system by combining all data sets in an exploratory manner. Our analyses suggest that light sensitivity is indeed reduced in summer compared to winter. Thus, to increase the reproducibility of NIF effects on sleep and circadian measures, we recommend an assessment of the light history and encourage standardization of reporting guidelines on the seasonal distribution of measurements.
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Affiliation(s)
- Isabel Schöllhorn
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, 4002 Basel, Switzerland; (I.S.); (O.S.)
- Research Cluster Molecular and Cognitive Neurosciences (MCN), University of Basel, 4001 Basel, Switzerland
| | - Oliver Stefani
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, 4002 Basel, Switzerland; (I.S.); (O.S.)
- Research Cluster Molecular and Cognitive Neurosciences (MCN), University of Basel, 4001 Basel, Switzerland
- Lucerne University of Applied Sciences and Arts, Engineering and Architecture, Technikumstrasse 21, 6048 Horw, Switzerland
| | - Christine Blume
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, 4002 Basel, Switzerland; (I.S.); (O.S.)
- Research Cluster Molecular and Cognitive Neurosciences (MCN), University of Basel, 4001 Basel, Switzerland
- Department of Biomedicine, University of Basel, 4001 Basel, Switzerland
| | - Christian Cajochen
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, 4002 Basel, Switzerland; (I.S.); (O.S.)
- Research Cluster Molecular and Cognitive Neurosciences (MCN), University of Basel, 4001 Basel, Switzerland
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Stoner AM, Patnaik JL, Ertel MK, Capitena-Young CE, SooHoo JR, Pantcheva MB, Kahook MY, Seibold LK. Subjective and Objective Measurement of Sleep Quality and Activity in Glaucoma. J Glaucoma 2023; 32:265-271. [PMID: 36795515 DOI: 10.1097/ijg.0000000000002186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 01/22/2023] [Indexed: 02/17/2023]
Abstract
PRCIS Glaucoma patients exhibit worse indices of sleep function by both objective and subjective metrics compared with controls. PURPOSE The purpose of this study is to characterize the sleep parameters and physical activity levels of glaucoma patients compared with controls. PATIENTS AND METHODS A total of 102 patients with a diagnosis of glaucoma in at least 1 eye and 31 control subjects were enrolled in the study. Participants completed the Pittsburgh Sleep Quality Index (PSQI) during enrollment and then wore wrist actigraphs for 7 consecutive days to characterize circadian rhythm, sleep quality, and physical activity. The primary outcomes of the study were subjective and objective metrics of sleep quality using the PSQI and actigraphy devices, respectively. The secondary outcome was physical activity, measured by the actigraphy device. RESULTS From the PSQI survey, glaucoma patients had higher (worse) scores compared with controls for sleep latency, sleep duration, and subjective sleep quality, whereas scores for sleep efficiency were lower (better), suggesting more time spent in bed asleep. By actigraphy, time in bed was significantly higher in glaucoma patients as was time awake after sleep onset. Interdaily stability, quantifying the synchronization to the 24-hour light-dark cycle, was lower in glaucoma patients. There were no other significant differences between glaucoma and control patients with regard to rest-activity rhythms or physical activity metrics. In contrast to the survey data, findings from the actigraphy demonstrated that there were no significant associations between the study group and controls regarding sleep efficiency, onset latency, or total sleep time. CONCLUSIONS In this study, patients with glaucoma demonstrated several subjective and objective differences in sleep function when compared with controls, whereas physical activity metrics were similar.
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Affiliation(s)
- Ari M Stoner
- Indiana University School of Medicine, Indianapolis, IN
| | - Jennifer L Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO
| | - Monica K Ertel
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO
| | | | - Jeffrey R SooHoo
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO
| | - Mina B Pantcheva
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO
| | - Malik Y Kahook
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO
| | - Leonard K Seibold
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO
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Arévalo-López C, Gleitze S, Madariaga S, Plaza-Rosales I. Pupillary response to chromatic light stimuli as a possible biomarker at the early stage of glaucoma: a review. Int Ophthalmol 2023; 43:343-356. [PMID: 35781599 DOI: 10.1007/s10792-022-02381-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
Glaucoma is a multifactorial neurodegenerative disease of the optic nerve currently considered a severe health problem because of its high prevalence, being the primary cause of irreversible blindness worldwide. The most common type corresponds to Primary Open-Angle Glaucoma. Glaucoma produces, among other alterations, a progressive loss of retinal ganglion cells (RGC) and its axons which are the key contributors to generate action potentials that reach the visual cortex to create the visual image. Glaucoma is characterized by Visual Field loss whose main feature is to be painless and therefore makes early detection difficult, causing a late diagnosis and a delayed treatment indication that slows down its progression. Intrinsically photosensitive retinal ganglion cells, which represent a subgroup of RGCs are characterized by their response to short-wave light stimulation close to 480 nm, their non-visual function, and their role in the generation of the pupillary reflex. Currently, the sensitivity of clinical examinations correlates to RGC damage; however, the need for an early damage biomarker is still relevant. It is an urgent task to create new diagnostic approaches to detect an early stage of glaucoma in a prompt, quick, and economical manner. We summarize the pathology of glaucoma and its current clinical detection methods, and we suggest evaluating the pupillary response to chromatic light as a potential biomarker of disease, due to its diagnostic benefit and its cost-effectiveness in clinical practice in order to reduce irreversible damage caused by glaucoma.
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Affiliation(s)
- Carla Arévalo-López
- Department of Medical Technology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Silvia Gleitze
- Biomedical Neuroscience Institute, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Samuel Madariaga
- Biomedical Neuroscience Institute, Faculty of Medicine, Universidad de Chile, Santiago, Chile.,Laboratorio de Neurosistemas, Department of Neuroscience, Faculty of Medicine, Universidad de Chile, Santiago, Chile.,Ecological Cognitive Neuroscience Group, Santiago, Chile
| | - Iván Plaza-Rosales
- Department of Medical Technology, Faculty of Medicine, Universidad de Chile, Santiago, Chile. .,Biomedical Neuroscience Institute, Faculty of Medicine, Universidad de Chile, Santiago, Chile. .,Laboratorio de Neurosistemas, Department of Neuroscience, Faculty of Medicine, Universidad de Chile, Santiago, Chile. .,Ecological Cognitive Neuroscience Group, Santiago, Chile.
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Uprety S, Adhikari P, Feigl B, Zele AJ. Melanopsin photoreception differentially modulates rod-mediated and cone-mediated human temporal vision. iScience 2022; 25:104529. [PMID: 35754721 PMCID: PMC9218364 DOI: 10.1016/j.isci.2022.104529] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/04/2022] [Accepted: 05/30/2022] [Indexed: 11/17/2022] Open
Abstract
To evaluate the nature of interactions between visual pathways transmitting the slower melanopsin and faster rod and cone signals, we implement a temporal phase summation paradigm in human observers using photoreceptor-directed stimuli. We show that melanopsin stimulation interacts with and alters both rod-mediated and cone-mediated vision regardless of whether it is perceptually visible or not. Melanopsin-rod interactions result in either inhibitory or facilitatory summation depending on the temporal frequency and photoreceptor pathway contrast sensitivity. Moreover, by isolating rod vision, we reveal a bipartite intensity response property of the rod pathway in photopic lighting that extends its operational range at lower frequencies to beyond its classic saturation limits but at the expense of attenuating sensitivity at higher frequencies. In comparison, melanopsin-cone interactions always lead to facilitation. These interactions can be described by linear or probability summations and potentially involve multiple intraretinal and visual cortical pathways to set human visual contrast sensitivity. Melanopsin ipRGCs support vision independent of the rod and cone signals Rod pathways mediate robust visual responses in daylight Temporal contrast sensitivity is contingent on the melanopsin excitation level Visual performance is collectively regulated by melanopsin, rod and cone pathways
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Affiliation(s)
- Samir Uprety
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, QLD 4059, Australia.,School of Optometry and Vision Science, Queensland University of Technology (QUT), Brisbane, QLD 4059, Australia
| | - Prakash Adhikari
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, QLD 4059, Australia.,School of Optometry and Vision Science, Queensland University of Technology (QUT), Brisbane, QLD 4059, Australia
| | - Beatrix Feigl
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, QLD 4059, Australia.,School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, QLD 4059, Australia.,Queensland Eye Institute, Brisbane, QLD 4101, Australia
| | - Andrew J Zele
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, QLD 4059, Australia.,School of Optometry and Vision Science, Queensland University of Technology (QUT), Brisbane, QLD 4059, Australia
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Maloca PM, Carvalho ER, Hasler PW, Balaskas K, Inglin N, Petzold A, Egan C, Tufail A, Scholl HPN, Valmaggia P. Dynamic volume-rendered optical coherence tomography pupillometry. Acta Ophthalmol 2021; 100:654-664. [PMID: 34750988 DOI: 10.1111/aos.15063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 09/29/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess intrapupillary space (IPS) changes in healthy subjects with regard to decreased iris motility in patients with pseudoexfoliation glaucoma (PEXG) or non-arteritic anterior ischaemic optic neuropathy (NAION) in a feasibility study in a clinical environment. METHODS Scotopic and photopic IPS measurements using three-dimensionally rendered swept-source optical coherence tomography (SS-OCT) data were obtained and compared for all subjects. Intrapupillary space (IPS) parameters were evaluated such as absolute volumetric differences, relative light response for volumetric ratios and pupillary ejection fraction (PEF) for functional contraction measurements. RESULTS From a total of 122 IPS from 66 subjects, 106 IPS were eligible for comparison providing values for 72 normal, 30 PEXG and 4 NAION eyes. In healthy, PEXG and NAION subjects, scotopic overall mean IPS was 8.90, 3.45 and 4.16 mm3 , and photopic overall mean IPS was 0.87, 0.74 and 1.13 mm3 , respectively. Three-dimensional contractility showed a mean absolute difference of 8.03 mm3 for normals (defined as 100% contractility), 2.72 mm3 for PEXG (33.88% of normal) and 3.03 mm3 for NAION (38.50% of normal) with a relative light response ratio between scotopic and photopic volumes of 10.26 (100%), 4.69 (45.70%) and 3.67 (35.78%), respectively. Pupillary ejection fraction (PEF) showed a contractile pupillary emptying of 88.11% for normals, 76.92% for PEXG and 70.91% for NAION patients. CONCLUSION This 3D pupillometry OCT assessment allows for quantitative measurements of pupil function, contractility and response to light. More specifically, PEF is presented as a potential (neuro)-pupillary outcome measure that could be useful in the monitoring of ophthalmic disorders that affect pupillary function.
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Affiliation(s)
- Peter M. Maloca
- Institute of Molecular and Clinical Ophthalmology Basel (IOB) Basel Switzerland
- OCTlab Department of Ophthalmology University Hospital Basel Basel Switzerland
- Department of Ophthalmology University of Basel Basel Switzerland
- Moorfields Eye Hospital London UK
| | | | - Pascal W. Hasler
- OCTlab Department of Ophthalmology University Hospital Basel Basel Switzerland
- Department of Ophthalmology University of Basel Basel Switzerland
| | | | - Nadja Inglin
- Institute of Molecular and Clinical Ophthalmology Basel (IOB) Basel Switzerland
| | - Axel Petzold
- Moorfields Eye Hospital London UK
- National Hospital for Neurology and Neurosurgery UCLH & UCL Institute of Neurology Queen Square London UK
- Dutch Expertise Centre Neuro‐ophthalmology Amsterdam UMC The Netherlands
| | | | | | - Hendrik P. N. Scholl
- Institute of Molecular and Clinical Ophthalmology Basel (IOB) Basel Switzerland
- OCTlab Department of Ophthalmology University Hospital Basel Basel Switzerland
- Department of Ophthalmology University of Basel Basel Switzerland
| | - Philippe Valmaggia
- Institute of Molecular and Clinical Ophthalmology Basel (IOB) Basel Switzerland
- OCTlab Department of Ophthalmology University Hospital Basel Basel Switzerland
- Department of Ophthalmology University of Basel Basel Switzerland
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Bertaud S, Zenouda A, Lombardi M, Authié C, Brasnu E, Hamard P, Sahel JA, Baudouin C, Labbé A. Glare and Mobility Performance in Glaucoma: A Pilot Study. J Glaucoma 2021; 30:963-970. [PMID: 34506355 DOI: 10.1097/ijg.0000000000001936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/14/2021] [Indexed: 11/26/2022]
Abstract
PRCIS Glare disability affects patients with moderate and severe glaucoma. Under glare conditions, mobility performances of glaucoma patients are reduced. PURPOSE The aim of this study was to evaluate glare disability and its impact on mobility and orientation in glaucoma patients. METHODS Twenty-two glaucoma patients and 12 age-matched control subjects were included. All patients underwent a clinical evaluation of visual function and halo size measurements to determine glare disability with a glare score (GS) of the best eye and worse eye. Mobility was evaluated by 4 mobility courses on an artificial street (StreetLab) under photopic conditions (P) and mesopic conditions with an additional light source in front of the patient to mimic dazzling conditions (M+G). Mobility time, mobility incidents, trajectory segmentation, distance traveled, preferred walking speed on trial (WS) and percentage of preferred walking speed (PPWS) were recorded, and the Nasa task load index (Nasa-TLX) was evaluated. RESULTS GS of the worse eye and GS of the best eye were significantly higher in glaucoma patients than in the control group (P=0.001 and 0.003). It was significantly different between moderate glaucoma patients and controls (P=0.001 and 0.010, respectively) and between severe glaucoma patients and controls (P=0.049 and 0.016). In locomotion tasks, comparing performance under M+G and P conditions, mobility performance was significantly different concerning mobility time (P=0.010), distance traveled (P=0.008), WS (P=0.007), PPWS (P=0.006), and Nasa-TLX (P=0.017) in the glaucoma group. Under M+G lighting conditions, mobility performance for glaucoma patients was significantly worse than controls with regard to WS (P=0.038), PPWS (P=0.0498), mobility time (P=0.046), and Nasa-TLX (P=0.006). CONCLUSION Glare disability was observed in patients with moderate and severe glaucoma and had an impact on their mobility performance.
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Affiliation(s)
| | | | - Marco Lombardi
- CHNO des Quinze-Vingts, IHU FOReSIGHT
- Streetlab, Institut de la Vision, Paris, France
| | | | - Emmanuelle Brasnu
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT
| | - Pascale Hamard
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT
| | - José-Alain Sahel
- CHNO des Quinze-Vingts, IHU FOReSIGHT
- Inserm, U968, UPMC Univ Paris 06, UMR_S968, Institut de la Vision, CNRS, UMR 7210, CHNO des Quinze-Vingts, INSERM-DHOS CIC 503
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT
| | - Christophe Baudouin
- CHNO des Quinze-Vingts, IHU FOReSIGHT
- Inserm, U968, UPMC Univ Paris 06, UMR_S968, Institut de la Vision, CNRS, UMR 7210, CHNO des Quinze-Vingts, INSERM-DHOS CIC 503
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT
- Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, Paris Saclay University
| | - Antoine Labbé
- CHNO des Quinze-Vingts, IHU FOReSIGHT
- Inserm, U968, UPMC Univ Paris 06, UMR_S968, Institut de la Vision, CNRS, UMR 7210, CHNO des Quinze-Vingts, INSERM-DHOS CIC 503
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT
- Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, Paris Saclay University
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11
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Bindiganavale MP, Moss HE. Development and Implementation of a Handheld Pupillometer for Detection of Optic Neuropathies. Curr Eye Res 2021; 46:1432-1435. [PMID: 33541152 PMCID: PMC8339172 DOI: 10.1080/02713683.2021.1878542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
Purpose: Quantitative pupillometry has utility in research settings for measuring optic nerve and autonomic function. We configured a portable device to perform quantitative pupillometry with application to detecting unilateral optic neuropathies in the clinical setting.Materials & methods: Light stimuli were delivered, and pupil diameter responses recorded using customized software implemented on a commercial portable electroretinography device. Increasing pupillary constriction occurred with increasing duration and intensity of full field blue light (470 nm) stimuli in healthy subjects. Flashes of 1 s dim (50 cd/m2) and bright (316 cd/m2) blue light were administered to both eyes of subjects with unilateral optic neuropathies (n = 10) and controls (n = 5). Maximum pupillary constriction (Cmax) for each stimulus was compared between control eyes and optic neuropathy eyes. Cmax for the inter-eye difference curve (Cdiffmax) was compared between control and optic neuropathy subjects.Results: The pupil protocol lasted 15 minutes and was well tolerated by subjects. Cmax for bright and dim stimuli was reduced in eyes with optic neuropathy compared to fellow and control eyes (p < .0005 for all). Inter-eye Cdiffmax was larger in optic neuropathy subjects than control subjects for both dim and bright stimuli (p = .002, <0.0005). There was no overlap between groups for Cmax and Cdiffmax for either stimulus.Conclusions: A portable pupillometer was implemented on a commercial portable electroretinography platform and applied in a pilot manner to subjects with and without unilateral optic neuropathies. Optic neuropathy eyes were distinguished from non-optic neuropathy eyes both within and between subjects.
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Affiliation(s)
| | - Heather E Moss
- Department of Ophthalmology, Stanford University, Palo Alto, USA
- Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, USA
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12
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Evangelisti S, La Morgia C, Testa C, Manners DN, Brizi L, Bianchini C, Carbonelli M, Barboni P, Sadun AA, Tonon C, Carelli V, Vandewalle G, Lodi R. Brain functional MRI responses to blue light stimulation in Leber’s hereditary optic neuropathy. Biochem Pharmacol 2021; 191:114488. [DOI: 10.1016/j.bcp.2021.114488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 12/20/2022]
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13
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Østergaard Madsen H, Hageman I, Kolko M, Lund-Andersen H, Martiny K, Ba-Ali S. Seasonal variation in neurohormones, mood and sleep in patients with primary open angle glaucoma - implications of the ipRGC-system. Chronobiol Int 2021; 38:1421-1431. [PMID: 34112046 DOI: 10.1080/07420528.2021.1931275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Primary open angle glaucoma is associated with an increased risk of mood and sleep disorders. These adversities have been suggested to relate to a disrupted function of the intrinsically photosensitive retinal ganglion cells (ipRGCs). The ipRGCs are key components in the nonvisual photoreceptive system that mediates light effects on mood, sleep and circadian rhythm. We assessed the diurnal hormone levels, pupillary responses and mood and sleep under seasons with different photoperiods in 24 patients with glaucoma and 24 age- and sex-matched healthy controls to investigate responses to naturalistic seasonal changes in daylight. The patients had moderate-to-advanced glaucoma with substantial visual field defects and reductions in the ipRGC-mediated pupillary responses (p < .001). In winter, compared with summer, patients with glaucoma had higher daytime melatonin concentration (p < .001) and lower nighttime cortisol (p = .002). In winter, the daytime melatonin level was inversely correlated with the ipRGC-mediated pupillary responses in the control group (p = .04). In the control group, there were no significant changes in hormone levels between seasons or any correlations between neurohormone levels and the ipRGC-mediated responses. The two groups showed a similar response to season with lower depression scores in summer compared with winter. In between-group comparison, the nocturnal melatonin level (area under curve from 20:00 h to 08:00 h) in summer was lower in glaucoma compared with controls (p = .03). In winter, nocturnal cortisol (at 04:00 h) was lower (p = .004) and daytime cortisol (12:00 h and 16:00 h) was higher (p = .007) in glaucoma compared with controls. In conclusion, we found that patients with glaucoma displayed a seasonal variation in diurnal hormone levels that was not present in healthy controls. Such neurohormonal changes may contribute to the increased risk of mood and sleep disorders seen in patients with glaucoma.
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Affiliation(s)
| | - Ida Hageman
- Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Miriam Kolko
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.,Department of Ophthalmology, Rigshospitalet-Glostrup Hospital, Copenhagen, Denmark
| | - Henrik Lund-Andersen
- Department of Ophthalmology, Rigshospitalet-Glostrup Hospital, Copenhagen, Denmark
| | - Klaus Martiny
- Mental Health Center Copenhagen, Copenhagen, Denmark
| | - Shakoor Ba-Ali
- Department of Ophthalmology, Rigshospitalet-Glostrup Hospital, Copenhagen, Denmark
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14
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Kawasaki A, Ouanes S, Crippa SV, Popp J. Early-Stage Alzheimer's Disease Does Not Alter Pupil Responses to Colored Light Stimuli. J Alzheimers Dis 2021; 75:1273-1282. [PMID: 32417780 DOI: 10.3233/jad-200120] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Pathologic changes in cerebral and retinal structures governing the pupillary light reflex occur in Alzheimer's disease (AD). Analysis of pupillary responses originating from different retinal cells may allow for non-invasive detection of cerebral AD pathology. OBJECTIVE This study aimed to quantify the pupil light reflex using a portable chromatic pupillometer in patients with early stage AD and compare their responses to those of a healthy control group. METHODS Participants in this case-control pilot study were recruited from a well-characterized cohort of elderly people participating in a larger prospective study on early AD. Cognitive testing, volumetric brain imaging, and lumbar puncture were performed in all participants to define two groups: early AD, i.e., cognitively impaired subjects with biomarker-confirmed AD pathology, and control group of subjects with normal cognition and normal CSF biomarker profile. Pupil responses to red and blue light stimuli intended to activate cone photoreceptors and melanopsin ganglion cells were recorded under photopic conditions. RESULTS Sixteen patients with AD (mean age 77 years) and sixteen controls (mean age 71 years) were tested. Baseline pupil size was significantly smaller in AD patients. Pupillary contraction amplitude to all red and blue lights was also smaller in AD patients but did not reach statistical significance. The post-illumination pupillary response was the same between the two groups. CONCLUSION Compared to healthy controls, we found only a smaller resting size of the pupil in patients with early AD. The pupillary dynamics to light stimulation remained relatively preserved.
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Affiliation(s)
- Aki Kawasaki
- Hôpital Ophtalmique Jules Gonin, Fondation Asile des Aveugles, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Sami Ouanes
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.,Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Sylvain V Crippa
- Hôpital Ophtalmique Jules Gonin, Fondation Asile des Aveugles, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Julius Popp
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.,Centre for Gerontopsychiatric Medicine, Department of Geriatric Psychiatry, University Hospital of Psychiatry Zürich, Zürich, Switzerland
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15
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Madsen HØ, Ba-Ali S, Heegaard S, Hageman I, Knorr U, Lund-Andersen H, Martiny K, Kessing LV. Melanopsin-mediated pupillary responses in bipolar disorder-a cross-sectional pupillometric investigation. Int J Bipolar Disord 2021; 9:7. [PMID: 33644827 PMCID: PMC7917036 DOI: 10.1186/s40345-020-00211-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/28/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Visible light, predominantly in the blue range, affects mood and circadian rhythm partly by activation of the melanopsin-containing intrinsically photosensitive retinal ganglion cells (ipRGCs). The light-induced responses of these ganglion cells can be evaluated by pupillometry. The study aimed to assess the blue light induced pupil constriction in patients with bipolar disorder (BD). METHODS We investigated the pupillary responses to blue light by chromatic pupillometry in 31 patients with newly diagnosed bipolar disorder, 22 of their unaffected relatives and 35 healthy controls. Mood state was evaluated by interview-based ratings of depressive symptoms (Hamilton Depression Rating Scale) and (hypo-)manic symptoms (Young Mania Rating Scale). RESULTS The ipRGC-mediated pupillary responses did not differ across the three groups, but subgroup analyses showed that patients in remission had reduced ipRGC-mediated responses compared with controls (9%, p = 0.04). Longer illness duration was associated with more pronounced ipRGC-responses (7% increase/10-year illness duration, p = 0.02). CONCLUSIONS The ipRGC-mediated pupil response to blue light was reduced in euthymic patients compared with controls and increased with longer disease duration. Longitudinal studies are needed to corroborate these potential associations with illness state and/or progression.
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Affiliation(s)
- Helle Østergaard Madsen
- Copenhagen Affective Disorder Research Center (CADIC), Mental Health Center Copenhagen, Rigshospitalet, Edel Sauntes Allé 10, 2100, Copenhagen Ø, Denmark.
| | - Shakoor Ba-Ali
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | | | - Ida Hageman
- Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Ulla Knorr
- Copenhagen Affective Disorder Research Center (CADIC), Mental Health Center Copenhagen, Rigshospitalet, Edel Sauntes Allé 10, 2100, Copenhagen Ø, Denmark
| | | | - Klaus Martiny
- Copenhagen Affective Disorder Research Center (CADIC), Mental Health Center Copenhagen, Rigshospitalet, Edel Sauntes Allé 10, 2100, Copenhagen Ø, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Mental Health Center Copenhagen, Rigshospitalet, Edel Sauntes Allé 10, 2100, Copenhagen Ø, Denmark
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16
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Walbeek TJ, Harrison EM, Gorman MR, Glickman GL. Naturalistic Intensities of Light at Night: A Review of the Potent Effects of Very Dim Light on Circadian Responses and Considerations for Translational Research. Front Neurol 2021; 12:625334. [PMID: 33597916 PMCID: PMC7882611 DOI: 10.3389/fneur.2021.625334] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/06/2021] [Indexed: 12/16/2022] Open
Abstract
In this review, we discuss the remarkable potency and potential applications of a form of light that is often overlooked in a circadian context: naturalistic levels of dim light at night (nLAN), equivalent to intensities produced by the moon and stars. It is often assumed that such low levels of light do not produce circadian responses typically associated with brighter light levels. A solid understanding of the impacts of very low light levels is complicated further by the broad use of the somewhat ambiguous term “dim light,” which has been used to describe light levels ranging seven orders of magnitude. Here, we lay out the argument that nLAN exerts potent circadian effects on numerous mammalian species, and that given conservation of anatomy and function, the efficacy of light in this range in humans warrants further investigation. We also provide recommendations for the field of chronobiological research, including minimum requirements for the measurement and reporting of light, standardization of terminology (specifically as it pertains to “dim” light), and ideas for reconsidering old data and designing new studies.
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Affiliation(s)
- Thijs J Walbeek
- Center for Circadian Biology, University of California, San Diego, La Jolla, CA, United States.,Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, OR, United States
| | - Elizabeth M Harrison
- Center for Circadian Biology, University of California, San Diego, La Jolla, CA, United States
| | - Michael R Gorman
- Center for Circadian Biology, University of California, San Diego, La Jolla, CA, United States.,Department of Psychology, University of California, San Diego, San Diego, CA, United States
| | - Gena L Glickman
- Center for Circadian Biology, University of California, San Diego, La Jolla, CA, United States.,Departments of Psychiatry and Neuroscience, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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17
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Kawasaki A, Udry M, El Wardani M, Münch M. Can Extra Daytime Light Exposure Improve Well-Being and Sleep? A Pilot Study of Patients With Glaucoma. Front Neurol 2021; 11:584479. [PMID: 33519670 PMCID: PMC7843442 DOI: 10.3389/fneur.2020.584479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/09/2020] [Indexed: 12/03/2022] Open
Abstract
Glaucoma damages retinal ganglion cells, including intrinsically photosensitive retinal ganglion cells (ipRGCs). These cells modulate various non-visual physiological and psychological functions which are modulated by light. In patients with glaucoma, we assessed the effect of daily bright light exposure (LE) on several melanopsin-dependent functions, such as the pupil constriction, circadian rest-activity cycles, sleep and subjective well-being including relaxation, alertness and mood. Twenty patients participated in the study (9 women, 11 men, mean age = 67.6 ± 7.5 y). Pupillometry was performed before the LE weeks and repeated on the last day of LE. The post-illumination pupil response (PIPR) was calculated as a proxy for melanopsin-dependent activation. Participants continuously wore an activity monitor and self-assessed sleep quality, well-being and visual comfort for 7 days before and during 4 weeks of daily bright LE (30 min to 10,000 lux polychromatic bright white light). After the LE, there was a significantly greater PIPR and higher subjective sleep quality when compared to the pre-LE week (p < 0.05), but no significant changes in 24-h rhythms or sleep parameters. A greater PIPR was correlated with an increase in circadian amplitude and higher inter-daily stability (derived from rest-activity cycles; p < 0.05). In a small group of patients with glaucoma, scheduled daily bright light exposure could improve subjective sleep quality. These findings highlight the importance to evaluate and maintain non-visual functions at different levels in patients with progressive loss of ipRGCs.
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Affiliation(s)
- Aki Kawasaki
- Hôpital Ophtalmique Jules Gonin, Fondation Asile des Aveugles, Department of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Morgane Udry
- Hôpital Ophtalmique Jules Gonin, Fondation Asile des Aveugles, Department of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Mohamad El Wardani
- Hôpital Ophtalmique Jules Gonin, Fondation Asile des Aveugles, Department of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Ophthalmology Department, Calderdale and Huddersfield NHS Foundation, Huddersfield, United Kingdom
| | - Mirjam Münch
- Sleep/Wake Research Centre, Massey University, Wellington, New Zealand
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18
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van Oterendorp C. Endocrine Dysfunction in Open Angle Glaucoma. Klin Monbl Augenheilkd 2021; 238:128-131. [PMID: 33434931 DOI: 10.1055/a-1306-1033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The eye, like all organs, is exposed to the effects of the body's endocrine system. In addition, however, local branches of the endocrine system control important organ-specific functions, such as the production and drainage of aqueous humour. Similarly, the eye as a sensory organ acts back on endocrine controlled functions of the body, for example the day-night rhythm. This article aims to illustrate the physiological and pathological interactions of the eye and the endocrine functions of the body in the context of glaucoma. 1. The renin-angiotensin-aldosterone system, which as a local system is involved in the control of aqueous humour production and outflow. 2. The hormone endothelin, which as a strong vasoconstrictor plays a role in the dysregulated perfusion of the optic nerve and retina, and 3. the disruption of the day-night rhythm in advanced glaucoma, which is thought to be caused by damage to light-sensitive ganglion cells.
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19
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Madsen HØ, Ba-Ali S, Lund-Andersen H, Martiny K, Hageman I. Mood and behavior seasonality in glaucoma; assessing correlations between seasonality and structure and function of the retinal ganglion cells. PLoS One 2020; 15:e0229991. [PMID: 32163458 PMCID: PMC7067444 DOI: 10.1371/journal.pone.0229991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/18/2020] [Indexed: 12/26/2022] Open
Abstract
Aim In glaucoma, depression and disturbed sleep has been associated with degeneration of the intrinsically photosensitive retinal ganglion cells, that mediate non-image forming effects of light such as regulation of circadian rhythm, alertness and mood. In this study we assessed associations between seasonal mood and behavior variation and retinal ganglion cell damage in outpatients with glaucoma. Methods The seasonal pattern assessment questionnaire was administered to outpatients with glaucoma. Data on visual field defects identified by autoperimetry and retinal nerve fiber layer thickness visualized by ocular coherence tomography were collected from patient charts. The correlations between seasonality and retinal damage were tested and the adjusted effects of retinal function on seasonality were evaluated in a linear regression model. Results In total, 113 persons completed the questionnaire. Of these, 4% fulfilled the criteria for seasonal affective disorder (SAD) and 8% for subsyndromal seasonal affective disorder (sSAD). Mean global seasonal score was 4.3. There were no significant correlations between seasonality and either visual field or retinal nerve fiber layer thickness. In the adjusted analysis there were trends toward differential effects of visual field on seasonality in subgroups with different sex and type of glaucoma. Conclusion There were no strong associations between seasonality and visual field or retinal nerve fiber layer thickness. Sex, age and glaucoma subtype may modify light effects on complex regulatory systems.
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Affiliation(s)
| | - Shakoor Ba-Ali
- Department of Ophthalmology, Rigshospitalet-Glostrup Hospital, Copenhagen, Denmark
| | - Henrik Lund-Andersen
- Department of Ophthalmology, Rigshospitalet-Glostrup Hospital, Copenhagen, Denmark
| | - Klaus Martiny
- Mental Health Center Copenhagen, Copenhagen, Denmark
| | - Ida Hageman
- Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
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20
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Münch M, Wirz-Justice A, Brown SA, Kantermann T, Martiny K, Stefani O, Vetter C, Wright KP, Wulff K, Skene DJ. The Role of Daylight for Humans: Gaps in Current Knowledge. Clocks Sleep 2020; 2:61-85. [PMID: 33089192 PMCID: PMC7445840 DOI: 10.3390/clockssleep2010008] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/21/2020] [Indexed: 01/04/2023] Open
Abstract
Daylight stems solely from direct, scattered and reflected sunlight, and undergoes dynamic changes in irradiance and spectral power composition due to latitude, time of day, time of year and the nature of the physical environment (reflections, buildings and vegetation). Humans and their ancestors evolved under these natural day/night cycles over millions of years. Electric light, a relatively recent invention, interacts and competes with the natural light-dark cycle to impact human biology. What are the consequences of living in industrialised urban areas with much less daylight and more use of electric light, throughout the day (and at night), on general health and quality of life? In this workshop report, we have classified key gaps of knowledge in daylight research into three main groups: (I) uncertainty as to daylight quantity and quality needed for "optimal" physiological and psychological functioning, (II) lack of consensus on practical measurement and assessment methods and tools for monitoring real (day) light exposure across multiple time scales, and (III) insufficient integration and exchange of daylight knowledge bases from different disciplines. Crucial short and long-term objectives to fill these gaps are proposed.
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Affiliation(s)
- Mirjam Münch
- Sleep/Wake Research Centre, Massey University Wellington, Wellington 6021, New Zealand
| | - Anna Wirz-Justice
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, 4002 Basel, Switzerland; (A.W.-J.); (O.S.)
- Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, 4002 Basel, Switzerland
| | - Steven A. Brown
- Chronobiology and Sleep Research Group, Institute of Pharmacology and Toxicology, University of Zürich, 8057 Zürich, Switzerland;
| | - Thomas Kantermann
- Faculty for Health and Social Affairs, University of Applied Sciences for Economics and Management (FOM), 45141 Essen, Germany;
- SynOpus, 44789 Bochum, Germany
| | - Klaus Martiny
- Psychiatric Center Copenhagen, University of Copenhagen, Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Oliver Stefani
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, 4002 Basel, Switzerland; (A.W.-J.); (O.S.)
- Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, 4002 Basel, Switzerland
| | - Céline Vetter
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA; (C.V.); (K.P.W.J.)
| | - Kenneth P. Wright
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA; (C.V.); (K.P.W.J.)
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado, Aurora, CO 80045, USA
| | - Katharina Wulff
- Departments of Radiation Sciences and Molecular Biology, Umeå University, 901 87 Umeå, Sweden;
- Wallenberg Centre for Molecular Medicine (WCMM), Umeå University, 901 87 Umeå, Sweden
| | - Debra J. Skene
- Chronobiology, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK;
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21
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Ahmadi H, Lund‐Andersen H, Kolko M, Bach‐Holm D, Alberti M, Ba‐Ali S. Melanopsin-mediated pupillary light reflex and sleep quality in patients with normal tension glaucoma. Acta Ophthalmol 2020; 98:65-73. [PMID: 31062491 DOI: 10.1111/aos.14133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 04/10/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE The intrinsically photosensitive retinal ganglion cells (ipRGCs) and sleep quality are impaired in patients with primary open-angle glaucoma (POAG). In this study, we investigated whether ipRGCs and sleep quality were also impaired in patients with normal tension glaucoma (NTG). METHODS We performed pupillometry and sleep quality assessment in 15 patients with NTG and 17 healthy age-matched controls. Pupillometry protocol consisted of monocular stimulation with high illuminance (100 lux) red (633 nm, 300 cd/m2 or 15.23 log quanta/cm2 /s) and blue light (463 nm, 332 cd/m2 or 15.27 log quanta/cm2 /s) and binocular pupil measurements. Prior to light stimulation, patients were dark-adapted for 5 min. The late postillumination pupillary response (PIPRL ate ) to blue light was used as marker of ipRGC activity. Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI) questionnaire. RESULTS The PIPRL ate to blue light was significantly reduced in patients with NTG compared to healthy subjects (p < 0.001), indicating impairment of the melanopsin-mediated pupillary pathway. There was no significant difference in the response elicited by red light (p = 0.6). Baseline pupil diameter and pupillary constriction amplitude to both red and blue light were reduced in patients with NTG (p < 0.05). The global score in PSQI was not significantly different between healthy controls and patients with NTG, indicating normal sleep quality (p = 0.6). Furthermore, we found no correlation between sleep parameters and pupillary light reflex parameters. CONCLUSION Patients with NTG exhibited reduced ipRGC activity compared to healthy subjects, while no differences were observed in sleep quality.
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Affiliation(s)
- Hamid Ahmadi
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Henrik Lund‐Andersen
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Miriam Kolko
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Daniella Bach‐Holm
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Mark Alberti
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Shakoor Ba‐Ali
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
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22
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Kelbsch C, Strasser T, Chen Y, Feigl B, Gamlin PD, Kardon R, Peters T, Roecklein KA, Steinhauer SR, Szabadi E, Zele AJ, Wilhelm H, Wilhelm BJ. Standards in Pupillography. Front Neurol 2019; 10:129. [PMID: 30853933 PMCID: PMC6395400 DOI: 10.3389/fneur.2019.00129] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/31/2019] [Indexed: 12/31/2022] Open
Abstract
The number of research groups studying the pupil is increasing, as is the number of publications. Consequently, new standards in pupillography are needed to formalize the methodology including recording conditions, stimulus characteristics, as well as suitable parameters of evaluation. Since the description of intrinsically photosensitive retinal ganglion cells (ipRGCs) there has been an increased interest and broader application of pupillography in ophthalmology as well as other fields including psychology and chronobiology. Color pupillography plays an important role not only in research but also in clinical observational and therapy studies like gene therapy of hereditary retinal degenerations and psychopathology. Stimuli can vary in size, brightness, duration, and wavelength. Stimulus paradigms determine whether rhodopsin-driven rod responses, opsin-driven cone responses, or melanopsin-driven ipRGC responses are primarily elicited. Background illumination, adaptation state, and instruction for the participants will furthermore influence the results. This standard recommends a minimum set of variables to be used for pupillography and specified in the publication methodologies. Initiated at the 32nd International Pupil Colloquium 2017 in Morges, Switzerland, the aim of this manuscript is to outline standards in pupillography based on current knowledge and experience of pupil experts in order to achieve greater comparability of pupillographic studies. Such standards will particularly facilitate the proper application of pupillography by researchers new to the field. First we describe general standards, followed by specific suggestions concerning the demands of different targets of pupil research: the afferent and efferent reflex arc, pharmacology, psychology, sleepiness-related research and animal studies.
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Affiliation(s)
- Carina Kelbsch
- Pupil Research Group, Centre for Ophthalmology, University Hospitals Tübingen, Tübingen, Germany
| | - Torsten Strasser
- Pupil Research Group, Centre for Ophthalmology, University Hospitals Tübingen, Tübingen, Germany
| | - Yanjun Chen
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, AL, United States
| | - Beatrix Feigl
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Queensland Eye Institute, Brisbane, QLD, Australia
| | - Paul D. Gamlin
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Randy Kardon
- Neuro-Ophthalmology Division, University of Iowa and Iowa City VA Healthcare System, Iowa City, LA, United States
| | - Tobias Peters
- Pupil Research Group, Centre for Ophthalmology, University Hospitals Tübingen, Tübingen, Germany
| | - Kathryn A. Roecklein
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Stuart R. Steinhauer
- VA Pittsburgh Healthcare System, VISN 4 MIRECC, University Drive C, Pittsburgh, PA, United States
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Elemer Szabadi
- Developmental Psychiatry, University of Nottingham, Nottingham, United Kingdom
| | - Andrew J. Zele
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, QLD, Australia
| | - Helmut Wilhelm
- Pupil Research Group, Centre for Ophthalmology, University Hospitals Tübingen, Tübingen, Germany
| | - Barbara J. Wilhelm
- Pupil Research Group, Centre for Ophthalmology, University Hospitals Tübingen, Tübingen, Germany
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Rukmini AV, Milea D, Gooley JJ. Chromatic Pupillometry Methods for Assessing Photoreceptor Health in Retinal and Optic Nerve Diseases. Front Neurol 2019; 10:76. [PMID: 30809186 PMCID: PMC6379484 DOI: 10.3389/fneur.2019.00076] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/21/2019] [Indexed: 12/19/2022] Open
Abstract
The pupillary light reflex is mediated by melanopsin-containing intrinsically-photosensitive retinal ganglion cells (ipRGCs), which also receive input from rods and cones. Melanopsin-dependent pupillary light responses are short-wavelength sensitive, have a higher threshold of activation, and are much slower to activate and de-activate compared with rod/cone-mediated responses. Given that rod/cone photoreceptors and melanopsin differ in their response properties, light stimuli can be designed to stimulate preferentially each of the different photoreceptor types, providing a read-out of their function. This has given rise to chromatic pupillometry methods that aim to assess the health of outer retinal photoreceptors and ipRGCs by measuring pupillary responses to blue or red light stimuli. Here, we review different types of chromatic pupillometry protocols that have been tested in patients with retinal or optic nerve disease, including approaches that use short-duration light exposures or continuous exposure to light. Across different protocols, patients with outer retinal disease (e.g., retinitis pigmentosa or Leber congenital amaurosis) show reduced or absent pupillary responses to dim blue-light stimuli used to assess rod function, and reduced responses to moderately-bright red-light stimuli used to assess cone function. By comparison, patients with optic nerve disease (e.g., glaucoma or ischemic optic neuropathy, but not mitochondrial disease) show impaired pupillary responses during continuous exposure to bright blue-light stimuli, and a reduced post-illumination pupillary response after light offset, used to assess melanopsin function. These proof-of-concept studies demonstrate that chromatic pupillometry methods can be used to assess damage to rod/cone photoreceptors and ipRGCs. In future studies, it will be important to determine whether chromatic pupillometry methods can be used for screening and early detection of retinal and optic nerve diseases. Such methods may also prove useful for objectively evaluating the degree of recovery to ipRGC function in blind patients who undergo gene therapy or other treatments to restore vision.
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Affiliation(s)
- A V Rukmini
- Programme in Neuroscience and Behavioural Disorders, Centre for Cognitive Neuroscience, Duke-NUS Medical School, Singapore, Singapore
| | - Dan Milea
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore.,The Ophthalmology and Visual Sciences Academic Clinical Programme (EYE-ACP), SingHealth and Duke-NUS, Singapore, Singapore
| | - Joshua J Gooley
- Programme in Neuroscience and Behavioural Disorders, Centre for Cognitive Neuroscience, Duke-NUS Medical School, Singapore, Singapore
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24
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RETRACTED: Astragaloside protects oxygen and glucose deprivation induced injury by regulation of microRNA-21 in retinal ganglion cell line RGC-5. Biomed Pharmacother 2019; 109:1826-1833. [DOI: 10.1016/j.biopha.2018.11.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 12/17/2022] Open
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25
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La Morgia C, Carelli V, Carbonelli M. Melanopsin Retinal Ganglion Cells and Pupil: Clinical Implications for Neuro-Ophthalmology. Front Neurol 2018; 9:1047. [PMID: 30581410 PMCID: PMC6292931 DOI: 10.3389/fneur.2018.01047] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 11/19/2018] [Indexed: 02/02/2023] Open
Abstract
Melanopsin retinal ganglion cells (mRGCs) are intrinsically photosensitive RGCs that mediate many relevant non-image forming functions of the eye, including the pupillary light reflex, through the projections to the olivary pretectal nucleus. In particular, the post-illumination pupil response (PIPR), as evaluated by chromatic pupillometry, can be used as a reliable marker of mRGC function in vivo. In the last years, pupillometry has become a promising tool to assess mRGC dysfunction in various neurological and neuro-ophthalmological conditions. In this review we will present the most relevant findings of pupillometric studies in glaucoma, hereditary optic neuropathies, ischemic optic neuropathies, idiopathic intracranial hypertension, multiple sclerosis, Parkinson's disease, and mood disorders. The use of PIPR as a marker for mRGC function is also proposed for other neurodegenerative disorders in which circadian dysfunction is documented.
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Affiliation(s)
- Chiara La Morgia
- Unità Operativa Complessa Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Valerio Carelli
- Unità Operativa Complessa Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Michele Carbonelli
- Unità Operativa Complessa Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy
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26
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Inner and Outer Retinal Contributions to Pupillary Light Response: Correlation to Functional and Morphologic Parameters in Glaucoma. J Glaucoma 2018; 27:723-732. [DOI: 10.1097/ijg.0000000000001003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Bauer M, Glenn T, Monteith S, Gottlieb JF, Ritter PS, Geddes J, Whybrow PC. The potential influence of LED lighting on mental illness. World J Biol Psychiatry 2018; 19:59-73. [PMID: 29251065 DOI: 10.1080/15622975.2017.1417639] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Two recent scientific breakthroughs may alter the treatment of mental illness, as discussed in this narrative review. The first was the invention of white light-emitting diodes (LEDs), which enabled an ongoing, rapid transition to energy-efficient LEDs for lighting, and the use of LEDs to backlight digital devices. The second was the discovery of melanopsin-expressing photosensitive retinal ganglion cells, which detect environmental irradiance and mediate non-image forming (NIF) functions including circadian entrainment, melatonin secretion, alertness, sleep regulation and the pupillary light reflex. These two breakthroughs are interrelated because unlike conventional lighting, white LEDs have a dominant spectral wavelength in the blue light range, near the peak sensitivity for the melanopsin system. METHODS Pertinent articles were identified. RESULTS Blue light exposure may suppress melatonin, increase alertness, and interfere with sleep in young, healthy volunteers and in animals. Areas of concern in mental illness include the influence of blue light on sleep, other circadian-mediated symptoms, prescribed treatments that target the circadian system, measurement using digital apps and devices, and adolescent sensitivity to blue light. CONCLUSIONS While knowledge in both fields is expanding rapidly, future developments must address the potential impact of blue light on NIF functions for healthy individuals and those with mental illness.
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Affiliation(s)
- Michael Bauer
- a Department of Psychiatry and Psychotherapy , University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden , Dresden , Germany
| | - Tasha Glenn
- b ChronoRecord Association, Inc , Fullerton , CA , USA
| | - Scott Monteith
- c Michigan State University College of Human Medicine, Traverse City Campus , Traverse City , MI , USA
| | - John F Gottlieb
- d Department of Psychiatry , Feinberg School of Medicine, Northwestern University , Chicago , IL , USA
| | - Philipp S Ritter
- a Department of Psychiatry and Psychotherapy , University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden , Dresden , Germany
| | - John Geddes
- e Department of Psychiatry , University of Oxford, Warneford Hospital , Oxford , UK
| | - Peter C Whybrow
- f Department of Psychiatry and Biobehavioral Sciences , Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA) , Los Angeles , CA , USA
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28
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Münch M, Ladaique M, Roemer S, Hashemi K, Kawasaki A. Melanopsin-Mediated Acute Light Responses Measured in Winter and in Summer: Seasonal Variations in Adults with and without Cataracts. Front Neurol 2017; 8:464. [PMID: 28955293 PMCID: PMC5601987 DOI: 10.3389/fneur.2017.00464] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/21/2017] [Indexed: 11/19/2022] Open
Abstract
Seasonal adaptation is a ubiquitous behavior seen in many species on both global hemispheres and is conveyed by changing photoperiods. In humans this seasonal adaptation is less apparent, in part because changes in daylength are masked by the use of electrical lighting at night. On the other hand, cataracts which reduce light transmission, may compound seasonal changes related to the reduced daylength of winter. To better understand the effects of different photoperiod lengths in healthy adults without and with cataracts, we tested their melanopsin-mediated light responses in summer vs. winter. Fifty-two participants (mean age 67.4 years; 30 with bilateral cataracts and 22 age-matched controls with clear lenses; pseudophakes) were tested twice, once in summer and once in winter. At each test session we assessed the electroretinogram and pupil responses during daytime and we determined melatonin suppression, subjective sleepiness and mood in response to light exposure in the evening. Circadian rest-activity cycles and sleep from activity recordings were also analyzed for both seasons. Both groups had similar visual function. There were no seasonal differences in the electroretinogram. For the pupil responses to bright blue light, the post-illumination pupil response (PIPR) was greater in winter than summer in pseudophakes, but not in cataract participants, whereas melatonin suppression to acute light exposure showed no differences between both groups and seasons. Overall, intra-daily variability of rest-activity was worse in winter but participants felt sleepier and reported worse mood at the laboratory in evening time in the summer. Those with cataracts had poorer sleep quality with lower sleep efficiency, and higher activity during sleep in winter than summer. In this study, the PIPR showed a seasonal variation in which a larger response was found during winter. This variation was only detected in participants with a clear intraocular lens. In the cataract group, visual function was not impaired yet these participants showed a lack of seasonal changes in the pupil response to blue light and poorer sleep in winter. These findings raise the question for tailored lighting conditions for cataract patients in order to counter potentially deleterious effects of living with chronically lower light exposure.
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Affiliation(s)
- Mirjam Münch
- Group Sleep Research & Clinical Chronobiology, Institute of Physiology, Charité University Médicine Berlin, Berlin, Germany
| | - Myriam Ladaique
- Hôpital Ophtalmique Jules Gonin, University of Lausanne, Lausanne, Switzerland
| | - Ségolène Roemer
- Hôpital Ophtalmique Jules Gonin, University of Lausanne, Lausanne, Switzerland
| | - Kattayoon Hashemi
- Hôpital Ophtalmique Jules Gonin, University of Lausanne, Lausanne, Switzerland
| | - Aki Kawasaki
- Hôpital Ophtalmique Jules Gonin, University of Lausanne, Lausanne, Switzerland
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29
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Charng J, Jacobson SG, Heon E, Roman AJ, McGuigan DB, Sheplock R, Kosyk MS, Swider M, Cideciyan AV. Pupillary Light Reflexes in Severe Photoreceptor Blindness Isolate the Melanopic Component of Intrinsically Photosensitive Retinal Ganglion Cells. Invest Ophthalmol Vis Sci 2017; 58:3215-3224. [PMID: 28660274 PMCID: PMC5490362 DOI: 10.1167/iovs.17-21909] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose Pupillary light reflex (PLR) is driven by outer retinal photoreceptors and by melanopsin-expressing intrinsically photosensitive retinal ganglion cells of the inner retina. To isolate the melanopic component, we studied patients with severe vision loss due to Leber congenital amaurosis (LCA) caused by gene mutations acting on the outer retina. Methods Direct PLR was recorded in LCA patients (n = 21) with known molecular causation and severe vision loss. Standard stimuli (2.5 log scot-cd.m−2; ∼13 log quanta.cm−2.s−1; achromatic full-field) with 0.1- or 5-second duration were used in all patients. Additional recordings were performed with higher luminance (3.9 log scot-cd.m−2) in a subset of patients. Results The LCA patients showed no detectable PLR to the standard stimulus with short duration. With longer-duration stimuli, a PLR was detectable in the majority (18/21) of patients. The latency of the PLR was 2.8 ± 1.3 seconds, whereas normal latency was 0.19 ± 0.02 seconds. Peak contraction amplitude in patients was 1.1 ± 0.9 mm at 6.2 ± 2.3 seconds, considerably different from normal amplitude of 4.2 ± 0.4 mm at 3.0 ± 0.4 seconds. Recordings with higher luminance demonstrated that PLRs in severe LCA could also be evoked with short-duration stimuli. Conclusions The PLR in severe LCA patients likely represents the activation of the melanopic circuit in isolation from rod and cone input. Knowledge of the properties of the human melanopic PLR allows not only comparison to those in animal models but also serves to define the fidelity of postretinal transmission in clinical trials targeting patients with no outer retinal function.
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Affiliation(s)
- Jason Charng
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Samuel G Jacobson
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Elise Heon
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Alejandro J Roman
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - David B McGuigan
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Rebecca Sheplock
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Mychajlo S Kosyk
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Malgorzata Swider
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Artur V Cideciyan
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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30
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Ba-Ali S, Lund-Andersen H. Pupillometric evaluation of the melanopsin containing retinal ganglion cells in mitochondrial and non-mitochondrial optic neuropathies. Mitochondrion 2017; 36:124-129. [PMID: 28716667 DOI: 10.1016/j.mito.2017.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 05/29/2017] [Accepted: 07/13/2017] [Indexed: 01/08/2023]
Abstract
In recent years, chromatic pupillometry is used in humans to evaluate the activity of melanopsin expressing intrinsic photosensitive retinal ganglion cells (ipRGCs). Blue light is used to stimulate the ipRGCs and red light activates the rod/cone photoreceptors. The late re-dilation phase of pupillary light reflex is primarily driven by the ipRGCs. Optic neuropathies i.e. Leber hereditary optic neuropathy (LHON), autosomal dominant optic atrophy (ADOA), nonarteritic anterior ischemic optic neuropathy (NAION), glaucoma, optic neuritis and idiopathic intracranial hypertension (IIH) are among the diseases, which have been subject to pupillometric studies. The ipRGCs are differentially affected in these various optic neuropathies. In mitochondrial optic neuropathies, the ipRGCs are protected against degeneration, whereas in glaucoma, NAION, optic neuritis and IIH the ipRGCs are damaged. Here, we will review the results of pupillometric, histopathological and animal studies evaluating the ipRGCs in mitochondrial and non-mitochondrial optic neuropathies.
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Affiliation(s)
- Shakoor Ba-Ali
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Henrik Lund-Andersen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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31
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Adhikari P, Zele AJ, Thomas R, Feigl B. Quadrant Field Pupillometry Detects Melanopsin Dysfunction in Glaucoma Suspects and Early Glaucoma. Sci Rep 2016; 6:33373. [PMID: 27622679 PMCID: PMC5020729 DOI: 10.1038/srep33373] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/23/2016] [Indexed: 12/20/2022] Open
Abstract
It is difficult to detect visual function deficits in patients at risk for glaucoma (glaucoma suspects) and at early disease stages with conventional ophthalmic tests such as perimetry. To this end, we introduce a novel quadrant field measure of the melanopsin retinal ganglion cell mediated pupil light response corresponding with typical glaucomatous arcuate visual field defects. The melanopsin-mediated post-illumination pupil response (PIPR) was measured in 46 patients with different stages of glaucoma including glaucoma suspects and compared to a healthy group of 21 participants with no disease. We demonstrate that the superonasal quadrant PIPR differentiated glaucoma suspects and early glaucoma patients from controls with fair (AUC = 0.74) and excellent (AUC = 0.94) diagnostic accuracy, respectively. The superonasal PIPR provides a linear functional correlate of structural retinal nerve fibre thinning in glaucoma suspects and early glaucoma patients. This first report that quadrant PIPR stimulation detects melanopsin dysfunction in patients with early glaucoma and at pre-perimetric stages may have future implications in treatment decisions of glaucoma suspects.
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Affiliation(s)
- Prakash Adhikari
- Medical Retina and Visual Science Laboratories, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Brisbane, QLD, 4059, Australia
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, QLD, Australia
| | - Andrew J. Zele
- Medical Retina and Visual Science Laboratories, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Brisbane, QLD, 4059, Australia
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, QLD, Australia
| | - Ravi Thomas
- Queensland Eye Institute, South Brisbane, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| | - Beatrix Feigl
- Medical Retina and Visual Science Laboratories, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Brisbane, QLD, 4059, Australia
- Queensland Eye Institute, South Brisbane, QLD, Australia
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
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32
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Adhikari P, Feigl B, Zele AJ. Rhodopsin and Melanopsin Contributions to the Early Redilation Phase of the Post-Illumination Pupil Response (PIPR). PLoS One 2016; 11:e0161175. [PMID: 27548480 PMCID: PMC4993463 DOI: 10.1371/journal.pone.0161175] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/01/2016] [Indexed: 12/03/2022] Open
Abstract
Melanopsin expressing intrinsically photosensitive Retinal Ganglion Cells (ipRGCs) entirely control the post-illumination pupil response (PIPR) from 6 s post-stimulus to the plateau during redilation after light offset. However, the photoreceptor contributions to the early redilation phase of the PIPR (< 6 s post-stimulus) have not been reported. Here, we evaluated the photoreceptor contributions to the early phase PIPR (0.6 s to 5.0 s) by measuring the spectral sensitivity of the criterion PIPR amplitude in response to 1 s light pulses at five narrowband stimulus wavelengths (409, 464, 508, 531 and 592 nm). The retinal irradiance producing a criterion PIPR was normalised to the peak and fitted by either a single photopigment nomogram or the combined melanopsin and rhodopsin spectral nomograms with the +L+M cone photopic luminous efficiency (Vλ) function. We show that the PIPR spectral sensitivity at times ≥ 1.7 s after light offset is best described by the melanopsin nomogram. At times < 1.7 s, the peak PIPR sensitivity shifts to longer wavelengths (range: 482 to 498 nm) and is best described by the combined photoreceptor nomogram, with major contributions from melanopsin and rhodopsin. This first report of melanopsin and rhodopsin contributions to the early phase PIPR is in line with the electrophysiological findings of ipRGC and rod signalling after the cessation of light stimuli and provides a cut-off time for isolating photoreceptor specific function in healthy and diseased eyes.
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Affiliation(s)
- Prakash Adhikari
- Visual Science and Medical Retina Laboratories, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
- School of Optometry and Vision Science, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Beatrix Feigl
- Visual Science and Medical Retina Laboratories, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
- School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
- Queensland Eye Institute, Brisbane, Queensland, Australia
| | - Andrew J. Zele
- Visual Science and Medical Retina Laboratories, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
- School of Optometry and Vision Science, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
- * E-mail:
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33
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van der Meijden WP, Van Someren JL, Te Lindert BHW, Bruijel J, van Oosterhout F, Coppens JE, Kalsbeek A, Cajochen C, Bourgin P, Van Someren EJW. Individual Differences in Sleep Timing Relate to Melanopsin-Based Phototransduction in Healthy Adolescents and Young Adults. Sleep 2016; 39:1305-10. [PMID: 27091519 DOI: 10.5665/sleep.5858] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/14/2016] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Individual differences in sleep timing have been widely recognized and are of particular relevance in adolescents and young adults who often show mild to severely delayed sleep. The biological mechanisms underlying the between-subject variance remain to be determined. Recent human genetics studies showed an association between sleep timing and melanopsin gene variation, but support for functional effects on downstream pathways and behavior was not demonstrated before. We therefore investigated the association between the autonomic (i.e., pupil diameter) and behavioral (i.e., sleep timing) readouts of two different downstream brain areas, both affected by the same melanopsin-dependent retinal phototransduction: the olivary pretectal nucleus (OPN) and the suprachiasmatic nucleus (SCN). METHODS Our study population included 71 healthy individuals within an age range with known vulnerability to a delayed sleep phase (16.8-35.7 y, 37 males, 34 females). Pupillometry was performed to estimate functionality of the intrinsic melanopsin-signaling circuitry based on the OPN-mediated post-illumination pupil response (PIPR) to blue light. Sleep timing was quantified by estimating the SCN-mediated mid-sleep timing in three different ways in parallel: using a chronotype questionnaire, a sleep diary, and actigraphy. RESULTS All three measures consistently showed that those individuals with a later mid-sleep timing had a more pronounced PIPR (0.03 < P < 0.05), indicating a stronger blue-light responsiveness of the intrinsic melanopsin-based phototransduction circuitry. CONCLUSIONS Trait-like individual differences in the melanopsin phototransduction circuitry contribute to individual differences in sleep timing. Blue light-sensitive young individuals are more prone to delayed sleep.
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Affiliation(s)
- Wisse P van der Meijden
- Netherlands Institute for Neuroscience, Department of Sleep and Cognition, Amsterdam, The Netherlands.,Sleep Disorders Center, CHU and FMTS, CNRS-UPR 3212, Institute of Cellular and Integrative Neurosciences, University of Strasbourg, Strasbourg, France.,Center for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Jamie L Van Someren
- Netherlands Institute for Neuroscience, Department of Sleep and Cognition, Amsterdam, The Netherlands.,Barlaeus Gymnasium, Amsterdam, The Netherlands
| | - Bart H W Te Lindert
- Netherlands Institute for Neuroscience, Department of Sleep and Cognition, Amsterdam, The Netherlands
| | - Jessica Bruijel
- Netherlands Institute for Neuroscience, Department of Sleep and Cognition, Amsterdam, The Netherlands
| | - Floor van Oosterhout
- Netherlands Institute for Neuroscience, Department of Sleep and Cognition, Amsterdam, The Netherlands.,Amsterdam Sleep Center, MC Slotervaart, Amsterdam, The Netherlands
| | - Joris E Coppens
- Netherlands Institute for Neuroscience, Department of Sleep and Cognition, Amsterdam, The Netherlands
| | - Andries Kalsbeek
- Netherlands Institute for Neuroscience, Dept. Hypothalamic Integration Mechanisms, Amsterdam, The Netherlands.,Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Christian Cajochen
- Center for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Patrice Bourgin
- Sleep Disorders Center, CHU and FMTS, CNRS-UPR 3212, Institute of Cellular and Integrative Neurosciences, University of Strasbourg, Strasbourg, France
| | - Eus J W Van Someren
- Netherlands Institute for Neuroscience, Department of Sleep and Cognition, Amsterdam, The Netherlands.,Departments of Integrative Neurophysiology and Medical Psychology, Center for Neurogenomics and Cognitive Research (CNCR), Neuroscience Campus Amsterdam, VU University and Medical Center, Amsterdam, the Netherlands
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