Isaac Kaplan

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 Patients with certain forms of macular degeneration can be helped with laser surgeries such as laser photocoagulation and photodynamic therapy. In a laser photocoagulation procedure (above), a laser beam is used to seal leaky blood vessels and slow abnormal vessel growth under the macula.


Over the past half century, lasers have found their way into ophthalmology, oncology, cosmetic surgery, and many areas of medicine and biomedical research. 

Lasers repair skin and eyes

The earliest medical applications for lasers were in ophthalmology and dermatology. Just a year after the invention of the laser in 1960, Leon Goldman demonstrated how a ruby laser, which emits red light, could be used to remove port wine stains, a type of birthmark, and melanomas from the skin.This application relies on the ability of lasers to operate at a specific wavelength. Lasers are now widely used in dermatology for things like tumor, tattoo, hair, and birthmark removal. 

 The use of lasers for vision correction and a wide variety of ophthalmology applications grew after Charles J. Campbell in 1961 became the first physician to use a ruby laser to treat a human patient with a detached retina.Later, ophthalmologists used argon lasers (which emit green-wavelength light) to treat detached retinas. This application uses the properties of the eye itself–specifically the lens–to focus the laser beam onto the area where the retina has become detached.


The highly-localized power from the laser causes the retina to reattach.  

 Similar experiments had been tried in the 1940s with sunlight, but doctors required the unique properties of lasers before the work was a success. Another medical approach, also with argon lasers, is used to stop internal bleeding in patients. Green light is selectively absorbed by hemoglobin, the pigment in red blood cells, in order to seal off bleeding blood vessels. This can also be used in cancer treatment to destroy blood vessels entering a tumor and deprive it of nutrients. 


 Both ophthalmology and dermatology have also benefitted recently from excimer lasers, which emit in the ultraviolet range. These lasers have become widely used to reshape corneas (LASIK) so that patients no longer need to wear glasses. They are also used in cosmetic surgery to remove spots and wrinkles from the face. 

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Profitable cosmetic surgery

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 Such technology developments are inevitably popular with commercial investors due to the huge revenue potential. The analyst firm Medtech Insight estimated in 2008 that the market for energy-based aesthetic devices would be worth more than $1 billion by 2011. Indeed, despite a decline in overall demand for medical laser systems during the global recession, laser-based cosmetic surgeries continue to be in regular demand in the United States, the dominant market for medical laser systems, according to a September 2010 Global Industries Analysts report.  

Laser imaging and diagnosis

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Lasers have a major role to play in the early detection of cancer as well as many other diseases. For example, in Tel Aviv, Katzir’s group is looking at infrared spectroscopy using IR lasers. This is interesting, according to Katzir, because cancer and healthy tissue may have different transmissions in the IR range. One promising application of the technique is to measure melanomas. With skin cancers, early detection is very important for the patients’ survival rates. Currently melanoma detection is done by eye, so relies on the skill of the physician. 

Laser-based systems are also starting to replace the x-rays traditionally used in mammography. Using x-rays poses a challenge: high intensities are needed to be able to detect cancers well, but as the intensity of the x-ray is raised, so is the risk of the x-ray itself causing cancer. The alternative being studied is to use very fast laser pulses to image breasts as well as other parts of the body such as the brain. 

OCT for eyes and beyond

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 There is much enthusiasm about the potential of optical coherence tomography (OCT) in many areas of medicine. This imaging technique can give high-resolution (on the order of microns), cross-sectional, and three-dimensional images of biological tissue in real time, using the coherence properties of laser light. OCT is already used in ophthalmology and can, for example, enable ophthalmologists to see a cross section of the cornea to diagnose retinal disease and glaucoma. It is now beginning to be used in other areas of medicine too.  

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In vivo microscopy

 Lasers also play a key role in many different types of microscopy. There have been many medical developments in this area and the aim is to be able to see what is going on inside the body without cutting the patient open. 


 One example of an emerging area in medical applications is scanning near-field optical microscopy, which can produce images with a resolution much greater than that obtained from standard optical microscopes. This technique is based on optical fibers that have been etched at their tips at a smaller scale than the wavelength of the laser. This enables sub-wavelength imaging and paves the way for imaging biological cells. 

PDT and other treatments

 Developments in optical fibers are helping extend the potential uses of medical lasers in other ways too. In addition to enabling imaging techniques within the body, these enable the energy of the laser to be transmitted to wherever it’s required. The same optical fiber used in diagnosis could also be used in treatment. Esterowitz of the NSF predicts an increasing use of fiber optics in medical applications. 


 The area of photomedicine, using light-sensitive chemicals that act with the body in particular ways, also enables lasers to be used in both diagnosis and treatment. In photodynamic therapy (PDT), for example, a laser and a photo-sensitive drug can restore vision for patients with the “wet” form of age-related macular degeneration (AMD), the leading cause of legal blindness in people over the age of 50.In oncology, some porphyrins will accumulate in cancers and fluoresce if illuminated with a particular wavelength of light to show where the cancer is. If these same compounds are then illuminated with a different wavelength they become toxic and kill the cancer cells. 


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What is PDT?

 The photosensitising drug makes cells more sensitive to light and is attracted to the cancer cells. It does not become active until it is exposed to a particular type of light, usually a high-intensity laser light of a very specific wavelength. The drug is activated when this light is directed at the area of the cancer, usually by means of a flexible optical fibre or a special lamp. The energy in the light activates the drug, which destroys the cancer cells by combining with oxygen to form a short-lasting substance that is toxic to the cells. Some healthy, normal cells in the body will also be affected by PDT, but these cells will usually heal after the treatment.The very nature of PDT means that other body tissue will remain sensitive to light for up to several weeks after treatment. Therefore it is very important for the patient to avoid direct sunlight and bright indoor light for a period afterwards; otherwise the skin gets very sensitive and may become very red an
d sore if it is exposed to light during this time.PDT has been in development since the 1960s but is not particularly widely used in the UK except in dermatology. The principle reasons for this lack of acceptance are the high cost of the drugs and laser equipment.A recent development of PDT is Intralesional PDT, or I-PDT.

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I-PDT

Intralesional-PDT (I-PDT) is a recent development from INTERmedic targeted at dermatological conditions.I-PDT is a selective, minimally-invasive treatment using a photosensitive drug which is activated by being irradiated with laser light to selectively destroy pathogenic cells while preserving the healthy ones. It is used to treat lesions internally at the desired depth and has proven clinical efficacy, with more than 7 years of study with proven results in these applications:
● Basal cell carcinoma 95%
● Keloids 90%
● Hidradenitis suppurativa 70%I-PDT is also indicated for:
● Fistulas
● Myxold cysts
● Warts
● Anal fistulas
● Other tumours (palliative) 

 

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Frontal & Diffuse delivery fibres

 For large basal cell carcinomas, fistulas and hidradenitis suppurativa.
Internal and poorly located lesions. Penetrates to the desired depth. 

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Percutaneous applicator

 For basal cell carcinomas and keloids. Well located lesions. For external lesions, the photosensitive gel penetrates to 1 cm. 

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Basel cell carcinoma on chin, complete response.

Many other laser uses in medicine

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  • Urologists can treat urethral strictures, benign warts, urinary stones, bladder obstructions, and enlarged prostates with lasers.
  • Neurosurgeons use lasers for precision cutting and endoscopic guidance into the brain and spinal cord.
  • Veterinarians make use of lasers for endoscopic procedures, photocoagulation of tumors, excision, and photodynamic therapy.
  • Dentists use lasers for drilling cavities, gum surgery, antibacterial treatments, tooth desensitization, and orofacial diagnostics.

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Laser tweezers an aid to biomedical researchers

 Optical tweezers, cell sorters, and a host of other laser-based tools are used by biomedical researchers around the world. Laser tweezers promise better and faster cancer screening and have been used to trap everything from viruses, bacteria, small metal particles, and strands of DNA. 
 Optical tweezers use laser light to hold and rotate microscopic objects, similar to the way we use metal or plastic tweezers to pick up small and delicate objects. Individual molecules can be manipulated by attaching them to a micron-sized glass or polystyrene bead. When a laser beam hits the bead, its light bends and exerts a small force on the bead, pulling it directly into the center of the beam. This creates an “optical trap” which is able to hold the small particle at its center. 

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Rehabilitation

 Lasertherapy can be used very successful in rehabilitation medicine, too. It leads to detumescence and anti-inflammatory effects after traumata, distortions or fractures and enhances healing of fractures. 
 It can be used for post-operative treatments because of the well-known positive effects on wound-healing.
Furthermore, transcranial infrared lasertherapy and additional local lasertherapy for the treatment of the spasticity are very successful options in the after-treatment of stroke. 
 Today, lasertherapy for rehabilitation is used especially in sports medicine for treatments of distortions, tendinopathies and overload damages of the skeletal muscle system. 
 Red and infrared lasers are mainly used here because of their deep penetration depths. 
 In one of the first studies, 90 % of the treated patients showed that especially acute sports traumatoligic injuries reacted very positive within the therapy.
Moreover, it could be shown that advanced arthritis still reacted with a high percentage within the therapy.  

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Dentistery

 Laser dentistry can be a precise and effective way to perform many dental procedures. The potential for it to improve dental procedures rests in the dentist's ability to control power output and the duration of exposure on the tissue (whether gum or tooth structure), allowing for treatment of a highly specific area of focus without damaging surrounding tissues. If you consider yourself somewhat of an anxious dental patient and are seeking extreme safety and comfort, you might consider looking for dentists who have incorporated laser techniques into their practices and treatments. It is estimated that 6 percent of general dentists own a laser for soft-tissue applications, with that number expected to increase over time. As the applications for dental lasers expand, greater numbers of dentists will use the technology to provide patients with precision treatment that may minimize pain and recovery time.  

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Comparison of the Q-switched alexandrite (755 nm) and Q-switched Nd:YAG (1064 nm)

 

BACKGROUND:

A variety of pigmented lesions have been shown to be effectively treated with several pigment-specific laser systems currently available. There has been recent evidence to indicate that they may also be useful in the treatment of melanocytic nevi.

OBJECTIVE:

To compare the clinical and histologic effects of the Q-switched (QS) alexandrite (755 nm) and Nd:YAG (1064 nm) lasers in the treatment of melanocytic nevi.

METHODS:

Eighteen patients received three QS alexandrite and Nd:YAG laser treatments to either half of a large nevus or to two small adjacent nevi. Tissue biopsies were obtained for histologic examination. Degree of clinical improvement was determined by comparative photographic global assessment scores. The amount of melanin present within the nevi before and after laser irradiation was measured by reflectance spectrometry.

RESULTS:

Clinical global assessment scores were significantly reduced in all QS alexandrite and QS Nd:YAG laser-treated nevi after three treatments. Melanin reflectance spectrometry scores improved after the first laser treatment only. Histologically, a significant reduction in epidermal pigmentation and melanocytes were observed following laser irradiation with either QS system.

CONCLUSION:

Both the QS alexandrite and Nd:YAG laser systems resulted in significant improvement (lightening) of treated nevi. The QS alexandrite laser produced slightly better results using the parameters outlined. 



( Washington Institute of Dermatologic Laser Surgery, Washington, DC 20037, USA. )



Source:https://www.ncbi.nlm.nih.gov/pubmed/9149789

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Efficacy of the Q-switched Neodymium: Yttrium Aluminum Garnet Laser in the Treatment of Blue-black

 

Background:

Q-switched neodymium: yttrium aluminum garnet (Nd: YAG) laser at a wavelength of 1064 nm primarily targets dermal melanin and black tattoo ink. Recent studies have shown that this laser is effective in treating black tattoos. There are few studies conducted in India for the same.

Aim:

The aim was to assess the effectiveness of Q-switched Nd: YAG laser (QSNYL) in the treatment of blue-black tattoos following 3 treatment sessions.

Materials and Methods:

This study, a prospective interventional study included a total of 12 blue-black tattoos. Following informed consent for the procedure, as well as for photographs, a questionnaire was administered, and improvement perceived by the patient was recorded. In addition, global assessment score (GAS) by a blinded physician was also recorded. Photographs were taken at baseline and at every follow-up. Each patient underwent three treatment sessions with 1064 nm QSNYL at 4–6 weekly intervals. Fluences ranged from 1.8 to 9 J/cm2. The follow-up was done monthly for 4 months from the first treatment session. The response was assessed by patient assessment (PA) and GAS by comparing photographs.

Results:

After three treatment sessions, although no patient achieved clearance, most patients showed good response with few adverse effects. An average of 64.1% (GAS) and 54.2% (PA) improvement was observed in 12 tattoos. Tattoos more than 10-year-old showed quicker clearing than those less than 10-year-old. Amateur tattoos also showed a better response in comparison to professional tattoos.

Conclusion:

Totally, 1064 nm QSNYL is safe and effective for lightening blue-black tattoos in pigmented Indian skin. All patients achieved near complete clearance following the continuation of treatment (an average of six sessions) although this was spaced at longer intervals. 

Introduction

Laser treatment in dermatology was started about 40 years ago but was limited due to the formation of scars over the treated areas. Only in the past 20 years have there been a major breakthrough in laser therapy of dermatological problems. Tattoos are exogenously placed chromophores either by a tattoo artist, cosmetologist (decorative tattoo), physician (delineating a radiation port) or a traumatic event. They are permanent because they are too big to be removed by the body. Laser treatment causes tattoo pigment particles to heat up and fragment into smaller pieces, which are removed by the body processes. Amateur tattoos are less dense and may be placed at variable depths (more superficial) and composed of carbon-based ink and usually require fewer laser sessions as compared to professional tattoos which are characterized by densely packed colored pigments at a uniform depth (usually deeper). Rapidly pulsed Q-switched lasers produce ultrashort bursts of light (pulses) useful for treating pigment-containing lesions. These pulses have a ultrashort pulse duration in the nanosecond range which matches the size of the target-melanosomes or tattoo ink particles. In addition, these ultrashort pulse duration results in a photoacoustic effect, which ruptures these pigment laden cells eliciting a “shock wave.”Recent studies have shown that 1064 nm Q-switched neodymium:yttrium aluminum garnet (Nd: YAG) laser is effective in treating blue-black tattoos and has one of the best safety profiles in darker skin types. This laser with a near infrared light is poorly absorbed by melanin, making it suitable for use in dark skin types. It is well-absorbed by dark tattoo pigments and is the wavelength of choice in the removal of black ink and tattoo removal in darker skin. This study highlights the safety and efficacy of Q-switched Nd: YAG laser (QSNYL) in the treatment of blue-black tattoos in the dark skin (Fitzpatrick skin types III-VI). 

Materials and Methods

 Twelve patients with blue-black tattoos were treated with three sessions of 1064 nm QSNYL.Males and females, 18 years and older with unwanted blue-black tattoos were included. Pregnant and lactating mothers, patients with herpes, keloidal tendencies, and melasma were excluded.After obtaining an informed written consent prior to starting the procedure and prior to taking photographs, a questionnaire was administered to each patient to be filled. At each review, the percentage of improvement perceived by the patient was recorded. This was a comparison of the baseline lesion and the lesion at the current visit. Photographs of each lesion were taken at baseline and before each treatment session using a DSLR Nikon D5100 in the same room with similar lighting conditions. The study was initiated following approval by the local Institutional Human Ethics Committee.

Procedure

Before initiating treatment, individual assessment including the patient's skin type and the nature and size of their lesions were recorded. Photographs were taken at baseline and before each treatment session. The subjects were of Fitzpatrick skin type III-VI.Tattoos were categorized as amateur or professional and also based on age (<10 years and > 10 years).Small lesions were targeted using a phototherapy stencil or were surrounded with micropore tape to protect the surrounding skin. Topical anesthesia is containing a eutectic mixture of lidocaine 25 mg and prilocaine 25 mg/g, was applied and kept under occlusion over the area to be treated, 1 h prior to treatment. Prior to the laser session, the topical anesthetic was wiped off, and ice packs were applied over the area. Cooling minimized pain and ensured optimal patient co-operation. Proper eye protection was given to the patient, as well as the treating doctor. Three sessions of 1064 nm using MedLite C6 QSNYL at 4–6 weekly intervals were administered. (Ideally tattoos would require longer intervals of 6–8 weeks).

Laser parameters

Laser parameters were selected according to the patient's Fitzpatrick skin type, type of lesion, and the site of the lesion. The wavelength used for all lesions in this study was 1064 nm as it has demonstrated a good safety profile on pigmented skin. The spot size varied depending on the size of the lesion. Initially, test fluence was tried to see the reaction of the laser on each patient. This fluence was dependent on the patient's skin type. A patient with Fitzpatrick skin type III-IV was started with a test fluence of 5 J/cm2, and a patient with skin type V-VI was started with a fluence of 3 J/cm2. If the patient tolerated the test fluence, the procedure was carried out at the same fluence level. If the patient could not tolerate the test fluence (as evidenced by pain), it was lowered to a level tolerable by the patient, and the procedure was carried out at that fluence.The laser was given in 1–2 passes for tattoos so as to achieve “frosting” (brisk whitening of the lesion). Tattoos showed frosting with fewer passes. The end point was taken when the lesion showed frosting.At subsequent treatment sessions, the fluence was increased in increments of 0.5–1 J/cm2.Each patient underwent 3 treatment sessions at 4 weeks intervals with QSNYL with the following settings:

  • 1064 nm wavelength
  • Fluences ranging from 1.8 to 9 J/cm2
  • Spot size of 3–6 mm, the majority being treated with 4 mm spot size
  • The repetition rate of 2–10 Hz.

The topical steroid was advised immediately following the procedure and for 3 consecutive days (at night) following the procedure. Sunscreens were advised to be applied throughout the entire course of treatment. All patients were followed up monthly for 4 months after the first treatment session.

Assessment

Patients’ self-assessmentThe patients were asked to give a percentage value based on their improvement from the baseline lesion.Global assessment scoreGlobal assessment scoring (GAS) was done by a blinded physician by comparing photographs of each lesion at each follow-up. A numeric score of 0–10 (0 – no improvement/10 - complete clearance) was assigned to each follow-up photograph after comparing the follow-up photograph to the baseline photograph.The results of each lesion were analyzed based on the patient's assessment (PA) and the GAS. The GASs were converted into a percentage, and the mean percentage improvement was calculated. The PA scores were similarly computed. 

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Results

Fitzpatrick skin types III-VI with blue-black tattoos were treated.

Fotona Surgical Lasers

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 Fotona is recognized as a world leader in medical laser technologies, working closely with top universities and research centers around the globe. With over 50 years of experience in laser technology, Fotona’s surgical lasers systems are leading the industry forward with new levels of excellence and unrivaled performance.The latest generation of surgical lasers offers treatments that are faster, safer and less invasive. Laser solutions are available across a wide range of surgical fields, from minimally invasive aesthetic surgical treatments (laser-assisted lipolysis and hyperhidrosis) to clinical surgical procedures such as endovenous laser ablation. 

High-Performance, Minimally Invasive Treatments

 Fotona's high-performance XP Line of surgical lasers incorporates the industry’s most effective and scientifically proven QCW Nd:YAG laser wavelength to ensure the safest, most comfortable and successful surgical treatments possible, and also includes a long-pulse Nd:YAG laser for performing transdermal aesthetic treatments.The Fotona SP Line of lasers additionally includes an Er:YAG laser (recognized as the optimal wavelength for extremely precise laser incision, with controlled thermal coagulation and bleeding effects).

Professionally designed handpieces, easy-to-select operating modes and advanced solutions for laser beam delivery further enhance the precision and performance of each Fotona laser system to ensure optimal clinical efficacy and unrivalled control during surgical treatments.

The Benefits of Fotona’s Surgical Lasers Include:

 

  • Less downtime and quicker healing
  • A haemostatic effect with simultaneous disinfection
  • Minimally invasive procedures
  • High-precision, tissue-selective treatments

The Right Laser for Your Practice

 Fotona's range of multi-application surgical laser systems allows practitioners to select a technology platform that best meets their patients' needs. 

Hyaluronic Acid (By injection)

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Uses of This Medicine

 

Hyaluronic acid injection is used to treat knee pain caused by osteoarthritis (OA) in patients who have already been treated with pain relievers (e.g., acetaminophen) and other treatments that did not work well.Hyaluronic acid is similar to a substance that occurs naturally in the joints. It works by acting like a lubricant and shock absorber in the joints and helps the joints to work properly.This medicine is to be administered only by or under the immediate supervision of your doctor.

How To Use

 

Injectable

Your doctor will tell you how many injections you will need. This medicine is injected into your knee joint.A nurse or other health provider will give you this medicine. 

Drugs and Foods to Avoid

 Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products. 

When Not To Use

 This medicine is not right for everyone. You should not receive it if you had an allergic reaction to hyaluronic acid or if you have a bleeding disorder. 

Warnings

 Tell your doctor if you are pregnant or breastfeeding, or if you have any allergies, including to birds, feathers, or eggs.Rest your knee for 48 hours after you receive an injection. Do not do strenuous, weightbearing activities, such as jogging or tennis. Avoid activities that keep you standing for longer than 1 hour. 

Possible side effects

 

Call your doctor right away if you notice any of these side effects:

Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing

If you notice these less serious side effects, talk with your doctor:

Mild increase in pain or swelling in your kneePain, redness, or swelling where the medicine is injectedIf you notice other side effects that you think are caused by this medicine, tell your doctor.Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. 

types of medical lasers

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 Laser type:


CO2 10,600 nm 


Argon 488/514 nm


Potassium-titanyl-phosphate (KTP) 532 nm 


Copper bromide/vapour 510/578 nm 


Argon-pumped tunable dye (APTD) 577/585 nm 


Krypton 568 nm


Pulsed dye laser (PDL) 585-595 nm 


QS ruby 694 nm 


QS alexandrite 755 nm 


QS neodymium (Nd):yttrium-aluminum-garnet (YAG) 1064 nm 


Erbium:YAG 2940 nm 


CO2 (pulsed) 10,600 nm

Benefit

 

  • A non-invasive optical method implemented in a portable device that provides low-cost, rapid screening for iron deficiency, which is found in particular among infants, young children, adolescents, and menstruating and pregnant women. Adverse effects of iron deficiency include anemia, impaired cognitive development, decreased immune responsiveness, and, when severe, death. Iron supplements are widely used to prevent or correct nutritional iron deficiency, but have been shown to increase the risk of severe illness and death in children when malaria is present. The World Health Organization has concluded that iron supplements should not be given without screening for iron deficiency.
  • Novel photonics-based tools to fundamentally change the clinical management of breast cancer - the most common cancer among women worldwide in high-income as well as low- and middle-income countries. Improving the selection of women entering breast cancer screening programs and adjusting the screening frequency based on a personalized risk assessment would lead to a better utilization of available resources, enable detection of predominantly early-stage breast cancer, and reduce the overall cost to health care systems.
  • In neurosurgery, fluorescence methods that permit identification during surgery of residual tumor tissue in treatment of glioblastoma multiforme, the most common form of primary brain cancer in adults. Survival after surgery and radiotherapy is linked to the completeness of tumor removal.
  • A minimally invasive laser treatment to relieve nasal airway obstruction in people with long-term allergies or other conditions. Patients who do not respond to sprays or other pharmacological treatment may require surgery, which is often accompanied by long-term bleeding and further discomfort. Endonasal laser treatments cause limited side effects with little or no bleeding, and result in similar airway clearing.
  • Laser treatment of varicose veins, which appear among ~50% of adults in some areas of Europe with symptoms including sensations such as heavy legs, tension, swelling, pain while standing and sitting, discoloring, and phlebitis. In half of cases, patients require surgery. Procedures such minimally invasive endovenous laser therapy have provided relief to the patient with just one puncture.