11/25/2014 Patricia Antero, DPM
Avoid Costly Mistakes When Buying a Therapy Laser
Over the last few years, laser therapy has been
changing the way medical practices all over the
world are helping their clients manage pain and
recover faster from injury, disease and surgery.
Every day, I talk with colleagues who are confused
about what is important to consider in selecting
and using a therapy laser in their practice. They
hear many conflicting opinions regarding lasers
and don’t know who or what to believe.
I have written this article about 5 costly
mistakes to avoid that can help you make the right
decision before choosing a laser. As a clinician,
I believe that the laser you choose should be the
one best suited for your clinical purposes, and
not a manufacturer’s bottom line. I have been
involved in laser therapy since 2007. In 2003; the
first FDA510K clearance for a Class IV therapy
laser was issued. Prior to this, the only Class IV
lasers were surgical lasers. The original therapy
laser approved was a 7.5 Watt laser, using a
significantly higher power level in comparison to
the Class IIIa (5mW) and Class IIIb (500mW)
lasers. Since then, thousands of Class IV therapy
lasers have been sold at these higher power
levels, showing greatly improved and more
consistent therapeutic outcomes.
Buy A True Laser, And Not An LED Or Light Therapy
Device
There are many different configurations of light
therapy products in the market, some offering
laser output only, some offering only LEDs, and
other devices combining both lasers and LEDs.
These are sometimes deceptively called “laser”
with no reference made to other emitter types. It
is important to know that LED devices are not
lasers. Often the buyer is unaware of the
distinction, thinking they have bought a true
laser device. While LED light therapy does have
some beneficial effect, it is limited to
superficial tissue treatment only. A number of
studies have been completed that compared the
effectiveness of laser light to LED light and the
majority have found laser light to be far more
effective, particularly in treating tissue of any
significant depth.
Buy a Laser With Higher Power
Although all lasers biologically stimulate cell
metabolism via a similar mechanism, that is where
the similarities end. The bottom line when it
comes to laser therapy it’s all about physics. In
order to get penetration you need power. An
analogy can be made with x-rays. X-ray penetration
is governed by the kVp setting. In laser therapy,
penetration is governed by the wavelength which is
measured in nanometers (nm) and even more
importantly by the power output of the laser. Both
kVp and wavelength are affected by tissue density.
Every doctor knows that in order to get deeper
penetration with x-rays you need to increase the
power output and time of exposure.
Just like x-rays, laser energy is another form of
energy on the electromagnetic spectrum and the key
to greater laser energy delivery and penetration
is the same principle and is based on the power
output of the laser and the time of laser
exposure. Without sufficient power you will not
penetrate and deliver the necessary therapeutic
dosage. A laser’s power is measured at the source
of the beam in Watts (W). The higher the power,
the lower the treatment time.
Dosage is the single most important parameter for
a successful outcome in laser therapy. Too little
energy produces no effect. The primary factors in
lasers that determine dosage is power and time:
DOSAGE = Power x Time. Power is the amount of
energy measured at the source of the beam and
dosage is the amount of energy delivered to the
skin and target tissue. Dosage may also be
referred to as energy density or fluence. Its unit
of measure is the Joule. You cannot make up for
insufficient power by increasing treatment time.
Buy a Laser with an Optimal Wavelength
Whenever light hits tissue, it can be transmitted,
scattered, reflected, or absorbed, depending on
the type of tissue and the wavelength (color) of
the light. However, light absorption must take
place for it to have any biologic effect, and a
given wavelength of light may be strongly absorbed
by one type of tissue, and be transmitted or
scattered by another. Infrared light is absorbed
primarily by water, while visible and ultraviolet
light are absorbed mainly by hemoglobin and
melanin, respectively.
As the wavelength decreases toward the blue-
violet, and ultraviolet, (shorter wavelengths)
scatter, which limits the depth that light may
penetrate into tissue, becomes more significant.
When light is absorbed, it delivers energy to
tissue, and the tissue’s reaction depends on the
intensity and exposure time of the light. Each
type of tissue has its specific absorption
characteristics depending on its specific
components (i.e., skin is composed of cells, hair
follicles, pigment, blood vessels, sweat glands,
etc.) In the Infrared (IR) spectrum, the longer
wavelengths penetrate deeper and a greater
percentage of the laser light will be transmitted
in a forward direction. This means less scatter
and better clinical results.
Some lasers use a single wavelength, while other
use two or more wavelengths combined, with the
claim that multiple wavelengths are clinically
more effective. However, dual or multiple
wavelength lasers can only penetrate as deep the
individual wavelength that penetrates the most.
This means that a 10 or 15 watt dual wavelength
laser will need to cut the penetration ability in
half.
Our experience over the last ten years has shown
that a single wavelength and at the level of 980nm
to be the most effective for the majority of skin
types, skin colors and conditions. This wavelength
lies at a peak in the light-water absorption
curve, as water, not hemoglobin is a strong
absorber, which explains the deep penetration
ability at this wavelength.
Some laser companies also claim deeper penetration
due to its “Super Pulse” emission, often stated at
25,000mW and higher. Although the stated peak
power is very high, the average output of super-
pulsed lasers is comparatively low. Despite these
claims there have been no studies undertaken to
compare or confirm the efficacy of super pulsed
lasers for bio-stimulation.
The bottom line when it comes to clinically
effective tissue penetration and concomitant
therapeutic stimulation, an important factor to
look for in a laser is one that emits in a single
wavelength with optimal penetration capabilities
for the diverse clients you will treat.
Buy a Laser with Training from Clinicians
Often after a sales rep gets a laser purchase
their job is done, as their only priority is
selling you a laser. Training usually involves
showing you how to turn on the equipment and
wishing you good luck.
Doctors are left to follow pre-programmed settings
with a common misunderstanding that a “point and
shoot” method of treatment is adequate. The
success rate in laser therapy is directly related
to the clinician’s ability to diagnose the true
cause of a client’s problem. Pointing laser light
at a painful area is not enough to get the
consistent results that properly trained
clinicians can achieve. It is important to get
your training from qualified clinicians and learn
treatment techniques and what type of conditions
they have had success treating utilizing laser
therapy.
Buy a Laser Based on Results and Not Price.
Don’t make decisions on price alone. Don’t buy a
laser, just to have a laser. When it comes to
therapy lasers, you get what you pay for. Are you
looking for the best laser to help your clients or
the cheapest one? Who cares if the laser has a
cheap price if it does not have the technical
capability to reach target tissues and treat
conditions properly? Can it do what it’s supposed
to do? Remember, the most expensive laser you
can buy is the one that fails to deliver results.
In summary, I wish to stress again that delivering
an effective dose to the target tissue is the key
to a successful outcome. Whether you are looking
at buying a laser and adding it as a service, or
already have a therapy laser and want to upgrade
and grow your practice with additional lasers, the
correct laser can be a vital tool for your
practice not only clinically but financially (and
even highly profitable). After years of
experience, I continue to be amazed at the results
from Class IV laser therapy. Results truly speak
for themselves!
Patricia Antero, DPM, Tuscaloosa, AL
