Laser Diode Selections in the Luminex® Laser System

Overview
This paper provides background information on the reasons for using laser diodes with wavelengths of 830, 867nm,
and 670 nm in the Luminex® Systems. How are Laser Diodes Used?
Laser diodes are used in industry and medicine to generate laser light from 360nm to 25,000nm. This is an extremely
broad range of products, but the applications for laser diodes fall into five or six major categories. The list shown
below indicates where laser diodes find application.

635-690nm In the visual light range, diodes are used in medicine to generate light for Photo Dynamic Therapy (PDT),
bar code readers and for pumping metal vapor gas lasers. The term pumping means to use laser diodes to generate
laser light at a specific wavelength that, in turn, starts up a more powerful gas, dye, or tunable solid state laser. In
effect, laser diodes at a variety of wavelengths start-up or pump more powerful lasers.
785nm Pumping exotic metal YAG laser systems.
808nm Pumping Nd:YAG laser systems 830nm In general use for laser printers, laser readers.
904nm Short pulse laser diodes are commonly used in ranging (measuring distances). Continuous wave 904nm
diodes are used in the military for target illumination.
940-980nm Pumping exotic metal, dye or tunable laser systems. 1300-1550nm Fiber optic communications is the
main use. > 1550nm Pumping highly exotic laser systems

A laser diode has never been produced specifically to generate laser light for use in Low Level Laser Therapy (LLLT).
Laser therapy manufacturers have been using whatever laser diodes were available from industrial, military or medical
applications. For these applications, the laser diode's wavelength, and various other important parameters, were
carefully matched to the design needs of printers, fiber optic transmission systems, ranging systems, target
illuminators or PDT. Nothing has ever been done to manufacture laser diodes with the wavelength, half power points,
slope efficiency and power output required to optimize LLLT treatment.

A Laser Diode for LLLT

The Luminex® System has been designed with output powers up to 500mW (average power). A 500mW laser diode
generates a great number of photons and the treatment time is far shorter than using a diode with less power. Jan
Tuner and Lars Hode indicate the advantage of irradiating with higher power lasers is that their photobiological effect
is greater and, consequently, the therapeutic effects are felt more quickly and at greater depth.They make the
following observation: "The (research) literature supports the hypothesis that higher power density yields better
clinical results."

Second, the Luminex® System has been engineered to deliver high output power per unit of current, resulting in less
heat dissipation, a direct cause of laser diode failures. High efficiency laser diodes result in longer mean time to failure
rates. Third, the laser diode in the Luminex® System has a narrow spread of wavelength at the half power points,
providing a sharp peak output power (intensity) with little side lobs (wavelength). The result is maximum output
power at one wavelength with the half power points, perhaps at ±5nm from the center.

Fourth, the Luminex® System has chosen a wavelength with ideal penetration characteristics, using higher energy
photons to accomplish this work faster. As demonstrated by our laboratory tests, the amount of forward light scatter in
tissue is high at 904nm. In shorter wavelengths, the energy of the photons and their absorption nearer the surface of
the skin is increased while the amount of deep scatter of laser light is reduced.

Ohshiro summarized the comparative transmission of laser wavelengths in tissue, in vivo, and found
that the absorption and penetration characteristics of laser light in the 830nm and 904nm window
was preferred as a clinical LLLT tool. The summary compared the absorption and penetration
characteristics of laser light from argon-pumped dye lasers at 488-514.5nm to carbon dioxide at
10,600nm. Another notable reference is the Ohshiro & Calderhead report on the relationship
between penetration of laser light and wavelength. The report eliminates the absorption component
and gives us a clear picture of the penetration, or deep scatter, of laser light. The peak penetration
occurs at about 904nm, which supports our laboratory depth of penetration work.Over the years,
researchers have studied laser light absorption at various wavelengths in different media, i.e., water,
skin, liver, and blood. From Charschan's report (see table below), typical values of absorption
coefficients can be obtained for some basic components of the human body at selective
wavelengths:Absorption Coefficients vs. Λ (cm-1)
 the large spread in
absorption coefficient values in the table above. The absorption factor for water increases rapidly with longer
wavelengths from a valley at about 660nm. At 660nm the absorption factor is approximately 0.0073 cm-1. In the
region near 860 to 870nm, the absorption value has jumped 40 fold to about 0.30 cm-1. Similar jumps in absorption
factors can be observed for all of the components as wavelength increases.

In summary, due to good forward scatter (depth of penetration) and good absorption (a higher proportion of photons
are absorbed) wavelengths between 860 and 870nm are highly desirable. Shorter wavelengths (860-870nm) have the
advantage of creating photons with more energy per photon, bringing more energy to the cells being photoactivated.

Selecting a Laser Diode for LLLT

The shape of the intensity of the laser light output vs. the wavelength further supports the choice of the 867nm laser
diode. In general, a sharp intensity peak at one wavelength with little spread is the most effective. The laser diodes at
867nm only spread ±1.8nm at the half power points, a low value. This means no jagged or odd shaped, multi-
wavelength power spikes in the power output, rather a pure beam of laser light at one wavelength. These desirable
characteristics can be traced to the purity of the elements and compounds used in the fabrication of the laser diodes, as
well as the lack of contamination in the clean room assembly process.

Many LLLT professionals express an interest in the spot size of the laser beam; some prefer tight, narrow beams
(focused), whereas others prefer a spread beam. The Luminex® System utilizes a 500mW diode. The laser light
output is 500mW (average power) measured at the lens of the diode. The laser light generated within the diode itself is
from a pinpoint source measuring 1µm by 50µm; with laser light generated from a narrow slot called the emitter
aperture. The light generated from this pinpoint source is dispersed in a wide elliptical pattern from the front lens. This
spread of laser light, or beam divergence, is characterized by two divergent angles. One is parallel to the "slot" and the
other perpendicular to the "slot", corresponding to the full angle at the point that is ½ of the peak power. The beam
divergence of the Luminex® System's 867nm diode is 8° by 35°, a narrow beam in one axis and a wide beam in the
other axis. The distribution of light intensity follows a Gaussian curve wherin the laser light is highly concentrated at
the center and grows progressively weaker as one moves to the edges of the ellipse. The power density represents an
average for the entire spot size area. Because of the Gaussian distribution of light over the area being irradiated, a 500
mW laser is effective for LLLT professionals desiring high laser light intensity, with the greatest amount of laser light
concentrated at the center of the spot.

Laser Penetration Through Fabric: Why we Recommend the Contact Method.

Medical Laser Systems' engineers did a study to observe what happens to laser output when laser light is shined
through clothing. Using both an infrared 867nm laser diode and a red beam 670nm laser diode, the engineers used a
cotton t-shirt to demonstrate the dramatic power loss when laser light is shined through fabric.

Wavelength mW without t-shirt mW through t-shirt % Loss

867nm 500 140 72%
670nm 507 109 79%

This CLEARLY indicates that although some laser light penetrates through clothing, the power output is severely
decreased. If you were to attempt to treat through heavier fabric, such as dungarees or sweatshirts, the laser energy
reaching the skin would be even lower. If you are using a low powered laser with a 5 or 10mW diode and lose 79% of
that power by treating through clothes, you are left with only about 1mW of power reaching the skin.
This is why we recommend that practitioners doing laser treatment always use the "contact method", with the laser
probe in direct contact with bare skin.

Laser as a Therapeutic Tool

Lasers have been used safely as a therapeutic tool for over 30 years. Laser Therapy (LT) differs from the use of lasers
in surgery due to a lower output power and reduced energy density. Instead of ablating tissue, LT stimulates cellular
activity that improves the speed and quality of healing. In over 1,800 publications worldwide, LT has demonstrated its
non-invasive, non-toxic quality, and its ability to augment and in some cases, replace, pharmaceuticals and surgical
intervention. LT is most often used as a primary medical treatment, but is also effective as a complement to other
modalities, such as needle acupuncture and chiropractic adjustment. Acupuncturists, Chiropractors, Physical
Therapists, Dentists, Osteopaths and M.D.'s currently use LT for a variety of problems; including the treatment of
acute pain and chronic degenerative conditions, improving the speed and quality of wound healing, and for muscle,
tendon and ligament injuries.

Laser Therapy as a Healing Stimulus

Lasers commonly in use for LT operate at a wavelength between 600 and 1060 nanometers (nm). Laser devices in this
range are known to be safe because they do not include wavelengths in the lower end of the spectrum, which includes
X-RAYs and Gamma Rays that cause destructive ionization in the cell. The first lasers used for LT were gas-tube,
helium neon lasers at 632nm. Developed in the 1960's, these lasers were very expensive to purchase and too difficult
to operate, limiting their availability to just a few well-financed researchers. In the 1980s however, technological
advances allowed for the emergence of relatively inexpensive laser diodes with a wide range of wavelengths. Many
Therapeutic Lasers were developed and sold during this period, but were all very low power, around 1 miliwatt(mW).
The development of devices for LT has proceeded in such small steps because rather than being driven by the demand
for LT devices, the production and availability of laser diodes is driven by the massive demand for laser diodes in
technology such as compact disc players, laser scanners, and for a wide range of defense applications. As these
technologies matured in the 1990's, they were able to handle much higher power outputs, as high as 500mW, resulting
in shorter treatment times for LT applications. The availability of more powerful lasers for LT allowed for the
treatment of a number of new conditions, and may explain some early clinical studies that showed non-significant
results using LT with very low power, sometimes less than 1 miliwatt(mW). Typical power outputs of diode lasers
currently available range from 50mW to 500mW.

Wavelengths and Impact of Penetration and Absorption

Portions of these diode laser wavelengths are visible, from 600 up to approximately 780 or 820 nm. Humans have a
declining ability to see light above approximately 820nm. Photon energy increases as the wavelength decreases;
conversely, penetration through the skin increases as wavelength increases. Thus, certain conditions may benefit from
lower wavelengths where most of the energy is absorbed at the surface, and other conditions may benefit more from
higher wavelengths that permit deeper penetration. It follows that an ideal wavelength for treating most conditions
would be in the midrange.
LT in the Literature

Below we summarize the wide range of effect of LT. A lengthy bibliography can be accessed by downloading or
viewing our Laser Bibliography PDF file. More reference can be located by viewing our Links page that connects you
to a wide range of sites with even more literature citations.

Cellular: Cellular homeostatis of the mitochondria is modified by laser irradiation, promoting a cascade of events in
the respiratory chain of cytochromes, cytochrome oxidase and flavine dehydrogenase that permit absorption of light.
The redox status of both mitochondria and cytoplasm are impacted, resulting in improved production of ATP. When
cellular membranes are irradiated, the flow of the membrane ion carriers sodium and potassium are altered, affecting
the movement of calcium between cytoplasm and mitochondria. (Karu)1 . Recent study by (Naviaux)2 et. al.
Demonstrate the affinity of varying mitochondria to varying wavelengths, promoting an enticing model which
matches mitochondria of one tissue type with its most effective laser wavelength. (Naviaux) Cell proliferation,
motility and secretion are altered when irradiated with laser with specific wavelength, intensity and dose.(Basford)3

Improved micro-circulation after laser irradiation promotes accelerated recovery after injury, resulting from reduced
arteriolar and venular vessles and improved blood-flow in nutritional capillaries and activation of angiogenisis. (Zhao4
, Skobelkin5 , Kozlov6 ,and Telfer7 )
Collagen synthesis, proliferation of fibroblasts, faster edema reduction and enhanced lymph flow from LT can
accelerate recovery after trauma, through improved edema resolution, regenerated blood and lymph vessels and
tendon strength (Lievens8 ).

The improvements induced by laser on collagen production lead to significant increases in collagen content and tensile
strength of wounds at one and two weeks following laser treatment (Lyon9 , Abergel10 ). Similarly, (Braverman11 ) and
(Enwemeka11) found improved tensile strength in laser treated wound and tendon groups. Also, Enwemeka found that
Laser Therapy not only improved the rate of healing; but led to a better quality of healing. Shoulder tendinitis showed
statistical improvement after LT (England12 ).

Beneficial Effect on Nerve Cells and the Production of B-Endorphins

Laser light has a highly beneficial effect on nerve cells which blocks pain transmitted by these cells to the brain.
Studies have shown that laser light increases the activity of the ATP-dependent NaK pump. In this case, laser light
increases the potential difference across the cell membrane moving the resting potential further from the firing
threshold, thus, decreasing nerve ending sensitivity. A less understood pain blocking mechanism involves the product
of high levels of painkilling chemicals such as endorphins and enkephalins from the brain, adrenal gland and other
areas, as a result of stimulation by laser light. Lombard concluded that the neuropharmacological analgesic effects of
lasers are likely due to the release of serotonin acetylcholine at the site and in higher centers. This pharmacological
effect leads Baxter to conclude that laser is the premier pain reliever compared to other electro-therapeutic modalities.

How is Laser Therapy Administered?

LT is usually conducted in an outpatient clinic setting, and requires no unusual equipment or precautions except that
safety glasses are normally recommended for the patient and therapist. In the United States, the Food and Drug
Administration (FDA) requires that laser devices be measured at a distance of 20cm, through a 7mm aperture stop;
this measurement is applied to the laser's label. This standard measurement permits the therapist to assess the potential
for eye hazard.

The laser is held against the skin in a contact mode (Oshiro ), applying the maximum amount of laser light to the area
of consideration. Many therapists recommend applying light to firm pressure to the area to distress the underlying
blood vessels and tissue to improve the penetration of the energy. The laser is applied at a given power output for a
specified period of time, to deliver the proper amount of laser energy, measured in joules. Dosages can range from 1
joule up to 30 or more, depending upon the condition being treated and the schedule of treatments. A wavelength is
chosen which meets the absorption requirements of the condition, with wounds and aesthetic conditions benefiting
from higher absorption (lower wavelengths), and deep tissue benefiting from deeper penetration (higher wavelengths).
Normally, multiple treatments are needed to resolve chronic conditions and injuries. Laser can be directed to
acupuncture points, trigger points, nerve endings and directly to the specific injury. Recent findings conclude that,
with few exceptions, patients do better when treatment begins as quickly as possible.
1
Karu, T. Molecular mechanism of the therapeutic effect of low-intensity laser irradiation. Lasers in the Life Sciences,
1988:;2:53-74.
2
Naviaux, Robert K. Mitochondrial Metabolism and the Injured Cell Response to Near Infrared Light, at the
N.A.A.L.T, April 5, 2003, Bethesda, MD..
3
Basford, J. Laser Therapy: Scientific Basis and clinical role, Orthopaedics, 1993;16:541-547.
4
Zhao, Y, Yasudam S, Yamamoto M, et al. He-Ne lasr irradiation against rat adjuvant arthritis. Jap J Assoc.
Phys. Med. Balneol Climatol, 1990;53 No. 2:95-100.
5
Skobelkin O, Kozlov V, Litwin G, et al. Blood microcirculation under laser physiotherapy and reflexotherapy in
patients with lesions in vessels of low extremeties. Laser Therapy, 1190; 2 No.2; 69-77.
6
Kozlov V, Terman O Builin V,et. al. Structural and functional basis at laser microvessels interaction. Proc of SPIE,
1993:48-55
7
Telfer J, Filonenki N, Salansky N. Leg ulcers: Plastic surgery descent y laser therapy. Proc of SPIE, 1993;2086:258-
261.
8
Lievens, P. The influence of laser irradiation on the motricity of lymphatical system and on the wound healing
process. InLT. Congress on Laser in Medicine and Surgery, Bologna, June 26-28, 1985.
9
Lyons R, Abergel R, White R, et al. Biostimulation of wound healing in-vivo by a helium neon laser. Annals of
Plastic Surgery, 1987;18:47-50.
10
Abergel R, Lyons R, Castel J. Biostimulation of wound healing by lasers: experimental approaches in animal models
and fibroblast cultures. J Dermatological Surgery Oncology, 1987;13:127-133.
11
Enwemeka, C. Rodriquez O., Gall N., et. al, Correlative Ultrastructural and biomechanical changes induced in
regenerating tendons exposed to laser photostimulation. Lasers in Surgery and Medicine, 1990: (Suppl.2)" 12-19.
12
England S, Farrell J, Coppock G, et al. Low power laser therapy of shoulder tendonitis. Scand J Rheumatologoy,
1989;18:427-431.
13
Baxter D, Bell A, Allen J. et al. Low Level Laser Therapy. Current clinical practice in Northern Ireland.
Physiotherapy, 1991;77:171-178.
14
Oshiro, T. Low Level Laser Therapy, Wiley and Sons, Bath Press, Avon, U.K., 1988, p.16.

Luminex® Laser Therapy System, Patent Pending

Developed after extensive research and testing, the Luminex® Laser Therapy System
possesses unique technological characteristics that make it ideal for LLLT.

Made of indestructible medical-grade plastic and aluminum, the attractive computerized

control unit, approx. 10" x 10" x 4", fits nicely on a small equipment table.

The Luminex® is equipped with a powerful optical-quality 500mW probe, appropriate for the typical
clinical setting where treatment sessions last less than one hour. Powered by a Gallium Aluminum
Arsenide laser diode, probes is available in several wavelengths, 670, 830, 867 and 904nm.

A laser power meter accurate within 2% allows users to check the probe's power output before beginning
treatment.Lithium Ion batteries power the portable version which permit the therapist to move from place to
place without having an electrical outlet available. The batteries last approximately 10 - 12 hours of use
prior to needing recharge. The recharge takes place in apprixomately 8 hours.

An audible tone signifies each joule/cm² of energy output, allowing easier measurement of the dosage
delivered by the laser probe.

Users can choose from the pre-set Nogier frequencies or Continuous wave at the touch of a button on the
control panel. Two pair of safety goggles are provided, blocking 99% of laser light between 904 and 670nm.

Optional Card Reader System permits realistic sham treatments and double blindingOptional LUCID Probe
Tip reduces laser aperture to 3mm for use on acupuncture points.

Technical Specifications for Luminex® Laser Therapy System

Weight: 4.2 lbs. Size (Power/Control): 10.5" W, 10.5" D, 4" HSize (Laser Probe): 1.25" Diameter x 7"
longLaser Type & Wavelength: Gallium Aluminum Arsenide (GaAlAs) @ 867, 808 and 670nm, and
Gallium Arsenide at 904nm.

Pulse Width: When operated at pulse settings F1 through F8, and P1 through P5, the laser light is
interrupted by 2 µsec pulses. At the continuous wave setting (CO), there is no pulse interruption.

Laser Spot Size: Spot size is the area of the beam measured at the lens, expressed in cm2, based upon a
production sample of 10 units. The average spot size is 1.04cm2Laser Class: BRH Class IIIb

Average Laser Power Output: A minimum of 500 mW measured at the lens of the HPLP. (Please note that
the Power Output shown on the Danger Warning logo is the power measured in accordance with NCDRH
regulations CFR21 part 1040.10.)

Power Supply: Wall mounted unit. Input: 120VAC @60Hz, 1.3A; Ouput:12VDC, 0.325A

Laser Safety Glasses: Infrared glasses are plastic body, blocking in excess of 99% of laser light at 670, 808,
867, and 904nm.
Technical Specifications for 500mW Laser ProbeIn addition, the power density (at 1.04cm2) and energy
density (for 2 seconds) is also shown for the Luminex® at 500mW.
Protocols

Medical Laser Systems, Inc. will continue to provide the latest studies and publications relating to laser
therapy protocols to promote effective laser therapy. Visit our site often to take stay up to date with your
protocols. These references are provided for information purposes only, and are not intended to render
medical advice or promotion of the usage of Medical Laser Systems laser product.

Margaret Naeser, PhD, provides a suggested protocol for treatment of Alopecia Areata. in particular
conditions within the last two years where hair has come out in "bunches."
WALT (World Association for Laser Therapy)ses dosage recommendations for 780-860 nm lasers to treat
common musculoskeletal conditions.
WALT (World Association for Laser Therapy) releases dosage recommendations for 904nm super-pulsed
lasers to treat common musculoskeletal conditions.

Recommendations for treating Pain, from Dr. Kevin Moore, Dept of Anesthesia, Royal Oldham Hospital,
UK. Dr. Bill Kneebone discusses Laser Therapy and pain relief strategies in Practical Pain Management.

National Acupuncture Detoxification Association's(NADA) acupuncture protocol is used around the world
to help people deal with and recover from substance abuse. This protocol is useful for all types of addictions,
including smoking, food, and all types of controlled substances.Dr. David Williamson, Chiropractic
Physician shares his treatment guidelines using laser for common conditions. Dr. Jan Tuner shares his
recommedations for treating TMD and TMJ with laser.Ann Thelander, A.U.A. (Dipl Physio) discusses
lymphoedema and provides a protocol for treatment of lymphatic obstructions using laser therapy. This can
be helpful for patients who are recovering from radiation therapy caused lymphedema.