BACKGROUND.Beyond image formation, the light that is detected by retinal photoreceptors influences subcortical functions, including circadian timing, sleep, and arousal. The physiology of nonimage-forming (NIF) photoresponses in humans is not well understood; therefore, the development of therapeutic interventions based on this physiology, such as bright light therapy to treat chronobiological disorders, remains challenging.
METHODS.Thirty-nine participants were exposed to 60 minutes of either continuous light (n = 8) or sequences of 2-millisecond light flashes (n = 31) with different interstimulus intervals (ISIs; ranging from 2.5 to 240 seconds). Melatonin phase shift and suppression, along with changes in alertness and sleepiness, were assessed.
RESULTS.We determined that the human circadian system integrates flash sequences in a nonlinear fashion with a linear rise to a peak response (ISI = 7.6 ± 0.53 seconds) and a power function decrease following the peak of responsivity. At peak ISI, flashes were at least 2-fold more effective in phase delaying the circadian system as compared with exposure to equiluminous continuous light 3,800 times the duration. Flashes did not change melatonin concentrations or alertness in an ISI-dependent manner.
CONCLUSION.We have demonstrated that intermittent light is more effective than continuous light at eliciting circadian changes. These findings cast light on the phenomenology of photic integration and suggest a dichotomous retinohypothalamic network leading to circadian phase shifting and other NIF photoresponses. Further clinical trials are required to judge the practicality of light flash protocols. light in a nonlinear fashion. Intermittent patterns of light tested thus far fail, however, to elicit greater changes in outcomes when compared with continuous light exposures. Shorter duration of light exposures in the order of microseconds to milliseconds have been tested in rodents (45)(46)(47). While a single 2-millisecond flash of light is insufficient to phase shift the murine circadian system, a sequence of flashes administered once per minute for 60 minutes is sufficient to evoke phase delays (48). This study by Van Den Pol and colleagues, in addition to other published studies in rodents (45)(46)(47), established that the mammalian circadian system has the capacity to respond to a sequence of very brief, millisecond flashes of light.of NIF photoreception in humans remains incompletely understood, as it has wavelength (35-39), intensity (40), duration (41), and pattern (42-44) responses that are considerably distinct from the traditional perceptual image-forming responses, and most knowledge in this field has been imputed from studies of nonhuman mammals. Understanding NIF characteristics and responses to light is crucial for the development and optimization of light therapy strategies. NIF responses to light in humans have mainly been tested using continuous or intermittent light exposures, ranging from the order of minutes up to more than 6 hours of bright light (41...