Q&A: Figueiro says clinical resources will expand studies at Light and Health Research Center

As LEDs Magazine has covered the growing knowledge base of light and health research, we have witnessed a transition from academic study to foundational data applied in developing methods for evaluating non-visual impacts of light, including the measurement of circadian stimulus. Readers may find a four-part series on the Circadian Stimulus (CS) metric and its application to lighting practice helpful (linked below). A leading research team in the field of lighting for health and wellbeing has also experienced a physical transition from its establishment in the Lighting Research Center (LRC) at Rensselaer Polytechnic Institute (RPI; Troy, NY) to forming the new Light and Health Research Center (LHRC) in Mount Sinai’s Icahn School of Medicine’s Department of Population Health Science and Policy.

Some readers may be familiar with published work and presentations from former LRC directors Mariana Figueiro, PhD, and Mark Rea, PhD, in both scientific and industry journals and magazines. Figueiro has been long entrenched in the scientific study of the links between light, sleep, and health, introducing new findings on the impact of light on circadian-effected conditions and diseases such as Alzheimer’s disease and related dementias. She has also advocated for introducing and improving metrics for defining the circadian impact of light, and along with colleagues has developed practical guidance for bringing circadian-effective light into a variety of environments. Along with research program coordinator Jennifer Brons, Figueiro recently spoke with LEDs Magazine about the new ventures into a healthcare organization, and how the center’s research will continue to expand with the clinical resources and collaboration enabled through the Mount Sinai system.

LEDs Magazine: How are you settling into the Mount Sinai organization?

Mariana Figueiro: Mount Sinai is a huge organization, so we’re all re-adapting to working differently than we had worked before. In terms of the staff, though, it’s been great because everybody came, so it’s almost a whole team that just moved [from the LRC]. We still count on each other; we’re still doing very similar things, so I guess we are just adapting to the culture of the place here — sometimes it’s more bureaucratic. It’s a much bigger hill to move because it’s a much, much larger organization, so that’s the only sort of adaptation that we need to get used to.

LEDs: What’s a big difference between the academic structure that you were in before, versus being in more of a clinical environment in an organization?

MF: The Mount Sinai system has actually two systems: It has the hospital system and it has the Icahn School of Medicine. We are actually part of the School of Medicine. We have faculty appointments there. Everybody at the center is part of the School of Medicine, but we have a very close relationship with the Mount Sinai Hospital. So it gives us a lot of access to the clinical population. And that has been absolutely wonderful because we’re meeting all the different physicians, all the different clinics, all the different practices of medicine that we simply didn’t have access to before. And I am surprised actually with the positive response that we have had here.

You would think that talking about lighting and non-pharmacological interventions, people are going to look at you weird, you know — like “You’re not serious!” — and so on. And it’s been quite the opposite. People are fascinated with just having a way to deliver better quality of life for the patients without giving them a medication. And I think they’re all curious. They want to understand, or they want to be able to learn from what we’re doing, so we have had a wealth of opportunities. And then in the hospital side, it’s interesting — we developed a relationship with the higher-up administration in the hospital, they’re actually starting to listen to us about lighting and starting to ask us questions when they have to do a remodeling in the hospital, and so on. We’re going to do a demonstration of the horizontal/vertical lights there. […] It’s really a pleasure to work with the people here.

LEDs: That’s great! I’m glad to hear things are going well. It’s also nice when you hear that there is a functional, logistical aspect to [the work] that carries over, because obviously Mount Sinai has a huge number of facilities, right? So this is information they can apply in a real-world environment and information that can help patients as well as staff.

MF: Correct, and it’s interesting because we now have the opportunity of the clinical side on the research and through the school, and then we have the opportunity on the clinical side on the very practical patient-care side, which is trying to change how people are doing the lighting at Mount Sinai at the hospital, which is a huge sort of enterprise.

I used the word that we’re sort of emissaries of good lighting. People are now saying, “Oh yeah, we’ve got to look at the lighting, we’ve got to think about the lighting.” Just the fact that we’re doing the remodeling at our facilities and working with the project managers that work with different projects within the hospital… They’re interested in learning about it, so we may by default make a change in the hospital lighting per se. That is not even related to the research side. We may just do it by accident — just because people are interested in what we’ve been doing.

LEDs: That’s phenomenal. It’s nice to have a response like that, rather than “Please won’t you stick to ‘XYZ’ and let us worry about the light placement and wiring, and how many lights we need and what kind of controls are happening,” and all that. It could feel a little bit territorial, I imagine.

MF: Yes, but I haven’t felt that. I think it’s more an enigma for them. They’ve been doing it the same way, all over again, and then somebody comes in and says, “Well, you know, we’ve got a better way to do it” or “We’ve got a way that you can actually help patients.” And they think, “Let’s listen to that. Let’s see what it is about.” Obviously, you still have the barriers of costs, of complications, and delivery times, because everybody is having that [supply] issue in lighting now. It’s a little bit of a barrier for us to implement more, since it’s slow.

We’ve been here only for a year. The whole team completed the full transition in June, so it’s really been about four months that we’ve been fully transitioned [to the organization], so I don’t expect to change the whole lighting in the hospital in less than a year. Let’s see what happens in five years.

Prioritizing studies for specific conditions

LEDs: Talking about that, what topics or studies have been prioritized in the lighting for health field through Mount Sinai and Icahn School of Medicine?

MF: Obviously, we continue the work that we carried from RPI, which is all the grants that we have for Alzheimer’s disease. So we’ve been continuing to do that. We’re expanding to mild cognitive impairments. In addition to working in nursing homes and assisted living facilities, we’re also expanding to delivering the lights in people’s homes and we’re now extending to look more at sleep — more like, EEG ambulatory, EEG sleep — we’re also looking at cognition.

We are expanding the Alzheimer’s part to look at the combination of lighting for circadian entrainment with the 40-Hz flicker — you know, it’s been shown that if you flicker the light at 40 Hz, you have what they call “gamma entrainment” in the brain. The gamma entrainment is associated with increased cognition and even a reduction in beta amyloid and Alzheimer’s plaque. So what we’re doing is instead of looking at just the 40 Hz, we’re actually looking at the combination: You improve sleep by improving circadian entrainment and you improve gamma powered by the 40 Hz. These two things are additive and then combined can have actually a better or more potent stimulation for the brain. That’s one area that we’re spending a little bit more in the AD, [and] where we’re getting to more different studies.

We just started a pilot study with Parkinson’s disease. The idea is to help sleep as well as reduce apathy and fatigue and depression in the Parkinson’s population. The physicians are absolutely thrilled to be working with us on this project, because they see the potential for helping the patients. And a lot of these patients are intelligent people that are very highly functional, living at home, and they have Parkinson’s, so anything that we can do to actually help them continue to have their normal lives with the disease — that’s one of the goals of the project.

LEDs: Does this mean that you might see in the future even more neurological type studies that have lighting applied to them — [multiple sclerosis], for example, and others?

MF: Yes, that’s absolutely right. There’s MS, then you have traumatic brain injury. We’re actually writing a proposal right now. We added to our staff and, circling back to your first question, we hired an assistant professor here in New York City and her background is on EEG [electroencephalography] and neuroscience, so she’s really interested in looking at the brain and brain changes. So we’re writing up a proposal to extend the work to traumatic brain injury, for example. We’re very much open to looking at other neurological diseases, because a root symptom of a lot of these diseases is sleep disruption.

We know that with lighting you can actually improve that; it really is a tool that can be applied to all different populations. So we’re extremely excited at adding more on the neurological side and understanding a little bit more on that. There has been some work looking at migraine and pain and the use of light for that. There really isn’t a lot of…how do I say it in a in a nice way — there hasn’t been a lot of [academic] rigor on the specification of the stimulus. It’s just that sometimes the researchers don’t understand light. We look at what has been published, then we’re like, “That could be improved if you understand how to specify this stimulus.” So we’re very interested in starting to do work in this area so that it can progress.

If [light] is really something that can be used [in treatment] — think about the opioid crisis and trying to find non-pharmacological ways to reduce the use of opioids for pain, for example. If we are able to show that [correlation]… Some work has been done that hints to the idea that light [can treat migraine pain], and more specifically they’re using green light. The question is why green light and not some other kind of light, and try to understand. Is it really green? Can it be something else? So looking at more of the spectral sensitivity and the specification of the stimulus and so on. I guess what we’re trying to do is really use our strength, which is understand the stimulus and then try to help with increasing the rigor and a lot of the work that has been done in these areas.

Ensuring quality data and sound analysis for lighting applications

LEDs: It sounds like there’s a lot of potential, but I think that’s the perfect word, “rigor,” because it’s very easy to do a short-term study and use the right words, publish it, and market it to a direct-to-consumer type of group, for example, and then have those people pin all of their hopes on a product that’s been commercialized for a specified purpose or condition, but they don’t really know what is behind this information. Why is it doing what it does — is it actually doing anything at all?

MF: That’s exactly right, and you hear sometimes people saying, “Wow, tunable lighting does that. Tunable lighting is better than static light.” Well, why? What is it that makes it better or worse? I think that we continue to be, you know, Mark [Rea] always referred to us as the ones with the black and white stripes, the referees, trying to apply some rigor and making sure that if we’re going to talk about lighting, we’ve really got to talk about it right. And not just say because it’s tunable or blue enriched or this and that, it’s better or worse. If you don’t know what blue enriched is, how can you say it’s better or worse? What is blue enriched? I mean, we don’t even have a definition for that.

LEDs: Sure, in terms of what are your metrics and what’s your standard for delivering that, and how often and how much. Does it need to be a brightness level, specific to the day, time of year, etc.?

MF: Correct. One of the things that [Jennifer Brons] has been helping with in projects is developing the way of delivering the light. You don’t get that much light at the eye very easily. You really need to be creative to be able to get that, so I don’t know, Jen, if you want to talk about your latest creation.

Jennifer Brons: Well, I’ve been doing field studies in lighting research for…now it’s over 20 years, so I really like taking what we’ve been doing in the lab into the field with real people. Maybe it’s people suffering from neurological conditions, but it may just be regular everyday people that want to help their body be circadian entrained, to have dark nights and light days to help them sleep better. So I’ve been taking products off the shelf and trying to kind of kludge them together with socket adapters, a whole bunch of light bulbs sticking out of it, and a big lampshade. And oh, it’s really heavy. I have to put ankle weights for fitness on the base so it doesn’t fall over and crush people! So yes, I’d like to see more products available that people could just get out their credit card and order a system that would have the ability to give you those bright days and dark nights that would help you to keep your body entrained with the circadian cycle.

So yes, there’s a new program we’re hoping to put together to help manufacturers develop products, create attractive products, and not just these ridiculous things that I’m kind of kludging together. It’s really funny, you know.

LEDs: Prototypes are important place to start, though!

JB: I’m actually using photography equipment right now — a big lantern, like you do in a studio to really shine a lot of light at people’s faces — for our research projects.

MF: I think it’s important because it has to be comfortable. You can’t just do a light box — sure, a light box will work. Everybody knows light boxes have been working for years with seasonal depression. But do people actually sit in front of a light box or do they just avoid it because it’s too bright and too uncomfortable? So we’ve been trying to flood the environment with a very comfortable light. But it’s a challenge because there aren’t any products out there. It’s a challenge because you do need more light than what you normally have at home. By just adding a one little table lamp here, it’s not going to cut it. It’s just not going to do the job.

Another project we’re about to start, we’re about to get another large NIH grant is on cancer — the myeloma transplant patients. So that’s in fact changing the lighting inside Mount Sinai Hospital and giving the light to myeloma transplant patients that stay in the hospital for two to three weeks. That’s almost like our opportunity to really demonstrate in the hospital facility how positive that can be to patients… I do want to increase and I do want to extend the work in this cancer area because I think it’s extremely important — the neurological, Alzheimer’s disease, and the cancer.

Education and collaboration between scientists and manufacturers

LEDs: You might not be aware of this, but in a recent interview that we conducted, you got a professional “shout out” with regard to being at the helm of studies that commercial organizations are very interested in, and that information bears on how they move forward with quality lighting that positively impacts human health and wellbeing. So how do you manage commercial partnerships if they’re still part of the research process now?

MF: Well, we continue to do what we always did. You have to do the research and you’re going to publish the research and journals that are going to be peer reviewed. I’m very honest when we work with manufacturers. I say the manufacturers are an arm that can help, to Jen’s point, we want to be able to have products [available on the market] that people can get their credit card out and buy them. That means that we need to work with the manufacturers to transfer that knowledge to the manufacturers so they can do that. And obviously the manufacturers are going to, in a way, use the partnership with us by saying, “We work with Mount Sinai.” Everybody does their part. What I tell people is I’m not endorsing any products, and we’re going to continue not to endorse any products. And we’re going to give the results of the study the way we found it, whether it’s positive or negative. […] So we need to be able to let the manufacturers participate in the process, but we keep our arm’s length and will continue to do that. […]

I do want to say, though, that we continue to do what we did before, so we are expanding the work on UV and disinfection. We continue to do the work with plants, UV and plants. […] You know, John Bullough came and continued to do the work on transportation and safety. In fact, we’re just about to get awarded a proposal looking at emergency vehicle lighting. Our umbrella is health and safety, and obviously the hospital, the human side, Mount Sinai is a large part of it, but we’re also doing all the other parts associated with health and safety that we had done before.

It was amazing, for example, with John, he has a transportation lighting alliance. They all came with us; they did not care that it was Mount Sinai because they realize we’re going to continue to do the work, and the same thing with the lighting energy alliance. Jen is the liaison and they came with us and they continue. So energy sustainability continues to be a big part of what we do. If you think about it, healthcare is a big chunk of energy and sustainability. So it’s actually to their benefit to be associated with it.

We’re talking about starting an educational program, maybe even a masters. Or we’re going to start with being a track within the existing programs at Mount Sinai, and then if we get a lot of popularity, we might even have our own program. So we’re starting to talk about that.

‘Extra credit’ resources

Circadian principles require a new light language

Industry must move beyond CCT to articulate circadian metrics

Subadditivity begins to explain the mysteries of the circadian system’s response to light

Creating the circadian lighting toolbox — Bringing the language into practice

Get to know our experts

MARIANA FIGUEIRO, PhD, is director of the Light and Health Research Center (LHRC) and a professor in the department of Population Health Science and Policy at Mount Sinai’s Icahn School of Medicine. Figueiro holds a bachelor’s in architectural engineering from the Federal University of Minas Gerais, Brazil, and a master’s in lighting and a doctorate in multidisciplinary science from Rensselaer Polytechnic Institute (RPI). She has authored more than 70 articles in the field of lighting and human health, with a particular focus on circadian photobiology and older adult populations. Figueiro has been a frequent presenter at industry and academic events, including LEDs Magazine’s Lighting for Health and Wellbeing conference.

JENNIFER BRONS, MS, LC, Educator IALD, is research program coordinator at the LHRC. Brons received a BA in architecture from the University of California – Berkeley and an MS in lighting from RPI. Since 1997, her work has focused on lighting design applications and human factor studies for new lighting technologies. Over her more than 20-year career, Brons has developed lighting designs and specifications for a variety of commercial and residential clients. After practicing lighting design on sabbatical in London, she taught lighting design as part of the MS in Lighting degree program at RPI. In addition to her design and research activities, she develops educational material about the more effective use of light.

CARRIE MEADOWS is associate editor of LEDs Magazine, with 20 years’ experience in business-to-business publishing across technology markets including solid-state technology manufacturing, fiberoptic communications, machine vision, lasers and photonics, and LEDs and lighting.

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