Since the first Class IV laser therapy booth appeared at the 2006 North American Veterinary Conference in Orlando, the modality has become arguably the fastest growing one in the veterinary profession. Why is everyone talking about laser therapy? Is it all hype? Why have more than 3,000 practices invested in it? To understand Class IV laser therapy’s rapid growth, one needs to recall practice trends of six years ago. Multi-million dollar marketing campaigns targeting pet owners transferred purchases of medications, food and products from veterinary practices to online and big-box pet stores. Similar direct-to-consumer campaigns focused on pharmaceutical solutions to pain management problems. These trends caught the attention of educated pet owners, which affected clinic revenue. The profession recognized this threat and developed renewed appreciation for sustainable practice-based service revenue, which could only be lost through competition from other practices. Clinical Considerations Class IV laser therapy does not treat conditions. Rather, it stimulates the body’s inherent healing mechanisms via a process called photobiomodulation or biostimulation. Pet owners searching for pain management solutions for older pets had begun to seek non-pharmaceutical, non-surgical solutions. Class IV therapy lasers provided the solution with a simple three- to eight-minute non-invasive treatment. Veterinary professionals and pet owners saw a positive response in one to four treatments. The science behind this light-based biostimulation has been researched for years, but most studies were in vitro and done with low-powered lasers needed for cell cultures. Class IV laser power provides the same therapeutic dose (4 to 10 J/cm2) but to a larger volume of patient tissue, and stimulates pain relief in deep joints and tissues of animals. The American veterinary profession understood biostimulation and began looking beyond pain management. Early adopters discovered accelerated wound healing responses for soft tissue, bone and infection. Many have seen dramatic post-surgical resolution for orthopedic and soft tissue surgical cases. Some Class 3b laser (<0.5 watts) proponents inaccurately contend that Class 4 laser power is unsafe and burns patients. Based on the number of installations, it is estimated that 1,560,000 animals have been safely treated with Class IV therapy lasers in the USA. Business Considerations K-Laser USA of Franklin, Tenn., brought an interesting clinical and business solution to the forefront in January 2006. It encouraged practices to offer a pain-management service performed by nursing and technical staff. The service required three to six visits, with chronic cases receiving monthly or quarterly single-treatment boosters. The average U.S. charge was $25 to $50 per treatment. To deliver the proper treatment, a technician selects species, body part, indicator and patient size. Efficient technical staff could perform four to six treatments per hour, resulting in doctor-level revenue at technician costs. Time with the pet owner allowed staff members to answer client questions, lift a lip and discuss dentistry and educate about geriatric exams or other important services the practice offered. Is 2012 Your Year? Manufacturers estimate that 2,000 veterinary practices will implement Class IV laser therapy this year. In choosing a vendor, understanding the technical specifications is imperative. But Steve Jobs and Apple Inc. demonstrated that corporate culture can be equally important. Implementation and training will ensure safe, effective treatments. Training designed by laser-accredited professionals must be based on standards from the medical and science community, rather than vendor-created laser training academies. Selecting a Device Wavelength The “therapeutic window” is the region between the peaks of melanin and water’s absorption where sufficient penetration is possible. All lasers in this range (700-1000 nm) will be useful to some extent. Some companies offer multiple and selectable wavelengths for more effective targeting. Continuous Wave (CW) or Pulsed Different tissue types respond better to different frequencies. It is important, therefore, to have a laser that has the ability to deliver the same dose at different frequencies to stimulate the most comprehensive healing. Power This defines the amount of energy emitted from a laser per unit time. For a given wavelength, and with knowledge of the optical properties of the tissue to be irradiated, power is the principal quantity that determines both penetration depth and duration of treatment. Spot Size The output spot size is important for two reasons: It determines the power density, which is the most important parameter of laser therapy; and Not every ailment is the same size. Having the ability to change your spot size to fit the need of the specific treatment is crucial. Pre-set Programs (Multi-Frequency Protocols) Different ailments are better treated using different power, wavelength, frequency and treatment time settings, and so the technical versatility of the machine needs to be matched by a software platform that allows a simple way to identify and select the most appropriate settings. Training and certification These are not only important for safety, but also to get optimal clinical and financial results. A company that sells a laser without full implementation and training for you and your entire staff is doing you a disservice. Obsolescence Technology, as a rule, is always growing and equipment becomes obsolete. It is important to buy a device that will grow with you. Hardware that can produce power densities up to 10 W/cm2—the highest power density the body will ever be able to withstand without potential thermal damage to tissue—and modulate the beam through a wide range of frequencies is the first step. The second is the ability and commitment to update software as the clinical knowledge-base grows. R and D In the last few years, the knowledge base for laser therapy has grown by leaps and bounds. Granted, clinicians pioneered this movement with very general hypotheses and virtually unguided protocol “guestimation.” We are now getting a solid grasp on the underlying mechanisms and identifying the optimal treatment parameters. Continued research and development of this modality is important and will come in the form of case histories, implementing standardized and definitive clinical trials, and quantifying millimeter accurate dosimetry of laser treatment sessions. Bryan Stephens is director of research and development for K-Laser USA, and Phil Harrington is manager of training and clinical support for the company. This Education Series article was underwritten by K-Laser USA of Franklin, Tenn.
