Visual Impairment Clinical Trial
Official title:
The Neurobiology of Seasonal Affective Disorder: Exploring the High Prevalence in Severe Visual Impairment
As a subtype of major depressive disorder, seasonal affective disorder (SAD) or winter
depression causes severe reductions in both quality of life and productivity and results in
high morbidity and frequent sick leave (1). SAD is a prevalent disorder with rates as high as
3-5% in central European countries and 8-10% in Scandinavian countries. In our recent
screening survey among persons with severe visual impairment or blindness (visual acuity <
6/60), we found a strikingly high prevalence of SAD of 17 % compared to 8% in the fully
sighted control group. Persons with maintained light perception had a highly increased SAD
prevalence of 18 % whereas no light perception (NLP) respondents had an SAD prevalence of 13
%. Light is unquestionably of great importance in the development and treatment of SAD. It is
suggested that a reduced retinal sensitivity to light leads to sub-threshold light input to
the brain and consequently to the development of SAD. The novel retinal non-visual
photoreceptors, the intrinsically photosensitive retinal ganglion cells (ipRGCs), are
involved in the regulation of circadian rhythm and mood and their function are in part
independent of the function of the classical rod and cone photoreceptors which form the basis
of conscious visual perception. Function of the ipRGCs can be assessed by chromatic
pupillometry where the sustained pupillary contractions following blue light stimulation
(PIPR) is the main outcome. In persons with SAD without eye disorder the function of the
ipRGCs is reduced. We here wish to investigate associations between ipRGC function and SAD
symptoms, circadian profile and treatment response to light therapy in persons with visual
impairment.
Persons with visual impairment (SAD and non-SAD) are assessed for ipRGC function with
chromatic pupillometry, for seasonal mood variation by interview and questionnaire and for
diurnal melatonin secretion by saliva analysis summer and winter. In winter SAD participants
are treated with daily morning bright light for 6 weeks. Reduction in depression scores and
tolerability is recorded.
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