TMA International — Class IV High Power Lasers — Laser Technology Overview
High Power Laser Therapy (HPLT) Revolutionizing The Non-Surgical Treatment of Neuro-musculoskeletal Pain and Wound HealingPHYSICIAN SEMINAR
HPLT – High Power Laser Therapy• HPLT was first introduced to the medical field in 2002 by then CEO of Avicenna Laser Technology, Inc, Bruce R. Coren, DVM, MS. The company invented and developed the first High Power Therapeutic Laser to receive FDA clearance in 2003.• TMA – Technological Medical Advancements is a spin off from Avicenna and was founded not only to advance the field of Laser Medicine but also to bring other innovative medical devices to the market place.• TMA offers the most powerful laser platforms in the world and thus allowing physicians of all medical disciplines the capability to heal injuries previously refractive to traditional medical care.
The Design of the TMA Laser• The TMA laser was designed from the ground up to be a therapeutic medical laser.• It was developed using research by our own biomedical engineers and clinicians as well as collaboration with a major medical school and university optics department.• We investigated important criteria such as wavelength, power and power density, optics and beam delivery in order to afford the greatest penetration and delivery of a therapeutic dose capable of stimulating tissue healing in deep seated pathologies.
LASER— an acronym for: Light Amplification by Stimulated Emission of Radiation
Lasers in MedicineSurgical Lasers:• Are used to cut, coagulate,and evaporate tissues.• This type of laser replacesthe scalpel of the surgeon.
Lasers in MedicineTherapeutic Lasers:• Are used for the stimulation of cellfunction.• The biological effect isphotochemical not thermal, as is thecase with surgical lasers.
Who is using TMA (HPLT)• Pain Management Specialists, Orthopedists,• Neurologists, Interventional Pain Management• Doctors, Physical Medicine and Rehab,• Physiatrists and Family Practice Physicians• Chiropractors and Physical Therapists• Podiatrists, Naturopaths and DOM’s• MLB, NBA, NFL and College Sports Teams• Medical Colleges• The United States Military and VA Hospitals• Veterinarians –Equine and Small Animal
Comparison of “Class IV” Surgical and Therapeutic Lasers• Surgical lasers collimate high amounts of laser energyinto a beam of high intensity resulting in tissuedestruction• High Power Therapeutic Lasers take a high amount oflaser energy but instead of beam collimation you getbeam divergence resulting in tissue stimulation
Properties of Infrared Laser Light• Laser Energy is just another form of energy on the electromagnetic spectrum. Depth of penetration is determined by wavelength and energy density. Just like with x-rays when deeper penetration is required, more energy must be delivered to reach the target tissues. In general the higher the wavelength the greater the depth of penetration. The TMA high power laser delivers infrared light at an optimal wavelength of 980nm.
Biological Effects of Therapeutic Lasers• Laser therapy aims to bio-stimulate injured anddysfunctional tissues.• Clinical studies and trials of Class III & IV lasertechnology indicate the following beneficial effectsof light therapy on tissues and cells.
Cellular Effects of Laser Energy• Chromophores are components ofmolecules which absorb light.• The stimulation of chromophoreson mitochondrial membranes incitesthe production of ATP.• Leading to a biological cascade of events.
Cellular Effects of Laser Therapy Continued:•Increased Growth factor responsewithin cells and tissue as a result ofincreased ATP and protein synthesis.•Accelerated cell reproduction andgrowth leading to faster repair ofdamaged tissues.•Increased metabolic activity- via increase in enzymeoutputs, oxygen and nutrient availability.
Wound Healing Effects of Laser Therapy• Faster Wound Healing- Laser significantly increases fibroblastand collagen production which are essential for tissue repair.•Improved Vascular Activity- Increased capillary productionleads to faster wound closure.• Greater Tensile Strength – Surgical repaired wounds healwith greater tensile strength, including skin, tendon, ligamentand fascia.•Scar Tissue Reduction- Wounds heal with less scar tissueformation.
Wound HealingPRE-LASER AND AFTER TWO AFTER TWO 5 MINUTE LASER THERAPYMONTHS OF TRADITIONAL THERAPY TREATMENTS AT 7.5 WATTS
Anti-inflammatory Effects of Laser Therapy: Anti-inflammatory via an anti-edemic effect as it causes vasodilatation and activation of the lymphatic drainage system.
Analgesic Effects of Laser Therapy:•Via increased endorphin release.•Anti-inflammatory via less edema as aresult of lymphatic system activation andless swelling.•Via Suppression of nociceptors.
Immune System Effects of Laser Therapy• Strengthening the immune system response via increasing levels of lymphocyte activity and through a newly researched mechanism termed photo-modulation of blood.• Documented evidence of Tumor size reduction in animals. Mechanism of action unknown.
Miscellaneous Effects of Laser Therapy• Improved Nerve Function via increased nerve cellreconnections• Trigger Point Resolution• Acupuncture Point Stimulation•Dermatology, Respiratory, GI and OB-GYN cases also beingtreated by numerous Avicenna clinicians in the field.(Corporately we only make claims pertaining to treatment ofneuromusculoskeletal pain and would healing.)
Summary of LT Biological Effects •Accelerated Tissue Repair and Cell Growth •Faster wound Healing •Reduced Fibrous (Scar) Tissue Formation •Anti-Inflammation •Anti-Pain (Analgesia) •Improved Vascular Activity •Increased Metabolic Activity •Improved Nerve Function •Immunoregulation •Trigger Point Resolution and Acupuncture Pt. Stimulation
Laser SafetySafety protocols mustensure sufficientprecautions are taken toprotect the health andsafety of employeesand patients. Use of safetygoggles to prevent retinalexposure is paramount.
All Lasers are Not Created Equally• Although all therapeutic lasers bio-stimulate tissue, that is where the similarities end.• Laser Therapy is all about Physics!
Therapeutic Laser Classifications• Therapy lasers are classified based on their power output•Class IIIa = lasers 1 to 5mw of power (laser pointers)• Class IIIb = lasers 6 to 500mw in power (typical cold laser you readabout)• Class IV = lasers above 500mw of power• TMA Laser Platforms = 1,000 – 60,000 mw maximum continuouswave output
Energy Medicine and Therapeutic Laser Physics• The therapeutic dosage of laser energy is measured in Joules• Dosage is a function of the lasers power output• For every one watt of continuous laser power output, one joule of laser energy is delivered per second of time• For a pulsed laser the energy delivery depends on the duty cycle. Duty cycle tells us what percentage of time the laser is on or actively firing. If the duty cycle is 50% then the laser at 1 watt only delivers 0.5 Joules / Second. For any given time period a continuous wave laser delivers twice as much energy than a pulsed laser with a 50% duty cycle
How Laser Light Penetrates Tissue• As light energy hits the surface of the skin and subsequent deeper layers, some of it is scattered and some of it is absorbed and some is reflected• At each tissue interface less energy is available to pass further through to the next layer because of the effects of absorption, reflectance and transmission
Absorption Curves980 nm: Low melanin, low water, low hemoglobin absorption thus an optimalwavelength to choose when designing a therapy laser for stimulating tissue at greaterdepths of penetration.
Physiological Effects Light – Tissue Interactions • 65% of laser energy is absorbed in the skin and subcutaneous tissue layers with the following having a high affinity for absorption: • Hemoglobin in blood • Melanin in skin, hair, moles, etc. • Water (present in all biological tissue) • In order to overcome those factors one most start with large quantities of energy on the skin
Therapeutic Laser Penetration• Prime Determinants of Laser Penetration andConcomitant Tissue Stimulation are: • Power – measured in Watts or milliwatts • Wavelength – measured in nanometers • Power Density – measured in mw / cm2 • Frequency – continuous wave versus pulsing
Importance of Power Density• Approximately 65% of the energy delivered is lost in the epidermis• If you don’t start with enough energy on the skin, there will not be enough to stimulate cell healing in deeper tissues• If you do not have sustained power density over a long enough period of time treatments may be ineffective
Multiple Wavelength Lasers vs. TMA Single Wavelength Continuous or Pulsed Wave Laser• A laser with two or more wavelengths only has the ability to penetrate as deep as each individual wavelengths allows• Most class iv lasers that pulse or have a high duty cycle coupled with multiple wavelengths of energy emission will not penetrate as deep as CW lasers of a single wavelength or lasers that can pulse but still maintain a high average power output• Continuous wave lasers = 100% duty cycle, laser is always delivering energy which is needed to overcome absorption in the superficial layers• Newer generation of TMA lasers can now pulse yet still maintain a high average power output allowing for greater tissue saturation with less thermal effects
In Laser Medicine 1 + 1 Does not Equal 2• Dual wavelength lasers onlypenetrate as deep as each wavelengthindividually. The penetration is notadditive, even our competitorsagree, and there is no real benefit to thisscenario. There are no scientific studies tosupport the benefits of a dual wavelength laser.• For purposes of penetration it is more advantageous to have onewavelength of greater power. that stimulates cell metabolism andtissue regeneration at all tissues in its pathway• The TMA laser is also available in a 810nm wavelength
Sponge Theory• In order to get penetration you must create significant energy density toovercome absorption in the superficial layers of the skin. With low powerdensity and even with pulsed class iv lasers it is like pouring small amounts ofwater onto a large sponge (the dermis and subcutaneous tissues) andexpecting the water to leak through. In order to do so you must saturate thesuperficial layers of the sponge- with enough water-energy to soak thesponge-superficial tissue structures, so as you pour more water-energy overthe sponge it will start to penetrate or leak through. This it what is neededand why it is important to deliver a high amount of laser on the skinespecially if you want to reach deep seated pathologies.• Low power or pulsed class iv lasers just cannot provide the energy necessaryto overcome the absorptive capabilities of the superficial skin layers and thatis why they fail to deliver a positive outcome when trying to reach deepseated pathologies.
How Much is Enough • 49-73 mw/cm2 for cell stimulation1 EFFECTS OF INFRARED LASER EXPOSURE IN A CELLULAR MODEL OF WOUND HEALING Mark D. Skopin and Scott C. Molitor, Department of Bioengineering, University of Toledo, Toledo OH• This study shows an optimal wavelength (980 nm) and power density range for wound healing and tissue stimulation
Laser & Tissue Powers Tissue Layer Max Power (mw/cm2) Epidermis 206 Dermis Layer 182 Dermis Plexus Super. 135 2nd Dermis Layer 115 Dermis Plexus Prof. 93 Muscle Tissue 9.7Power Setting 5 Watts, 3.0cm spot size, 980nm(This is a snapshot in time. Calculated using computer models by U of Toledo).Translation – As laser light or energy penetrates through the body more andmore energy is absorbed so by the time you start reaching deeper structuresthere is not enough therapeutic energy to cause adequate tissue stimulationand thus the reason why low power lasers as well as pulsing lasersCannot effectively treat deep seated pathologies.
Translation of Previous Two Slides• Translation – It is important to comprehend thatas laser energy penetrates through the body, moreand more energy is absorbed at each tissueinterface, so by the time you start reaching deeperstructures there may not be enough therapeuticenergy to cause adequate tissue stimulation unlessyou start with a sufficient amount of energy on theskin. This is the reason why low power lasers as wellas pulsing lasers with low power output fail todeliver when treating deep seated pathologies.
Other Factors Affecting Lasers Penetration • Duty Cycle – 100% • Laser is firing continuously • Duty Cycle – 50% • Laser is firing 50% of the time. This will not only cut energy delivery but it will also affect ability to penetrate. • Pulsing – Lasers that pulse also do not emit continuous energy • TMA can operate at 100% continuous wave output or pulse the laser energy while still maintaining a high average power output. Maintaining a high power output is key to treating deep seated pathologies.
Class III vs. “Class IV” Laser BeamsWith a high power output the laser beam can easily penetrate deeper jointsespecially when compared to a class iii laser which at best only offersSuperficial penetration.
Laser PhysicsWith a high power output the laser beam can easily penetrate deeper joints
Why Therapeutic Lasers Fail• Under penetration - The typical low level or cold laser or weak or pulsed class iv laser does not concentrate the laser energy sufficiently to allow for adequate penetration• Under-dosage – The typical low level or cold laser or weak or pulsed class iv laser does not deliver enough energy to adequately stimulate deep seated inflammatory conditions• TMA protocols are successful because they call for delivery of significantly larger amounts of therapeutic energy than industry standard protocols.
TMA Philosophy• TMA’s goal has always been to build the most efficacious laser available to deliver the best outcomes.• Our lasers are built from the ground up and are designed to get patients who have failed traditional therapy better• Our competitors lasers are built based on economic factors• There is a hugh difference between making a patient feel better vs. actually getting them better.• There are no shortcuts to treating deep seated pathologies and one must deliver the correct dosage of laser energy in order to get the best outcomes.
“The Key to Better Outcomes”• Higher the power output of laser energy•The Greater The Penetration•The Faster the Therapeutic Outcome•The Quicker the Patient Returns to Normal•This is the main reasons we keep advancing ourtechnology and developing more powerful lasers.
Why More Power is Better• More power equates to deeper penetration, faster delivery of the proper therapeutic dosage, and ultimately better outcomes• A 30 watt laser will not only penetrate deeper, it will put more therapeutic energy to the target pathology• It will do this 3X faster than a 10 watt laser and 5X faster than a 12 watt laser with a duty cycle of 50%
Evidence Based Medicine•The effects of HPLT can easily be documented•Clinician’s can measure results using outcome assessment tools: • Pressure Algometer • Inclinometer , Goniometer • Thermal Imaging and Doppler Studies • VAS, PDQ – Pain Disability Questionnaire•These tools are vital to document outcomes which ultimatelylead to adequate reimbursement
Lasers vs. Standard Modalities Currently Used to Treat Neuromusculoskeletal Pathologies
—HPLT —A New Trend in Pain Management• Profound anti-inflammatory and analgesic effects• Pain relief typically immediate• Non-invasive and no side effects• Profound tissue regeneration of all tissue types• Overall contraindications minimal
Clinical Translation of the Previous Slide as it Pertains to the Spine • Decreased inflammation of disc, nerve roots and the cauda equine • Increase microcirculation of spinal structures • Accelerate healing of annular defects • Decreased formation of abnormal/non functional scar tissue • Decreased scar tissue and non-osseous hypertrophic changes • Reduce pain associated with prolotherapy injection • Decrease or even eliminate need for epidurals
Clinical Translation of the Previous Slide as it Pertains to the Lower Extremities• Decreased inflammation of nerve tissue• Accelerated Reinervation of nerve fibers• Increase blood flow and microcirculation of tissue structures• Accelerate healing of open wounds• Decreased formation of abnormal/non-functional scar tissue
Clinical Translation as it Pertains tothe Lower Extremities Continued…• Increase synovial fluid and cartilage production• Increase collagen and fibroblast production• Increase osteoblastic activity and fracture healing• Decreased bony edema – osteochondral bone bruise• Decrease in pain associated with epidural, prolotherapy or other invasive injections
Applications of Laser Therapy•Disc Pathologies, Spinal Stenosis, Radicular Pain,spondylolesthesis, and sacroiliac dysfunction•Peripheral Neuropathy and other Nerve Entrapment Syndromes•Failed surgical back syndrome• Accelerated Post Surgical, Soft and hard Tissue healing•Arthritis (Degenerative Joint Disease)•Foot and Ankle Pain•Muscle, Ligament and Tendon Injuries•Ulcerations and Open Wounds
Introducing the 2012 TMA Suite of Laser Platforms• A technological advancement in energy output and delivery• The TMA suite of laser platforms offer the world’s most powerful and advanced therapeutic laser system ranging in power output from 10 – 60 watts or 10,000mw -60,000mw.• As a physician based company we have treated or will know how to treat any condition you are confronted with, the ultimate result being a better outcome• With the superior training and clinical support we provide physicians, the above goal will readily be achieved
Introducing the 2012 TMA Diowave Laser Platforms10 -15 Watt Laser Platform 20 - 30 and 60 Watt Laser Platform
Changing the WayPhysician’s Manage Pain www.tmainternational.com 1-(866)-862-6606