1. The Truth About Laser Therapy
Presented by
“Avicenna Laser Technology, Inc. ”
Inventors of “Class IV” Laser Therapy
PHYSICIAN WEBINAR

2. Today’s Moderators:
Bruce R. Coren, DVM, MS
Cofounder, Chairman & CEO
Avicenna Laser Technology
Joseph Costello, DC. DABCO
Chief of Clinical Services
Avicenna Laser Technology
(Please hold all questions till after the presentation is over)

3. Today’s Format
• Please hold all questions till after the presentation is over as we
will answer all of your questions
• You can raise your hand by clicking the icon when you have a
question or
• You can also type in a question and submit it

4. HPLT – High Power Laser Therapy
• HPLT (Class IV) was first introduced to the medical field in 2002 by
Avicenna Laser Technology, Inc. Avicenna invented and developed
the first High Power Therapeutic Laser to receive FDA clearance,
in 2003.
• Up until that time only low power therapeutic or cold lasers
where available.
• The first therapeutic laser system we developed was capable of
delivering healing laser energy to depth’s never before achieved
in the field of laser therapy.
• It was developed to allow physician's of all medical disciplines the
capability to heal injuries previously refractive to traditional
medical care.

5. The Design of the Avicenna Laser
• The Avicenna laser was designed from the ground up to
be a therapeutic medical laser.
• It was developed using research by our own biomedical
engineers , specifically James Ohneck, the other
Cofounder of Avicenna, physicians, and most recently
collaboration with the medical school and optics
department at the University of Toledo.
• We investigated important criteria such as wavelength,
power output and power density, optics and beam
delivery, in order to safely produce the greatest
penetration and delivery of a therapeutic dose of laser
energy capable of stimulating tissue healing in deep
seated pathologies.

6. The Design of the Avicenna Laser
• All of our lasers have there own research to
support our claims as well as being tested in our
patient treatment and R&D center.
• No other laser manufacturer that we are aware of
can make this statement.
• They typically use studies done with other lasers
and then make a great leap of faith to make the
claims they do without any of their own research.
• The world of laser therapy is unfortunately buyer
beware! We frequently receive calls from
physicians who wish they were better educated
before they made their laser purchase.

7. Review of the
Biological Effects of Therapeutic Lasers
• Therapeutic lasers are designed to bio-stimulate
injured and dysfunctional tissues.
• Clinical studies and trials of Class III & IV laser
technology indicate the following beneficial effects
of light therapy on tissues and cells.
• For those of you who are new to laser therapy we
are going to briefly present these benefits, as this
topic could constitute a webinar all by itself.

8. Summary of LT Biological Effects
•Accelerated Tissue Repair and Cell Growth
•Faster wound Healing
•Reduced Fibrous (Scar) Tissue Formation
•Anti-Inflammation
•Anti-Pain (Analgesia)
•Improved Vascular Activity
•Increased Metabolic Activity
•Improved Nerve Function
•Immunoregulation
•Trigger Point Resolution and Acupuncture Pt. Stimulation

9. All Lasers are Not Created Equally
• Although all therapeutic lasers bio-stimulate
tissue, that is where the similarities end.
• Laser Therapy is all about Physics!

10. Therapeutic Laser Classifications
• Therapy lasers are classified based on their power output
•Class IIIa = lasers 1 to 5mw of power (laser pointers)
• Class = lasers 6 to 500mw in power
(typical cold laser or Low Level Laser)
• Class IV = lasers above 500mw of power

11. Therapeutic Laser Physics
• Laser therapy is a positive form of energy medicine
• When you treat a patient with a therapeutic laser there is a
measurable dosage delivered during every treatment.
• The dosage delivered is based on the power output of the laser,
how long the patient is treated for, and how often the laser is on
during the treatment time
• There are no shortcuts to clinical success.

12. Therapeutic Laser Physics
• The therapeutic dosage of laser energy is measured in Joules
• 1 Watt = 1 Joule / Second
- For every one watt of laser power output, one joule of energy is
delivered per second of time, for a continuous laser.
- For a pulsed laser the energy delivery depends on the duty
cycle, which tells us what percentage of time the laser is on or
actively firing. If the duty cycle is 50% then the laser at 1 watt
only delivers 0.5 Joules / Second.
- For any given time period a continuous wave laser delivers
twice as much energy that a pulsed laser with a 50% duty cycle.
• From this we can see that high power lasers can deliver
considerably more energy than low power or their cold laser
predecessors.

13. How Light Penetrates Tissue
• As light energy hits the surface of the skin and
subsequent deeper layers, some of it is scattered
and reflected and some of it is absorbed
• At each tissue interface less energy is available to
pass further through to the next layer because of
the effects of absorption, reflectance and
transmission. This is a very important concept to
be aware of.

14. Laser Tissue Interactions

15. Irradiance Map
• Light coming out of a fiber optic cable, the typical high power laser delivery
system, is bell shaped. For that reason the energy delivery is not uniform and
more energy is concentrated in the center of the beam. This creates hot spots that
cause more superficial vasodilatation, and as you will soon learn, more laser
energy to be absorbed at the skin level.

16. Overcoming the
Weaknesses of Fiber Optics
• Our research efforts revolved around finding a
transmission medium that would produce a more uniform
beam distribution and less superficial heat build up than
with a fiber optic delivery system
• We accomplished this by transmitting the laser light thru a
proprietary liquid light medium, called a light guide
• Translation: more uniform energy delivery, less superficial
tissue heating, and thus greater penetration for any given
power output when compared to traditional fiber optic
delivery systems

17. Depth Penetration Factors
• Instrumentation
– Total Power
– Spot size
– Time
– Power density ( Measures the concentration of
the laser energy, measured in mw / cm2)
– Wavelength
– Method of delivery
Pulsed or Continuous

18. More Depth Penetration Factors
• Patient
– Skin pigmentation
– Hair
– Thickness of each tissue layer
– Vascular content of treatment area
– Cleanliness of treatment area
– Method of laser application
One thing to note when you apply the wand to the skin and push back and forth you are
Actually pressing blood out of the area and by doing so you actually INCREASE depth
Penetration. Having a laser delivery system that can contact the skin is a good design
Feature.

19. Physiological Effects Light – Tissue Interactions
• It is widely agreed upon that almost 65% of laser energy is
absorbed in the skin and subcutaneous tissue layers with the
following having a high affinity for absorption:
• Hemoglobin in blood
• Melanin in skin, hair, moles, etc.
• Water (present in all biological tissue)
• In order to overcome those factors one most start with large
quantities of energy on the skin as well as choose a wavelength
which helps to increase penetration

20. Therapeutic Laser Penetration
The Prime Determinants of Laser Penetration and
Concomitant Tissue Stimulation are:
• Power – measured in Watts or milliwatts
• Wavelength – measured in nanometers. It is important to
use a wavelength that provides both tissue stimulation and
depth of penetration. Our research led us to the 980 nm
wavelength
• Power Density – measured in mw / cm2
• Frequency – continuous wave versus pulsing

21. Importance of Power Density
• Becausethat almost 65% of the energy delivered is lost in
the epidermis
• If you don’t start with enough energy on the skin surface,
there will not be enough to stimulate cell healing, especially
in deeper pathologies
• Also if you do not have a sustained power density over a
long enough period of time, treatments may be ineffective
• Too much power density can also be detrimental (surgical
lasers that have been converted to therapy lasers.)
• Collimated beam vs. Divergent Beam

22. How Much is Enough
• 49-73 mw/cm2 for cell stimulation1
EFFECTS OF INFRARED LASER EXPOSURE IN
A CELLULAR MODEL OF WOUND HEALING
Mark D. Skopin and Scott C. Molitor, Department of
Bioengineering, University of Toledo, Toledo OH
• This independent study showed us that the 980 nm wavelength was
effective for tissue stimulation as well as the power density range that
was optimal for tissue stimulation and wound healing.

23. Laser & Tissue Powers
Tissue Layer Max Power (mw/cm2)
Epidermis 206
Dermis Layer 182
Dermis Plexus Super. 135
2nd Dermis Layer 115
Dermis Plexus Prof. 93
Muscle Tissue 9.7
(Power Setting 5 Watts, 3.0cm spot size, 980nm)
The above chart, calculated using sophisticated computer
models by U of Toledo shows us how the concentration of
energy diminishes as the laser energy passes thru the
different tissue interfaces.

24. Translation of Previous Two Slides
• It is important to understand that as laser energy
penetrates through the body more and more energy
is absorbed at each tissue interface, so by the time
you start reaching deeper structures there is not
enough therapeutic energy to cause adequate
tissue stimulation. This is the reason why low power
lasers as well as pulsing lasers fail to deliver when
treating deep seated pathologies.

25. Multiple Wavelength Lasers
vs.
Avicenna Single Wavelength & Continuous Wave Laser
• Companies that use a dual wavelength platform typically
have no research to prove their efficacy and in fact are
actually inhibiting penetration as
• A laser with two or more wavelengths only has the ability
to penetrate as deep as each individual wavelengths
allows.
• Lasers that pulse or have a high duty cycle coupled with
multiple wavelengths of energy emission will not
penetrate as deep as CW lasers of a single wavelength
• Continuous wave lasers = 100% duty cycle, laser is always
delivering energy which is needed to overcome
absorption in the superficial layers

26. In Laser Medicine 1 + 1 Does not = 2
• Dual wavelength lasers only penetrate as deep as each
wavelength will go individually. The penetration is not additive so
there is no real benefit to this scenario.
• It is more advantageous to have one wavelength of greater
power that stimulates cell metabolism and tissue regeneration at
all tissues in its pathway. We knew this going into the formation of
our laser system unlike our competitors, who relied on other laser
manufacturers incorrect theories of wavelength and tissue
biostimulation.

27. Other Factors Affecting Lasers Penetration
• Duty Cycle – 100%
• Laser is firing continuously
• Duty Cycle – 50%
• Laser is firing 50% of the time. This will not only cut
energy delivery but it will also affect ability to penetrate.
• Pulsing – Lasers that pulse also do not emit continuous
energy
• Avicenna is 100% continuous wave energy

28. Why Therapeutic Lasers Fail
• Under dosage – The typical low level or cold laser does not
deliver enough energy to adequately stimulate deep seated
inflammatory conditions
• Under penetration - The typical low level or cold laser does
not concentrate the laser energy sufficiently to allow for
adequate penetration
• What is the correct dosage? Avicenna protocols typically call
for thousands of joules and may approach as high as 10,000
joules for deeper seated pathologies
• There are no short cuts to clinical success

29. High Power Therapeutic
Laser Medicine (HPTLM)
presented by
Joseph Costello, DC, DABCO
A New Medical Discipline that Allows
Physicians to Successfully Treat
Medical Failures

30. The Success of HPTLM Revolves
Around Creating the Best
Environment for Tissue Healing
• High Power Therapeutic Laser Medicine is a
new discipline in Neuromusculoskeletal
Medicine created by Avicenna Laser
Technology’s Team of Physicians
• It revolves around using the Avicenna High
Power Laser in conjunction with numerous
areas of medicine such as:

31. • High Power Laser Therapy
• Non-surgical orthopedics
• Neurology
• Foot pathology
• Biomechanics, gait and kinetic chain dysfunction
• Orthotic intervention
• All of the above are critical components in
achieving a successful outcome.

32. “The Key to Better Outcomes”
• Higher the power output of laser energy
•The Greater The Penetration
•The Faster the Therapeutic Outcome
•The Quicker the Patient Returns to Normal
•This is one of the reasons we developed our new
technology the AVI HPLL-12

33. Goal of Pain Management
Using Laser Therapy
• Relieve Pain and Reduce Inflammation
• Promote Tissue Healing
• Minimize Side Effects
• Restore Active Range of motion

34. Lasers vs. Standard Modalities Currently Used
to Treat Neuromusculoskeletal Pathologies

35. Applications of Laser Therapy
•Disc Pathologies, Spinal Stenosis, Radicular Pain,
spondylolesthesis, and sacroiliac dysfunction
•Failed surgical back syndrome
• Accelerated Post Surgical, Soft and hard Tissue healing
•Arthritis (Degenerative Joint Disease)
•Foot Pain and Neuropathies
•Muscle, Ligament and Tendon Injuries
•Ulcerations and Open Wounds

36. Clinical Translation of the Previous Slide
as it Pertains to the Spine
• Decreased inflammation of disc, nerve roots and the
cauda equine
• Increase microcirculation of spinal structures
• Accelerate healing of annular defects
• Decreased formation of abnormal/non functional scar
tissue
• Decreased scar tissue and non-osseous hypertrophic
changes
• Reduce pain associated with prolotherapy injection
• Decrease or even eliminate need for epidurals

37. Clinical Translation of the Previous Slide
as it Pertains to the Lower Extremities
• Decreased inflammation of nerve tissue
• Accelerated Reinervation of nerve fibers
• Increase blood flow and microcirculation of tissue structures
• Accelerate healing of open wounds
• Decreased formation of abnormal/non-functional scar tissue

38. Clinical Translation as it Pertains to
the Lower Extremities Continued…
• Increase synovial fluid and cartilage production
• Increase collagen and fibroblast production
• Increase osteoblastic activity and fracture healing
• Decreased bony edema – osteochondral bone bruise
• Decrease in pain associated with epidural, prolotherapy
or other invasive injections

39. Evidence Based Medicine
•Avicenna clinicians all subscribe to the theory of EBM
•Clinicians measures results with outcome assessment tools:
• Pressure Algometer
• Inclinometer , Goniometer
• Thermal Imaging and Doppler Studies
• VAS, PDQ – Pain Disability Questionnaire
•These tools are vital to document outcomes which
ultimately lead to adequate reimbursement

40. Avicenna Laser Therapy Protocols
• Developed by Clinicians for Clinicians
• Proprietary to AVI HP –7.5 and AVI HPLL-12
•Utilizes Texas Back Institute Protocols in conjunction with
laser
• Will not work for LLLT or other Low Power Lasers as they
cannot create significant power (energy density) to over
come tissue saturation to reach deep structures in the
disc, joint or areas of deep seated inflammation

41. Avicenna’s Clinical Advantage
• Avicenna's training incorporates the teachings of multiple
disciplines including non-surgical orthopedics, physical
medicine and rehab, neurology, podiatry, bio-mechanics and
kinetic chain dysfunction.
• Regardless of your medical discipline or level of experience
we will train you to outperform anything in medicine when it
comes to treating neuromusculoskeletal pain.
• The training you will receive will be second to none, you will
receive it along with unlimited phone consultation services!
• As good as our laser is, without proper training you may fail
when treating difficult conditions
• With our training, when it comes to pain management you
will now be able to outperform anything in medicine, safely
and without the potential for side-effects.

42. Clinical Importance of Proper
Therapeutic Laser Dosage
• Treating pathologies in large joints and/or the spine, requires
large dosages, typically greater that 10,000 Joules.
• This is the dosage we have researched necessary to get a long
term if not permanent result.
• Anything short of this and especially the typical LLLT dosage
recommendation of 10-20 joules or other class iv laser companies
who claim you can treat for 5-10 minutes with a pulsed laser,
should raise a red flag.
• There is a great difference between feeling better and getting
better.
• The latter should always be the clinicians goal.

43. Introducing the AVI HPLL-12
• A technological advancement in energy output and delivery,
that delivers a therapeutic dosage of laser energy necessary to
treat deep seated pathologies
• The AVI HPLL-12 is the world’s most powerful and advanced
therapeutic laser system
• But: As good as this technology is, without the appropriate
training when it comes to treating medical failures your results
will be marginal at best
• As a physician based company we have treated or will know
how to treat any condition you are confronted with the ultimate
result being a better outcome
• With the superior training and clinical support we provide
physicians the above goal will readily be achieved

44. Changing the Way
Physician’s Manages Pain
Thank You For Attending
Feel Free to Ask Questions
www.AvicennaLaser.com
561-882-1430