In contrast to Class 1, 2, and 3 low level lasers (LLLT) with relatively low power from 1 – 500 miliWatts (0.5 Watts) resulting in limited dosage levels; each Berman Medical Laser incorporates advanced Class 4 laser technology that are upwards of 1,200 times more powerful providing power levels of .5 – 60.0 Watts of power in either CW continuous wave or a pulsed action. These higher powers, in combination with proper wavelengths, laser beam spot size coupled with treatment techniques enable clinicians to safely and effectively deliver significantly higher dosage levels (a key to success) and enhancing the laser photons abilities to penetrate deeper into the cellular tissue providing better and longer-lasting sustained clinical outcomes.

Integrating a Berman Medical Laser into a healthcare practice has been made easy with the Berman Program. If you’re looking to purchase a new therapy laser or upgrade an old therapy laser to newer technology, Multiple Laser Models in varying strengths and nanometers are available to match any need or budget. With all the different lasers on the market to choose from, it can be difficult to decide what laser is best. Having a wide array of laser size, power levels and wavelengths is a needed and required aspect to ensure your practice has the appropriate laser to meet you and your patients current and future needs while the Berman Program program protects your overall investment.

It’s Time To Take A New Approach To Achieving Outcomes With Laser Therapy. Since 1917 when Albert Einstein established the theoretical foundations for the laser, research has produced a variety of improved and specialized laser types, optimized for different performance goals. However, a form of laser technology used in medicine and referred to since the late 1960’s as “cold laser” or “low level laser therapy (LLLT)” has yet to achieve universal recognition and use by the medical community due to a lack of consistent clinical outcomes and poorly designed and outdated laser technology. Treatment parameters for LLLT were originally established from clinical studies using cells in vitro and in small animal models that recommended very low dosage levels resulting in inconsistent or negative clinical outcomes. The exciting news is that new and advanced High intensity Laser Therapy technology is now available from Berman Medical Lasers that overcomes the past challenges with consistent and positive sustained clinical outcomes in a shorter amount of treatment time.

Featuring World-Class Cutting-Edge Technology, each Berman Medical Laser has been carefully designed to provide high quality and reliable long-term performance.

Effective from the very first treatment, our lasers are more than just another piece of equipment, as they IMPROVE LIVES, RETURN QUALITY OF LIFE, RESTORE FUNCTIONALITY to patients by offering Drug-Free Pain Relief and Reduced Inflammation for Accelerated Healing.

• HIGH INTENSITY LASER THERAPY – Revolutionizing Treatment Dosage Levels
• TRUE SINGAL & DUAL WAVELENGTH TECHNOLGY – Revolutionizing Treatment Results

In contrast to Class 1, 2, and 3 low level lasers (LLLT) with low power from 1 – 500 miliWatts (0.5 Watts) resulting in limited dosage levels; each Berman Medical Laser incorporates advanced Class 4 laser technology that are upto 1,200 times more powerful providing power levels of .5- 60.0 Watts. These higher powers, in combination with proper wavelengths, laser beam size and treatment techniques enable clinicians to safely and effectively deliver significantly higher dosage levels (a key to success) and enhanced abilities to penetrate deeper into the cellular tissue providing better and longer-lasting sustained clinical outcomes.

All light is composed of photons. Photons are small packets of light energy in the form of waves with a defined wavelength and frequency.

Laser (acronym for Light Amplification by Stimulated Emission of Radiation) can be used as a therapeutic device which produces monochromatic (one specific wavelength), coherent (constant phase) and polarized (directional) light.

Photobiomodulation has been officially defined as a form of light therapy that utilizes non-ionizing forms of light sources, including lasers, LEDs, and broadband light, in the visible and infrared spectrum. It is a nonthermal process involving endogenous chromophores eliciting photophysical (i.e., linear and nonlinear) and photochemical events at various biological scales. This process results in beneficial therapeutic outcomes including but not limited to the alleviation of pain or inflammation, immunomodulation, and promotion of wound healing and tissue regeneration.

Source:   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4390214

The Berman Medical lasers suit of laser systems features advanced laser technology and can deliver more energy than most other therapy lasers. Berman Medical lasers additional power coupled with our optimal wavelengths and treatment beam size, result in deeper penetration, significantly faster treatment times and delivery of the proper therapeutic dosage to achieve the desired goal. These features provide healthcare professionals an enhanced and superior ability to treat difficult conditions and ultimately provide better sustained clinical outcomes to all patients.

Each Hand-piece for laser therapy has been specifically designed to maximize therapeutic treatments and outcomes.

SPECIFICATIONS:
• 30mm diameter treatment spot size
• Finger Switch for On/Off
• Lightweight, durable plastic composition
• T-shape design provides ergonomic use
• Special lens for direct on-skin treatment
• Optional spacer for off-skin treatment

Real Science. Real Results.

LIGHT: Energy

LASER: Visible and Near Infrared (NI) Light

MECHANISM OF ACTION: Photochemical

PHOTOBIOMODULATION THERAPY

Biological Effects of Laser Therapy

What are the Clinical Benefits of Laser Therapy?

Lasers have been classified by wavelength and maximum output power into four classes and a few subclasses since the early 1970s. The classifications categorize lasers according to their ability to produce damage in exposed people, from class 1 (no hazard during normal use) to class 4 (severe hazard for eyes and skin). These classes are I, II IIa, IIIa, IIIb and IV for the U.S., and 1, 1M, 2,2M, 3R, 3B and 4 for Europe.

The Federal Food and Drug Administration (FDA) Center for Devices and Radiological Health (CDRH) has the responsibility for implementing and enforcing the laws and regulations which apply to radiation- producing electronic products and medical devices.

Medical devices, including laser systems for medical applications, require clearance by the FDA in order to be introduced commercially in the US. The clearance can follow the review of a premarket notification under section 510(k) of the Federal Food, Drug and Cosmetic Act (FFDCA) for a device that is substantially equivalent to a device that was in commercial distribution in the US prior to May 1976 or to previously cleared devices. Clearances are device specific and for indications claimed in the cleared labeling.

MPE is the maximum level of laser radiation to which a person may be exposed without hazardous effects or biological changes in the eye or skin. The MPE is determined by the wavelength of a laser, the energy involved, and the duration of the exposure. MPE is a necessary in determining appropriate optical density and the nominal hazard zone.

CDRH            The Center for Devices and Radiological Health
IEC                 The International Electrotechnical Commission
ANSI               The American National Standards Institute

Some states currently require registration of medical lasers. The regulations cover use of class IIIB and IV medical lasers and require following specific guidelines for use.

The Food and Drug Administration (FDA) recognizes four major hazard classes (I to IV) of lasers, including three subclasses (IIa, IIIa, and IIIb). The higher the class, the more powerful the laser and the potential to pose serious danger if used improperly. The labeling for Classes II–IV must include a warning symbol that states the class and the output power of the product. IEC equivalent classes are included for products labeled under the classification system of the International Electrotechnical Commission.

The Center for Devices and Radiological Health (CDRH) is a regulatory bureau within the U.S. Federal Food and Drug Administration (FDA) of the Department of Health and Human Services. CDRH has been chartered by Congress to standardize the performance safety of manufactured laser products.

All laser products that have been manufactured and entered into commerce, after August 2, 1976, must comply with these regulations. The regulation is known as the Federal Laser Product Performance Standard (FLPPS), and is identified as 21CFR subchapter parts 1040.10 and 1040.11. The FLPPS assigns lasers into one of four broad hazards in a manner similar to the ANSI Z136.1 (2000) Standard – Classes I, II, IIIa, IIIb and IV) depending on the potential for causing biological damage.(2)

These lasers are exempt from the requirements of most corporate Laser Safety Programs. Class 1 laser cannot, under normal operating conditions, produce damaging radiation levels. All Class 1 lasers must be labeled.

Class 2 lasers are low power lasers or laser system in the visible range (400 – 700 nm wavelength) that may be viewed directly under carefully controlled exposure conditions. Eye protection is usually afforded by aversion response and blink reflex (0.25 seconds). However, a class 2 laser beam could be hazardous if one were to intentionally expose the eye for longer than 0.25 seconds. Class 2 lasers must be labeled. The laser beam should not be purposefully directed toward the eye of any person. Alignment of the laser optical systems (mirrors, lenses, beam deflectors, etc.) should be performed in such a manner that the primary beam, or specular reflection of the primary beam, does not expose the eye to a level above the MPE for direct irradiation of the eye.

Class 3a denotes lasers or laser systems that normally would not produce a hazard if viewed for only momentary periods with the unaided eye. They may present a hazard if viewed using collecting optics. Do not view the direct or reflected beam. Class 3a lasers must be labeled accordingly. The work area should be posted with a warning label or sign cautioning users to avoid staring into the beam or directing the beam toward the eye of individuals. Removable parts of the housing and service access panels should have interlocks to prevent accidental exposure.

Class 3b denotes lasers or laser systems that can produce a hazard if viewed directly. This includes intrabeam viewing or specular reflections. Except for the higher power Class 3b lasers, this class laser will not produce diffuse reflections. Class 3b lasers and laser systems must be labeled accordingly. These lasers are used in areas where entry by unauthorized individuals can be controlled. If an individual who has not been trained in laser safety must enter the area, the laser operator or supervisor should first instruct the individual as to safety requirements and must provide protective eyewear, if required.

An alarm, warning light or verbal countdown should be used during use or startup of the laser. The controlled area should:

• have limited access to spectators,
• have beam stops to terminate potentially dangerous laser beams,
• be designed to reduce diffuse and specular reflections,
• have eye protection for all personnel,
• not have a laser beam at eye level,
• have restrictions on windows and doorways to reduce exposure to levels below the MPE, and
• require storage or disabling of the laser when it is not being used

Class 4 Lasers are high power lasers or laser systems that can produce a hazard not only from direct or specular reflections, but also from a diffuse reflection. In addition, such lasers may produce fire and skin hazards.

Class 4 lasers include all lasers in excess of Class 3 limitations.

In addition to the control measures described for Class 3b, Class 4 lasers should be operated by trained individuals in areas dedicated to their use. Failsafe interlocks should be used to prevent unexpected entry into the controlled area, and access should be limited by the laser operator to persons who have been instructed as to the safety procedures and who are wearing proper laser protection eyewear when the laser is capable of emission. Laser operators are responsible for providing information and safety protection to untrained personnel who may enter the laser controlled areas as visitors.

The International Electrotechnical Commission (IEC) is a global organization that prepares and publishes international standards for all electrical, electronic and related technologies. The IEC document 60825-1 is the primary standard that outlines the safety of laser products. Classification is based on calculations and determined by the AEL as with the ANSI standard, but the IEC standard also incorporates viewing conditions:

Class 1 lasers are very low risk and “safe under reasonably foreseeable use”, including the use of optical instruments for intrabeam viewing.

Class 1M lasers have wavelengths between 302.5 nm and 4000 nm, and are safe except when used with optical aids (e.g. binoculars).

Class 2 lasers do not permit human access to exposure levels beyond the Class 2 AEL for wavelengths between 400 nm and 700 nm. Any emissions outside this wavelength region must be below the Class 1 AEL.

Class 2M lasers have wavelengths between 400 nm and 700 nm, and are potentially hazardous when viewed with an optical instrument. Any emissions outside this wavelength region must be below the Class 1M AEL.

Class 3R lasers range from 302.5 nm and 106 nm, and is potentially hazardous but the risk is lower than that of Class 3B lasers. The accessible emission limit is within 5 times the Class 2 AEL for wavelengths between 400 nm and 700 nm, and within 5 times the Class 1 AEL for wavelengths outside this region.

Class 3B lasers are normally hazardous under direct beam viewing conditions, but are normally safe when viewing diffuse reflections.

Class 4 lasers are hazardous under both intrabeam and diffuse reflection viewing conditions. They may cause also skin injuries and are potential fire hazards.

The American National Standards Institute (ANSI) is an organization for which expert volunteers participate on committees to set industry consensus standards in various fields. The ANSI Z136 Committee has published or has under development seven standards specific to the laser field. The current version of the main ANSI Z136.1 Standard (Z136.1-2000) assigns lasers into one of four broad hazard Classes (1, 2, 3a, 3b and 4) depending on the potential for causing biological damage. Classification is determined by calculations based on exposure time, laser wavelength and average power for CW or repetitively-pulsed lasers and total energy per pulse for pulsed lasers. (1) These calculations are used to determine a factor defined as the Accessible Emission Limit, or AEL which is the mathematical product of the Maximum Permissible Exposure limit (MPE) given in the Standard and an area factor computed from the defined term called the Limiting Aperture (LA). That is: AEL = MPE x Area of LA. Limiting Apertures are dependent on factors such as laser wavelength and are based on physical factors such as the fully dilated pupil size (7mm) and beam “hotspots” (1mm). For most all exposures to the skin and IR exposures to the eye lasting greater 10 seconds, the involuntary movement of the eyes and the body as well as heat conduction will average an irradiance profile over an area of about 10 mm2, even if the irradiated body part is kept intentionally still. This equates to a size of about 3.5 mm. Especially in the near-infrared, radiation is penetrating relatively deep into skin and due to scattering, the irradiance profile is averaged over corresponding dimensions. For wavelengths larger than 0.1 mm, an aperture size of 11 mm is specified, as smaller apertures would lead to inaccurate measurements due to diffraction effects.

Each laser class is based on these AEL thresholds:

Class 1 lasers or systems cannot emit accessible laser radiation in excess of the applicable Class 1 AEL for any exposure times within the maximum duration inherent in the design or intended use of the laser. Class 1 lasers are exempt from all beam-hazard control measures.

Class 2 lasers are CW and repetitively pulsed lasers with wavelengths between 0.4 µm and 0.7 µm that can emit energy in excess of the Class 1 AEL, but do not exceed the Class 1 AEL for an emission duration less than 0.25 seconds and have an average radiant power of 1mW or less.

Class 3a lasers have an accessible output between 1 and 5 times the Class 1 AEL for wavelengths shorter than 0.4 µm or longer than 0.7 µm, or less than 5 times the Class 2 AEL for wavelengths between 0.4 µm and 0.7 µm.

Class 3b lasers cannot emit an average radiant power greater than 0.5 Watts for an exposure time equal to or greater than 0.25 seconds or 0.125 Joules for an exposure time less than 0.25 seconds for wavelengths between 0.18 µm and 0.4 µm, or between 1.4 µm and 1 mm. In addition, lasers between 0.4 µm and 1.4 µm exceeding the Class 3a AEL cannot emit an average radiant power greater than 0.5 Watts for exposures equal to or greater than 0.25 seconds, or a radiant energy greater than 0.03 Joules per pulse.

Class 4 lasers and laser systems exceed the Class 3b AEL.

Electromagnetic Spectrum and Wavelengths

The biological effect of laser therapy is related to the wavelength of light emitted by the laser.

• Different wavelengths target different tissues e.g. blood, melanin, water, etc.
• These targets are known as Chromophores
• Ultraviolet radiation consists of wavelengths between 180 and 400 nanometers
• The visible light region is radiation with wavelengths between 400 and 700 nm
• The infrared light region (not visible) of the spectrum consists of radiation with wavelengths between 700 nm and 1 mm.

3 Types of Light – Tissue Interactions:

1. Photo – Thermal Lasers

Photothermal converts light energy into heat energy. This causes the tissue to heat up and vaporize. These lasers are “long pulsed”.

Examples: 

• Most surgical lasers
• Hair removal lasers

2. Photo –Mechanical (or Photo-Acoustic) Lasers

Photoablative causes photodissociation or breaking of the molecular bonds in tissue. These lasers are “short pulsed”.

Examples:

• Q-switched lasers
• Tattoo removal lasers

3. Photo-Chemical Lasers

Photochemical causes target cells to start light-induced chemical reactions.

Examples:

• Therapy lasers – treating pain in a joint or the deep tissues

Photo-dynamic lasers (PDT) – cancer treatment, ophthalmic

Laser light’s monchromaticity is responsible for its selective effect on biologic tissue. 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 there to be 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, 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.). The main absorbing components, or chromophores, of tissue are:

• Hemoglobin in blood
• Melanin in skin, hair, moles, etc.
• Water (present in all biologic tissue)
• Protein or “Scatter” (covalent bonds present in tissue)

Power and energy are closely related. Power is the rate at which energy is delivered, not an amount of energy itself.

• Formula: Power = Energy / Time 1 Watt = 1 Joule / Second
• Therapeutic Energy = Power (Watts) or Joules/sec x Time (sec).

Power Density

Power density or Irradiance refers to the amount of power delivered per unit area. Power density indicates the degree of concentration of the laser output. It is expressed in Watts per square centimeter (W/cm2), or miliWatts per square centimeter (mW/cm2). Some studies have concluded that the power density may be of even greater significance than the dose.

• Example: A laser’s output is 4 Watts, and it is illuminating a circle of 3 centimeter diameter.
• First find the area of the circle, 3.14 x 1.5 x 1.5 = 7 cm2.
• Then divide the power by the area, 4W / 7cm2 = 0.6 W/cm2.

The energy density expresses the total amount of energy delivered per unit area, in Joules per square centimeter (J/cm2). The energy is measured in Joules, and is calculated by multiplying the power output of the laser times the amount of time elapsed during the laser treatment.

• Example:  A 4 Watt continuous wave laser would deliver 240 Joules in one minute.
• (4 Watts x 60 seconds = 240 Joules)
• Then simply divide the total energy by the area to arrive at the energy density in Joules per centimeter squared.

• Formula: Fluence (ED) = Power x Exposure Time, measured in Joules/cm2 (Watts x Seconds)
• Key: The amount of energy delivered, determines the magnitude of the laser interaction within the tissues and the individual cells.
• Effect of Laser Spot Size on Tissue Distribution of Light Energy

A beam of light incident on tissue may be:

• Reflected
• Absorbed
• Scattered

Scattering in tissue broadens the incident beam, decreasing the effective fluence in the intended target area.

For effective penetration, light needs to avoid scattering and surface absorption.

Doubling the spot size will increase the effective volume by a factor of eight. A larger spot size usually enables faster and more effective treatment in dermatologic applications such as treatment of vascular lesions, laser hair removal, etc. However, more photons must be supplied by more complex and expensive power supplies, components, and delivery devices. As a general rule, doubling the spot size and halving the fluence will yield an equivalent effective fluence at a given depth. This effect becomes more pronounced with increasing depth.

Characteristics of Laser Light

A laser generates a beam of very intense light.  Laser light has three distinct characteristics that distinguish it from ordinary light:

Laser light is:

1. Collimated
2. Monochromatic
3. Coherent

A laser beam is collimated, meaning it consists of waves traveling parallel to each other in a single direction with very little divergence (Figure 1). This allows laser light to be focused to very high intensity (Figure 2). Ordinary light waves spread and lose intensity quickly.

Monochromatic refers to the single (wavelength) color of a laser beam. Ordinary white light is a mixture of colors, as you can demonstrate by shining sunlight through a prism. Because the wavelength of laser light determines its effect on tissue, the monochromatic property of laser light allows energy to be delivered to specific tissues in specific ways.

Laser light is coherent, which means all the light waves move in phase together in both time and space. A laser has a very tight beam that is strong and concentrated. A flashlight, by comparison, releases light in many directions; the light is weak and diffuse.

• All light is composed of photons. Photons are small packets of light energy—in the form of waves— with a defined wavelength and frequency.
• Photon energy is able to more effectively penetrate the skin and underlying structures, therefore accelerating the healing process.
• Light travels at a constant speed and oscillate up and down as it moves forward.
• However, all light is not the same. It is measured in wavelengths, with each wavelength of light representing a different color of the spectrum.
• The number of oscillations per second represents the frequency of each wavelength; shorter waves have a greater frequency than longer waves.
• Laser energy is coherent (well-ordered photons), monochromatic (single-color) light energy. When produced as a narrow, bright beam.

Photo-Chemical Action

Studies have shown that when tissue cultures are irradiated by Lasers, enzymes within cells absorb energy from laser light. Visible (red) light and Near Infrared (NIR) are absorbed within the mitochondria and the cell membrane. This produces higher ATP levels and boosts DNA production, leading to an increase in cellular health and energy. When applied as treatment, therefore, Lasers have been shown to reduce pain and inflammation as well as stimulate nerve regeneration, muscle relaxation and immune system response. Lasers have no effect on normal tissues, as photons of light are only absorbed and utilized by the cells that need them.

Role of Chromophores

Chromophores are components of various cells and sub-cellular organelles which absorb light.  The stimulation of Chromophores on mitochondrial membranes incites the production of ATP. This results in:

• Increases cellular energy levels
• Allows pain relief
• Accelerates cellular healing

Acute Inflammation Reduction

How does Laser Therapy reduce inflammation?

1. Stabilization of the cellular membrane
   • Ca++, Na+ and K+ concentrations, as well as the proton gradient over the mitochondria membrane are positively influenced.
   • This is accomplished in part, by the production of beneficial Reactive Oxygen Species aka (ROS).
   • These ROS’s modulate intracellular Ca++ concentrations and laser therapy improves Ca++ uptake in the mitochondria.

1. Enhancement of ATP production and synthesis
   • ATP production and synthesis are significantly enhanced, contributing to cellular repair, reproduction and functional ability
   • Photonic stimulation of Cytochrome c Oxidase, a chromophore found on the mitochondria of cells, plays a major role in this rapid increase in production and synthesis of ATP.

1. Stimulation of vasodilation
   • Vasodilation is stimulated via an increase in Histamine, Nitric Oxide (NO) and Serotonin levels, resulting in reduction of ischemia and improved perfusion
   • Laser-mediated vasodilation enhances the transport of nutrients and oxygen to the damaged cells and facilitates repair and removal of cellular debris.

1. Acceleration of leukocytic activity
   • Beneficial acceleration of leukocytic activity, resulting in enhanced removal of non-viable cellular and tissue components.
   • Thus allowing for a more rapid repair and regeneration process.

1. Increased prostaglandin synthesis
   • Prostaglandins have a vasodilating and anti-inflammatory action

1. Reduction in interleukin 1
   • Laser irradiation has a reducing effect on this pro-inflammatory cytokine that has been implicated in the pathogenesis of rheumatoid arthritis and other inflammatory conditions.

1. Enhanced lymphocyte response
   • In addition to increasing the number of lymphocytes, laser irradiation mediates the action of both lymphatic helper T-cells and suppressor T-cells in the inflammatory response.
   • Along with laser modification of beta cell activity, the entire lymphatic response is beneficially affected by laser therapy.

1. Increased angiogenesis
   • Both blood capillaries and lymphatic capillaries have been clinically documented to undergo significant increase and regeneration in the presence of laser irradiation.

1. Temperature modulation
   • Areas of inflammation typically demonstrate temperature variations, with the inflamed portion having an elevated temperature.
   • Laser therapy has been shown to accelerate temperature normalization, demonstrating a beneficial influence on the inflammatory process.

1. Enhanced superoxide dismutase (SOD) levels
   • Laser stimulated increases in cytokine SOD levels interact with other anti-inflammatory processes to accelerate the termination of the inflammatory process.

1. Decreased C-reactive protein and neopterin levels
   • Laser therapy has been shown to lower the serum levels of these inflammation markers, particularly in rheumatoid arthritis patients

Analgesia

How does Laser Therapy reduce pain?

1. Increase in beta endorphins
   • The localized and systemic increase of this endogenous peptide, after laser therapy irradiation has been clinically reported in multiple studies, to promote pain reduction.

1. Increased nitric oxide production
   • Nitric oxide has both a direct and indirect impact on pain sensation. As a neurotransmitter, it is essential for normal nerve cell action potential in impulse transmission activity.
   • And indirectly, the vasodilation effect of nitric oxide can enhance nerve cell perfusion and oxygenation.

1. Decreased bradykinin levels
   • Since Bradykinins elicit pain by stimulating nociceptive afferents in the skin and viscera, mitigation of elevated levels through laser therapy can result in pain reduction.

1. Ion channel normalization
   • Photobiomodulation promotes normalization in Ca++, NA+ and K+ concentrations, resulting in pain reduction as a result of these ion concentration shifts.

1. Blocked depolarization of C-fiber afferent nerves
   • The pain blocking effect of therapeutic lasers can be pronounced, particularly in low velocity neural pathways, such as non-myelinated afferent axons from nociceptors.
   • Laser irradiation suppresses the excitation of these fibers in the afferent sensory pathway.

1. Increased nerve cell action potentials
   • Healthy nerve cells tend to operate at about -70 mV, and fire at about -20 mV. Compromised cell membranes have a lowered threshold as their resting potentials average around this -20 mV range.
   • That means that normal non-noxious activities produce pain.
   • Laser therapy can help restore the action potential closer to the normal -70 mV range.

1. Increased release of acetylcholine
   • By increasing the available acetylcholine, Laser Therapy helps in normalizing nerve signal transmission in the autonomic, somatic and sensory neural pathways.

1. Axonal sprouting and nerve cell regeneration
   • Several studies have documented the ability of laser therapy to induce axonal sprouting and some nerve regeneration in damaged nerve tissues.
   • Where pain sensation is being magnified due to nerve structure damage, cell regeneration and sprouting may assist in reducing pain.

Summary of Light Induced, Anti-Inflammatory Responses

1. Stabilization of the cellular membrane
2. Enhancement of ATP production and synthesis
3. Stimulation of vasodilation
4. Acceleration of leukocytic activity
5. Increased prostaglandin synthesis
6. Reduction in interleukin 1
7. Enhanced lymphocyte response
8. Increased angiogenesis
9. Temperature modulation
10. Enhanced superoxide dismutase (SOD) levels
11. Decreased C-reactive protein and neopterin levels

Summary of Light Induced, Analgesic Responses

1. Increase in beta endorphins
2. Increased nitric oxide production
3. Decreased bradykinin levels
4. Ion channel normalization
5. Blocked depolarization of C-fiber afferent nerves
6. Increased nerve cell action potentials
7. Increased release of acetylcholine
8. Axonal sprouting and nerve cell regeneration

Accessible Exposure Limit (AEL) is the maximum permissible power level for the appropriate class of laser as defined in ANSI Z136.1.

American National Standards Institute, ANSI Z136.1 “safe use of lasers” this standard establishes occupational exposure limits and laser safety practices in the United States.

Aperture is an opening through which laser radiation can pass.

Aversion Response is closing the eye and moving the head away to avoid exposure to laser light.

Biological Amplification when photobiomodulation occurs, the photon activates a chromophore, amino acid, nucleic acid, or molecule. Activation of a single enzyme molecule rapidly catalyzes thousands of other chemical reactions amplifying the signal to the cell. This is similar to the calcium regulated 2nd messenger camp cascade. Biological amplification explains how systemic, cellular, and clinical effects can occur almost instantaneously after exposure to light therapies.

Biomodulation is the process of changing the natural biochemical response of a cell or tissue within the normal range of its function, stimulating the cell’s innate metabolic capacity to respond to a stimulus. a cell can heal itself by this stimulation mechanism.

Chromophores literally means, “Color lover” (l. chromo = color; l. phore = to seek out, to have an affinity for, to love). Chromophores are generally pigmented molecules that accept photons within living tissue. When the chromophore accepts a photon, it causes a biochemical change within an atom, molecule, cell or tissue. if this change increases cellular function, it is said to have activated the tissue. if this change decreased cellular function it is said to have inhibited the tissue. Biomodulation occurs in both cases.  

Coherence the photons within a laser beam are extremely well organized and directional. This means that all of the photons (energy) have waves that travel in unison – they are highly parallel with a specific wavelength. true laser systems focus all of their energy in one direction in a very concentrated line. a super-luminous diode, on the other hand, diffuses its energy in all directions with only a small percentage of the energy travelling in the direction of the treatment. a true laser system will deliver 90% more power to the treatment area than a super-luminous diode system of exactly the same power rating.

Collimation a property of light commonly associated with lasers and accomplished with focusing lenses where all the photons are traveling in the same direction.

Continuous Wave (CW) laser a laser with a continuous output of laser radiation for a duration that is greater than or equal to 0.25 seconds.

Diffuse Reflection when a laser beam is reflected in many directions by a surface reducing its intensity.

Dose the term dose is an estimate of a therapy which produces a desired therapeutic action without harmful side effects. The therapeutic dose (safe and effective) range is defined by clinical evaluation of the response of a sufficient number of patients, generally 50 percent who improve without toxicity. The most important parameter in laser therapy is always the dose, often referred to as “fluence”. By dose (d) is meant the energy (e) of the light directed at a given unit of area (a) during a given session of therapy. The energy is measured in joules (j), the area in cm2 and consequently, the dose in j/cm2.

Duty Cycle relates to the amount of time the light source is active, usually from 10% to 100%. a laser operating in continuous wave is running at 100% duty cycle.

Energy Density the energy density expresses the total amount of energy delivered per unit area, in joules per square centimeter, j/cm2. The energy is measured in joules, and is calculated by multiplying the power output of the laser times the amount of time elapsed during the laser treatment. (energy = power x time, and the units are joules = watts x seconds.) a 4 watt continuous wave laser would deliver 240 joules in one minute. (4 watts x 60 seconds = 240 joules) then simply divide the total energy by the area to arrive at the energy density in joules per centimeter squared.

Frequency the frequency of light is inversely proportional to its wavelength, and is dependent upon the energy value of the individual photons being emitted. The higher the frequency, the higher the energy, and the shorter the wavelength.

Infrared Radiation (IR) this is invisible radiation of wavelengths from 700nm – 1mm. this part of the electromagnetic spectrum is broken down into 3 bands: near infrared (IR-A) 700nm – 1400nm, mid infrared (IR-B) 1400nm – 3,000nm, and far infrared (IR-C) 3,000nm – 1mm.

Intrabeam Viewing direct viewing of a point source laser beam on axis.

Irradiance the power per unit area expressed in watts per square centimeter (w/cm2). It is also referred to as power density and applies to cw lasers.

Laser Diode a semiconducting device which emits monochromatic non-ionizing radiation by a process of stimulated emission. a laser beam has a number of unique properties, such as coherence, polarization and directionality. Beams emitted by laser diodes are not, as is often stated, ‘straight’ and/or ‘parallel’. Unless manipulated with additional optical devices such as lenses, a laser diode’s beam is broadly divergent along one plane and narrowly divergent along the perpendicular plane, producing an elliptical cross-section.  

Laser Safety Officer (LSO) the LSO is responsible for monitoring the control of laser use and implementing the laser safety program.

Laser light amplification by stimulated emission of radiation; refers to the specific qualities and methods by which lasers produce light. Originally theorized and defined by Albert Einstein in 1917, it was not produced until the 1950s. Laser light is coherent, has a monochromatic wavelength, is collimated, and polarized. These four characteristics differentiate lasers from LED & SLD light sources.

Light is a small spectrum of electromagnetic energy with wavelengths between 380 nanometers (nm) and 760nm in length. This spectrum of energy is visible to the naked eye.  

Maximum Permissible Exposure (MPE) the maximum level of laser radiation to which a human can be exposed without harmful effects to the eye or skin. MPE values for eye exposure to direct beam viewing can be found in table 5 of ANSI Z136.1 Standard.

Monochromatic contains one specific wavelength of light (one specific color). It is an exclusive property of laser light, setting them apart from all other light sources. Because the wavelength of laser light determines its effect on tissue, the monochromatic property of laser light allows energy to be delivered to specific tissues in specific ways. Non-laser therapies such as LED’s (light emitting diodes) are sufficient for superficial treatment (wounds), but are questionable on penetration for musculoskeletal conditions. Lasers penetrate deeper.  

Nominal Hazard Zone (NHZ) an area where the MPE is exceeded for the laser radiation emitted.

Optical Density (OD) is the base ten logarithm of the reciprocal of the transmittance. The OD is calculated for protective eyewear to reduce the transmission density to the safe MPE level.

Penetration refers to the distance an energy wave travels into the tissue before it is absorbed and dissipated as heat or molecular vibration. Penetration is a physical and thermal phenomenon, not a therapeutic phenomenon. Penetration of laser light is dependent on the wavelength of the light. Lower wavelengths are absorbed by hemoglobin and melanin, and higher wavelengths are absorbed by water in the tissues.

Photobiomodulation when biomodulation occurs from a photon transferring its energy to a chromophore it is referred to as photobiomodulation.

Physiological Dose of Therapy a physiological dose of any therapy is designed to stimulate production of, or provide to the body what it needs to normalize and heal itself through biomodulation. The symptomatic response to a physiological dose of therapy is dependent of the capacity of the patient’s body to respond to the therapy. The physiological dose of any treatment has specific advantages. A physiological dose represents the body’s own response to a stimulus. A physiological dose generally improves the patient’s health.

Power Density is amount of power delivered per unit area. Power density indicates the degree of concentration of the laser output. it is expressed in watts per square centimeter, or milliwatts per square centimeter, w/cm2 or mw/cm2. Some studies have concluded that the power density may be of even greater significance than the dose. Example: a laser’s output is 4 watts, and it is illuminating a circle of 3 centimeter diameter. first find the area of the circle, 3.14 x 1.5 x 1.5 = 7 cm2. Then divide the power by the area, 4w / 7cm2 = 0.6 w/cm2.

Power = energy / time 1 watt = 1 joule / second.it is important not to confuse power and energy, although they are closely related. Power is the rate at which energy is delivered, not an amount of energy itself.

Pulsed (Simulated) in most modern therapeutic lasers, the pulsing is simulated by mechanically or electronically interrupting the output of a continuous beam laser. The pulse rate may be adjusted up or down without significantly affecting treatment time. This is accomplished by modulating pulse duration and/or the space between pulses.

Pulsed Laser a laser that delivers energy in single or multiple pulses which are less than or equal to 0.25 seconds in duration.

Radiant Exposure radiant energy per unit area expressed in joules per square centimeter (j/cm2). Radiant exposure applies to pulsed lasers.

Retracing from time to time, a patient will experience an increase in pain following treatment. It is not an adverse reaction, but indicates that the laser treatment is working. Patients will frequently observe improvement once this pain subsides which is usually within 24-hours.

Specular Reflection is a mirror-like reflection of the beam in which most of the power is retained in the reflected beam.  therapeutic energy = power (watts) or joules/sec x time (sec).

Ultraviolet Radiation (UV) invisible radiation that has wavelengths from 180nm – 400nm. UV radiation is broken down into 3 regions; near ultraviolet (UV- A)-315nm – 400nm, mid ultraviolet (UV-B)-280nm – 315nm, and far ultraviolet (UV-C)-100nm – 280nm.

Visible Radiation is radiation that is visible to the human eye. The wavelengths are from 400nm – 700nm. At these wavelengths the eye can focus the light onto the retina increasing the radiant exposure by 100,000 times.

Wavelength the property that differentiates different spectrums of energy within the electromagnetic spectrum of energy is wavelength. The wavelength of light is measured in billionths of a meter, or nanometers (nm). The energy of a wave is inversely proportional to its wavelength. In other words, the greater the energy, the shorter (smaller) the wavelength. Light of shorter wavelength carries greater the energy of the light. As wavelength becomes longer, the energy carried is less. Some wavelengths work better than others for therapy. Wavelength is the prime determinant of tissue penetration. The wavelength is very specific for cell absorption. 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 results. Each photon contains energy and just as energy of the ocean comes to shore in waves of high and low energy, the same is true of photons. Only with photons the energy is not measured by the height of the wave but the number of waves the photon carries. These waves are measured in two ways, the number of waves that will pass a given point in one second, or wavelength, the distance between one wave and the next.

A Comparison

Light Emitting Diode (LED): LED is a semiconductor device that emits incoherent low intensity light.

LED Clusters: Deliver energy superficially over broader regions.

Laser Light: Delivers photonic energy deeply and specifically

Primary Difference

The main difference is coherency.   Laser light is coherent (“coherent waveform”), which means all the light waves move in phase together in both time and space. A laser has a very tight beam that is strong and concentrated.

An LED (“incoherent waveform” ) releases light in many directions; with the result that the light is weak and diffuse.

There are many different configurations of phototherapy instruments in the market, some offering laser output only, some offering only LEDs, and – excluding LEDs that are provided for indication only – other devices combining both lasers and LEDs as active therapeutic components.  The two latter types are sometimes deceptively called “laser” with no reference made to other emitter types; this is inaccurate, at best. Often the buyer is unaware of the distinction, thinking they have bought a true laser device.

Of the hundreds of referenced and reported clinical and scientific studies and papers available, they are almost exclusively done with laser light sources as the medically beneficial light source.

In fact, even on the web sites of the leading LED light devices, the sources and references they list are not for LED therapy, but rather for laser light therapy.

Manufacturers of such devices as Bioflex, Anodyne and the Dynatron Solaris units, which are LED therapy devices, primarily use laser light studies as their medical efficacy support.

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.

While LED light therapy does have some beneficial effect, it is limited to superficial tissue treatment only.

These international laser experts and researchers agree that in comparison, laser light therapy is far superior to LED therapy, as indicated by the studies of these researchers’ published work.

Bihari – LED’s, when compared to lasers, demonstrate a much lower efficacy.

Kubota – found there was no difference between control and LED 840 nm groups.

Berki – found the positive effects from laser therapy were not seen when irradiating the cell cultures with normal monochromatic (LED) light of the same wavelength and doses.

Muldiyarov – Analyzed cases where the rats were treated with ordinary red light and found there was no essential differences from the control group.

Haina – compared to the 22% increase in positive laser effects, the increase in the incoherent (LED) group was less than 10%.

Laakso – ACTH and B-endorphin levels were significantly elevated in the LLLT groups but not in the LED group.

Pöntinen – 670nm laser induced a temporary vasodilation and increased blood flow; however, LED at 635nm with doses between 0.68 and 1.36 J/cm2 decreased blood flow at least for 30 minutes after irradiation.

Lederer – found that incoherent light of the same wavelength and power density showed no influence.

Rosner – found that non coherent infrared light was ineffective or had adverse effect.

Nicola – Non-coherent light of the same wavelength and dose was less favorable.

Onac – The therapeutic window appears to be narrower for monochromatic noncoherent light.

Zhou – laser showed the best effect while the non-coherent LED light showed the poorest. Coherency does not influence the transmission; rather, because of interference in the scattered light field, coherency influences the microscopic light distribution into tissue. While it is easier to achieve higher power density with lasers than with LED’s, this is not the general reason for the better results with lasers; the coherency of the laser light source is the most important factor behind the superior results of laser light.

“Monochromatic infrared energy therapy or monochromatic, near-infrared photo energy (MIRE™) (e.g., Anodyne® Therapy or Anodyne® Therapy System) remain unproven for all conditions, due to the lack of well-designed, controlled, randomized, double-blind trials.  In addition, there is lack of evidence of long-term health outcomes supporting the efficacy of this treatment.”

Laser Therapy surpasses LED Therapy for clinical effectiveness and results.

“The authors of Laser Therapy- Clinical Practice and Scientific Background, Dr. Jan Tun’er and Lars Hode, have performed an analysis of a number of frequently cited studies on the effects of low-power-laser therapy. Selected Quotes:

“In many of these studies, analysis uncovered one or more reasons for the negative findings reported, the most common being the use of extremely low doses.”

“The trend in laser therapy for the past 10 years has been to increase power density and dose, since this has been shown to improve therapeutic outcomes considerably.”

“There is no point in increasing the dose if the wavelength has a low penetration factor; the penetration of the particular wavelength must be taken into account.”

“For the moment, we must rely on our own clinical experience. That experience, however, is so encouraging that it cannot be ignored, even with lack of scientific support. It would appear that “high powered” therapeutic lasers will be able to further expand the scope of laser therapy.”

“I can see two alternatives for myself: to speak up and start a conflict within the laser community, maybe discrediting the therapy itself in the eyes of the general public or to keep quiet and let US practitioners pay a lot of money for very low-powered lasers, leaving us with dissatisfied customers and discredit from those who are supposed to use laser therapy in medicine.”

The laws of laser physics have demonstrated that the higher the wavelength, the deeper the penetration. Penetration is paramount in order to stimulate deep musculoskeletal, vascular, lymphatic, and neurological structures.

If Class III lasers are therapeutically ineffective, it is because of insufficient energy or dosage, combined with poor penetration.

“While the FDA has approved the marketing of the device, many payers have

declined to provide recognize LLLT as effective treatment. Results of treatment have not been consistent so that it is difficult to state that such treatment would be necessary. Last, given the reported number of visits required to be nine to 12 visits, the cost of such treatment would be approximately $1000 to $1500. These costs appear to be somewhat unreasonable for a treatment that has not been demonstrated in the medical literature to be effective.”

Source:  Position Paper on Low Level Laser Therapy (LLLT) 12 pages

Ohio Bureau of Workers’ Compensation

“Aetna considers cold laser therapy experimental and investigational because there is inadequate evidence of the effectiveness of low-energy (cold) lasers in wound healing, pain relief, or for other indications such as musculoskeletal dysfunction, arthritis, and neurological dysfunctions.”

Source:   Aetna: Clinical Policy Bulletins, Number 0363, Subject: Cold Laser Therapy

Class IV lasers offers better therapeutic outcome, based on six characteristics of this new technology:

Larger dosages of therapeutic energy. Class IV lasers can deliver up to 1,500 times more energy than Class III and consequently reduce treatment time.

Deeper penetration into the body. Leading Class III lasers only penetrate 0.5-2.0 cm2. Class IV can penetrate up to 10 cm2.

Larger treatment surface area. Class III cover a treatment area of 0.3-5.0 cm2, depending on the model and manufacturer. Class IV cover up to 77 cm2. This is important when treating large regions, such as the lumbar spine, quadriceps or hips.

Greater power density. Power density indicates the degree of concentration of the power output. This property has been shown to play a major role in therapeutic outcomes.

Continuous power supply. In Class III lasers, the power is pulsed or modulated approximately 50 percent of the time. In other words, light is permitted to pass through the probe for only 50 percent of the total operating time.

In most cases, Class IV lasers deliver a consistent amount of energy over a given time. Their power can be adjusted for acute and chronic conditions.

Superior fiber optic cables. Fiber optic cables transmit laser energy from the laser to the treatment probe (wand) at the end of the cable.

Several studies reveal that as much as 50 percent of the light energy generated by a Class III laser may be lost by the time it reaches the end of the probe.

• Pain-free treatment
• Heals Naturally
• Affordable
• Easy-To-Use
• Controls Inflammation
• Speeds Healing
• Accelerates pain relief
• Safe and Effective
• Increases joint flexibility
• Drug-Free
• Surgery-Free
• Non- Invasive

Unlike injections and prescriptions which just mask the symptoms and do nothing to treat the injury, High-Intensity Laser Therapy delivers light energy units, in the form of photons, to damaged cells. These photons, absorbed by the cells through laser therapy stimulate the mitochondria to accelerate the production of Adenosine Triphosphate (ATP). This biochemical increase in cell energy is used to help transform cells from a state of illness to a stable, healthy state. The result is it reduces inflammation, increases blood flow, stimulates tissue growth, and helps aid the body’s own healing process.

WORLD CLASS MEDICAL LASER PRODUCTS

• High Intensity Laser Therapy (HILT)
• Dual Wavelength Technology (TRUE DUO)
• Multiple Laser Models (SMART CHOICE)
• Laser Upgrade Technology (UPGRADE PLUS)

FINANCIAL SERVICES AND PROGRAMS

• Leasing Programs to Maximize ROI
• Cash Reimbursement Strategies
• Patient Credit Services
• Qualified Tax Savings Program

CUSTOMIZED PRACTICE MARKETING

• Berman Medical Center For Laser Therapy
• Customized Marketing Solutions

COMMITTEMENT TO CUSTOMER SERVICE

• Excellent Warranty Programs
• USA Based Service and Repair Center

CUTTING EDGE RESEARCH

• Berman Medical Lasers Sponsored Clinical Studies
• NeuroLaser Foundation Sponsorship

COMPREHENSIVE TRAINING, CERTIFICATION AND EDUCATION

• Berman Medical Lasers Sponsored Product Training
• American Academy of Laser Therapy Clinical Training and Certification