Maximizing Efficacy in PBM
For many years, cold laser practitioners have been saying that they need a hand-free and safer way to apply larger doses of light like a you get with class-4 laser systems but with less risk of eye/tissue damage. The holy grail is to do this unattended (to reduce the cost) with a very high safety standard. In the cold lasers world, there are 6 basic concept of what makes a PBM device a great system.
1. Selecting the Best Wavelengths: The ReGen Pod uses similar wavelengths to those that are proven in the cold laser industry (see below).
2. Controlling the Dosage: The key is having enough power to get to a target dosage in a reasonable time. With the ReGen Pod's higher power, adjustable power level and multi-phase programs, user have total control over dosage.
Pulsing Control: Many PBM users that have worked with major laser equipment manufacturers like Avant®, Biolight®, Erchonia®, Multiradiance® and Theralase® have felt that controlled pulsing is key to success. Many of these companies also provide complex pulsing with independent diode control. The ReGen Pod takes this concept to the next level by allowing simultaneous pulsing at different pulsing frequencies for each wavelength.
3. Great programs: There are lots of books available that specify laser programs but many of them are hard to adapt between devices. The better laser systems have internal programs and some systems like the Eltech Klaser and the EVOlaser adapt the programs to the users skin color and size (following the best practices in PBM). The ReGen Pod can takes this ideas further because it is cloud connected. The ReGen Pod includes full turnkey internal programs that are adapted to the user skin color and size and it allows for 3rd party programs to be downloaded onto the pod. This means that if some develops the ultimate program, it can be instantly downloaded to the ReGen Pod.
4. Upgradability: PBM technology is is a rapidly changing field. Many older hardware-based systems are underpowered, inflexible and out-of-date when you buy them and others are just slowly getting more and more out-of-date every day. Because the ReGen Pod is a cloud connected device, it is always 100% up-to-date and it is continuously improving.
5. User/Program Tracking: A few higher-end systems like the Eltech Klaser offer user tracking but the ReGen Pod takes the concept even further because the system allows for user feedback. By polling users before and/or after a session (optionally through their phone or the kiosk), the ReGen Pod allows a constant feedback loop on the performance of the programs. The data from each user can be used to constantly improve the performance of the system through anonymous statistical process control.
When you look at the world of cold lasers systems, it is easy to see that the best systems typically give users more power, programmability and flexibility. The ReGenPod solves all the typical cold laser problems by combining 4 independently controlled wavelengths that can be turned off, turned on in a continuous wave (CW) or pulsed at any frequency between 6Hz and 6000Hz. The multi-step programs allow users the maximum flexibility to include multiple steps with different pulsing frequencies in one program and the user tracking system ensures that the system is constantly improving. The following table shows how the ReGen Pod stacks up against traditional therapy lasers.
| Criteria |
Class 1 Cold Laser | Class 3 Cold Laser | Class 4 HILT Laser | ReGen Pod |
|---|---|---|---|---|
| Risk of Eye Damage | Almost Impossible | Low | High | None |
| Risk of Tissue Heating over 45° C* | None | Low | High | No |
| Typical Dosage (in 15 minutes) | Low | Medium | Medium to high | Medium to very high |
| Flexibility in Pulsing Frequency Input | Higher-end lasers only | Higher-end lasers only | Higher-end lasers only | 4 independently controlled pulsing frequencies> |
| Unattended Operation | Yes | Sometimes | Rarely | Fully self service |
| Skill Level Required for high efficacy | Sometimes high efficacy can not be achieved with low dosages | Medium | High | Low, easy to customize |
| Inter-diode & Inter-wavelength Pulsing | Erchonia and Biolight inter-diode | Avant inter-diode | Rarely | Yes, inter-wavelength |
| Adapts for skin color and size | Not critical because of low power | Rarely | Eltech Klaser, EVOlaser | Yes, optional |
| Multi-Step programs | None | Rarely, Avant | Eltech Klaser, EVOlaser | Yes, unlimited steps |
| User Tracking | Rarely | Rarely | Eltech Klaser, EVOlaser | Yes and accessible through app |
*Part of the requirement for FDA clearance of a laser based on product code: ILY is based on testing the system to show that it will maintain the skin temperature at 40° - 45°C in a standard 10-minute test. This test does not specify a distance between the light source and the skin and this distance has a huge impact on the skin temperature. To pass this test with Class-4 lasers, they space the laser at a distance away from the skin to maintain a consistent temperature in this range. Unfortunately, most lasers are not used at the "test" distance so higher power systems be kept moving or the skin must be cooled to avoid excess temperatures. The potential for overheating can be much worst if the test subject has darker skin. Using a device with a lower power density like the ReGen Pod eliminates the chances of exceeding 45°C.
PBM Wavelengths and The Optical Window
Much of the theory for cold lasers and PBM is based on which wavelengths can travel through tissue most efficiently and stimulating the release of adenosine triphosphate (ATP) from the mitochondria. There has been a lot of research in this area and some of the research can be summarize in a graph showing the optical window (left graph). This graph is republished from the book Laser Field Therapy by Anja Fuchtenbush, Volmar Kriesel and Peter Rosen. This group has published many of the most complete resources in laser therapy and we have a lot of respect for these PBMT leaders. In this graph, we can see that the optical window (also called the therapeutic window) is the range of wavelengths that provide the best depth of penetration AND the desired reaction with the mitochondira. I added the purple line to show the transition frequency where water starts to become the dominant photonic interaction. In this graph, we can see that some wavelengths are much better at traveling through tissue and other are absorbed with less benefit. As we approach the lower end of the wavelength graph, we see that more of the energy is absorbed by melanin and then hemoglobin in the blood. As we approach the higher end, we see that water is absorbing much of the energy. Any energy that is absorbed by water can not be converted in to chemical energy.
As we see in the graph, higher wavelengths can result in up to 100% of the energy being absorbed by the water in tissue. This is not PBM, this is a thermal process that has some benefit by increasing circulation and dialating bood vessels. In some cases, this is desired but it is not a photo-chemical reaction like we are typically wanting in PBM. The design of the ReGen Pod is based on the optical window and our pod uses carefully selected wavelengths that provide wavelength diversity while properly balancing the absorption and photochemical response that we want from PBMT. We strategically avoided any "trendy", exotic or unproven wavelengths that some manufacturers use to make their product more unique. If you want a system based on alternate wavelengths, we will custom build one for you.
From the above table is easy to see that the most established wavelength for use in laser therapy is 810nm. In general 810nm wavelength diode are much more expensive that similar wavelengths so manufacturers are using 810nm because it has higher efficacy.
In the graph above, we also see that 940nm can be a good choice because it is before the rapid slope increase where the energy is mainly absorbed by the water in human tissue. By staying at 940nm and below, we get wavelength diversity while avoid wasting energy that would be absorbed by water in a thermal reaction and not a chemical reaction. At 940nm, we feel the ReGen Pod give users the maximum flexibility to match the performance of High Intensity Laser Therapy (HILT) class-4 systems and our system avoids the lower efficiency wavelengths above 940nm illustrated in the graph.
Digging Deeper
The following is a summary of table of many of the most credible therapy laser manufacturers. Let look at what the experts are using to get the best results. Then we will dig into each band and see why it might be appropriate for a pod.
| Manufacturer | Class | Wavelengths |
|---|---|---|
| Thor® | 3b | 810nm, 630nm |
| Apollo® | 4 | 810nm Only |
| Avant® | 3b | 808nm primary, 637nm secondary |
| Chattanooga® Vectra Genysis | 3b | 850nm |
| 3 B Scientific® /MKW® | 3b | 810nm primary, 635nm secondary |
| Cutting Edge® | 4 | 810nm Only |
| Omega® | 3b | 820nm primary |
| Eltech Klaser® | 4 | 800nm, 905nm, 970nm, Secondary 660nm |
| Pilot® Laser | 4 | 810nm |
| LiteForce® | 4 | 980nm primary 810nm secondary |
| Microlight® | 3b | 830nm |
| LiteForce® | 4 | 980nm primary 810nm secondary |
| PowerMedic® | 3b | 810nm Only |
| Erchonia® and Biolight® | 2 | 633nm and Violet |
| EVOlaser® | 4 | 810nm primary 980nm, 910nm and 633nm Optional |
Near Infra Red (NIR)
This graph clearly illustrates that 650nm to 900 nm is the recommend wavelength for PBMT because it minimized undesired absorption and that wavelengths like 808/810nm are a great option for deep penetration PBMT applications. Many cold laser companies offer other wavelengths to supplement this wavelength but 810nm is one of the most common in the world of cold lasers. The table below shows some the the market leaders in laser therapy and which wavelengths, they use. Also, in publications from Dr. Morris and Dr. Hamblin, 800nm to 860nm is discussed as one of the best wavelength because it produces a great balance between depth of penetration and the strongest interaction with the mitochondria. Here is more published research analyzing different wavelengths. The ReGen Pod combines 810nm and lower cost 850nm diodes to provide a good balance between optimizing the wavelength and managing the cost. Here is a table of some of the leaders in the cold laser market.
Near Infra Red (NIR)
In the cosmetic industry, the requirements are very different . For this market, device designers use 600nm to 660nm as the primary wavelength because they want to maximize how much of the energy is absorbed by the melanin close to the surface of the skin. In general, red light systems are best for treating acne, rashes, wrinkles, wounds, abrasions and other superficial issues. In fact, you will find most cosmetic devices on Amazon are based on red LEDs. Even though it is not a good primary wavelength, Red is can be a good secondary wavelength in the cold laser market. There are several cold laser companies that work primarily in the 600nm to 660nm range. Both Biolight and Erchonia use 633/630nm as a primary wavelength. These companies are unique because they do low dosages and put the emphasis on the pulsing. If pulsing is the key to success in some programs, then pulsing visible red light (600nm to 680nm) is probably the best wavelength for these applications. When designing the ReGen Pod, we wanted to give users maximum flexibility so we included 633nm and gave users total control over the pulsing of each wavelength.
Near Infra Red (NIR)
As the non-profit Skin Cancer Foundation says on their website, " it was once thought that only UVB was of concern, but we keep learning more and more about the damage caused by UVA." . In the published research: "Low-level laser (light) therapy (LLLT) in skin: stimulating, healing, restoring" by Pinar Avci, MD, Asheesh Gupta, PhD, Magesh Sadasivam, MTech, Daniela Vecchio, PhD, Zeev Pam, MD, Nadav Pam, MD, and Michael R Hamblin, PhD - 2014, they state "It is widely accepted that the UV range (< 400 nm) exposure is responsible for almost all damaging photo-induced effects on human skin." In case you need more info, The Journal of Biological Chemistry published "Blue light induces mitochondrial DNA damage and free radical production in epithelial cells ." by Bernard Godley, Farrukh Shamsi, Fong-Qi Liang, stuart Jarrett, Sallyanne Davies and Mike Boulton. Since the underlying concept of PBM is to push light into the mMitochondia, blue light seems like a bad choice. Although there have been some positive studies associated with blue wavelengths of light, we do NOT include blue wavelengths in the ReGen Pod because of the possible health risks.
950nm and Up
There are some therapy laser manufacturers that use higher wavelengths claiming among other things that a bigger number is always better. Some of these system seem to exist because the diodes are cheap since they are used in other applications (like surgical laser). As seen in the graph above, wavelengths above 950nm are great at heating water. In the published paper The 980-nm diode laser for brain surgery: histopathology and recovery period by Ozguncem Bozkulak, Hasim Ozgur Tabakoglu, Ayla Aksoy,Ozlem Kurtkaya, Aydin Sav, Resit Canbeyli and Murat Gulsoy, the first sentence in the publication is "The 980-nm diode laser has been under investigation for neurosurgery because of a local peak in the absorption spectra of water around this wavelength." Although generalized heating has some health benefits like increased circulation, any energy that is converted into heat (in the water molucules) is not turned into chemical energy. For these reasons, we avoid using wavelengths above 950nm for PBMT but we invite you to do your own research.
