Let there be light
Laser therapy improves patient care, boosts clinic revenue and can deliver an excellent return on investment.
Therapeutic lasers have come a long way since their introduction to veterinary medicine over a decade ago. Back then, so many yet-to-be-studied beneficial claims were made that veterinarians commonly responded with dubiousness.
“There is far less skepticism whether it works now because there has been confirmation that it does, both peer to peer and in numerous studies,” said John Mercurio, vice president of Companion Animal Health, which offers therapeutic lasers for use on people, horses and small animals.
Where does a practitioner who wants to add this modality to her practice start?
Plan and Research
Make a plan before even looking at a laser product, advised Aaron Bakken of Summus Medical Laser (formerly K-Laser USA). “The plan should include not only equipment but the implementation process, training and client education.
“Then do your research,” he said. “Talk to your colleagues, look at products at trade shows, ask questions on the Veterinary Information Network.”
He said the most important factor in choosing a vendor is to make sure the equipment is backed by a reputable company and comes with a warranty, installation, training and customer support. A list of veterinarians a prospective buyer can call to ask about their experience is key, too.
J. Mark Strong, global director for business development, human and veterinary, at Multi Radiance Medical, said research into laser therapy is important.
“There’s a lot of peer-reviewed evidence that laser therapy actually does what it says it does,” he said, advising practitioners to ask a vendor for studies on the effectiveness of its products at their power levels.
Mercurio recommended that practitioners ask peers what products they use or recommend, and ask about the financial impact that laser therapy had on the practice.
When it comes to choosing a specific therapy laser, a comparison is important.
“The consumer has to be careful to compare apples to apples,” said Jennifer Johnson, VMD, CVPP, president-elect of the International Veterinary Academy of Pain Management and an early adopter of the modality. “She will be disappointed if she doesn’t see success. And if she doesn’t, it may be because of the equipment she bought.”
Current research, Dr. Johnson said, boils down to most studies showing that dose is the most important factor in treatment efficacy. This thinking has evolved over the past 10 to 15 years.
“With the advent of higher- powered lasers used at appropriate doses, we see better results,” she said. “With lower power, we can’t generate the needed dose in a practical period of time. Twelve to 15 watts generates joules necessary for efficacy.”
The U.S. Food and Drug Administration bases laser classifications on how dangerous the laser can be to the human eye, she noted.
“What is important in choosing a laser is that the practitioner be able to determine two things,” Dr. Johnson said. “First, that the vendor can say what wavelengths the laser is producing to stimulate a cellular response — basically, is it going to work? The second is, can I calculate a dose and know what dose I’m putting into tissue?
“Otherwise,” Dr. Johnson said, “it’s as if you’re buying prednisone without knowing the milligrams in each tablet. If you can’t determine your dose, how do you know what you bought is going to work?”
Many publications and supporting research now suggest a “therapeutic window” of appropriate near-infrared wavelengths to stimulate the photobiochemical process in the cell, she said.
“Most researchers agree that 810 to 980 nanometers creates less chance of absorption by other pigments such as melanin and hemoglobin,” Dr. Johnson said.
Consider the Software
Software featuring an advanced user interface makes a therapeutic laser easy to use, Bakken said, suggesting that prospective buyers ask what a unit’s software is capable of.
“It allows easier integration into your practice and provides feedback data on usage,” he said. “This helps the clinician make better decisions and augment the use of laser. It can be a performance tracker,” capturing usage data that can flag underutilization.
“If it says you should have made $1,800 this month, you’ll know you have a missed-billing situation,” Bakken said.
To determine proper dose and treatment time, the practitioner enters into the software the patient’s species, condition being treated, weight, and coat or skin color. The unit recommends the total treatment time and dose.
Don’t Forget Training
Another area to investigate is the training offered by vendors.
“Onsite training is really important,” Bakken said. “The biggest question today isn’t ‘Does laser work?’ It’s ‘Is it going to work in my practice?’ We focus on implementation and integration, contraindications, how to use it, how to talk about the laser. We include everyone from the front desk to nurses to doctors.”
Buy-in from the entire staff helps promote the modality, said Strong, of Multi Radiance.
“Ask staff who have aches and pains, who have old, arthritic pets. You can introduce the laser to staff for their own aches and pains, then their pets,” he said, and they often become vocal proponents when interacting with clients.
Training isn’t that difficult, Dr. Johnson said.
“It has to cover the effective use of the laser, and it has to be performed by trained personnel,” she said. “[Trainees] need to know anatomy and be trained to apply the dose appropriately. It isn’t hard, but should be done by trained professionals for best success.”
Look for vendors that will never stop coming back for retraining, said Mercurio, of Companion Animal Health.
Protocol manuals, online interfaces, webinars and a social media presence are offered by many therapy laser companies to augment onsite training.
Set Your Prices
Many vendors suggest pricing strategies for their clients. A common one is to bundle treatments, as multiple sessions might be required, depending on the animal’s ailment.
Companion offers a business model that helps the veterinarian implement pricing and marketing. Common uses are post-surgical and to alleviate acute and chronic conditions. Suggested fee for post-op therapy, to assist in wound healing, is $10 to $20; for acute conditions, $30 to $40; and for chronic, $40 to $60.
“You can compare it to drug pricing, financially and long term,” Mercurio said. “It’s affordable and less impactful to the patient.”
Clients who have seen improvement in their pets are often amenable to monthly maintenance sessions, he added.
Summus Medical Laser presents veterinary clinics with a business plan that includes pricing and marketing training, Bakken said.
A small wound or anal gland abscess might need one or two treatments of under 10 minutes, Dr. Johnson said. If more treatments are warranted, she suggests bundling them into one week and then rechecking in two weeks.
A condition such as osteoarthritis likely will need to be treated chronically.
“An old dog with OA probably needs treatment not just for bad hips, but in secondary and tertiary areas,” she said. “His knees and spine need treatment, too. You can charge per time, or in six- or 10-packs.”
The Return on Investment
The experts agreed that the return on investment is almost unparalleled with therapy lasers.
Class 4 units cost in the range of $20,000 to $30,000, Bakken said, depending on the power, wavelength and other features. Lower-level units can range from about $2,000 to $15,000.
“I’m not aware of any modality in veterinary medicine that can bring as much new revenue into a practice, in relation to its cost, as laser therapy,” Bakken said.
Smaller practices, he said, have increased revenue by $1,000 to $3,000 a month.
Dr. Johnson bought her first laser a decade ago, thinking it would be “awesome for Labradors on Rimadyl.” She was interested in treating pain.
“My first laser was paid off in less than four months,” she said. “Then I traded it in for a newer model. When I sold the practice, I had three lasers, used among six veterinarians and 45 team members. One was used in surgery and recovery, one in rehabilitation, and the third went from room to room to room for both sick and well visits. It was completely tech-driven, and follow-up appointments would be scheduled with the technician.
“There really isn’t much you can’t use it on as an adjunct. When you add it to your practice, you’re having faster returns to normal healing. A hot spot used to itch for a few days after treatment, but a laser provides a faster return to normal. It dries up faster, stops itching sooner.”
Uses: Pain and Beyond
Among conditions suitable for laser therapy are musculoskeletal conditions, degenerative joint disease, drains, sprains, intervertebral disc disease, degloving injuries, dermatological conditions, bacterial and fungal otitis, and intra-abdominal and thoracic conditions. Postoperative therapy is often included automatically as part of a clinic’s standard of care.
“Today’s pet owner is very open to drug-free, surgery-free alternatives,” Bakken said. “They are much more open to this type of treatment. There has been real growth in the past 11 years, and we’ve seen that change in pet owner adoption of these procedures.”
Laser therapy has become almost the standard of care in most small animal practices, according to Dr. Johnson.
“I was originally interested in it to treat painful conditions,” she said. “It’s a good adjunct for pain management as opposed to pharmacological options. Anything inflammatory should respond to therapy laser. It reduces inflammation and promotes healing. That’s the basis of all the response to laser therapy, a particular wavelength of light.”
When Dr. Johnson started lecturing at conferences, most questions were about how photobiomodulation works and its validity.
“There was a lot of skepticism for non-pharma treatments, similar to acupuncture,” she said. “But now, most people in my lectures come to learn about how else they can use it and how others are implementing it in their practices.”
Marilyn Iturri is a freelance editor and writer specializing in veterinary and pet topics.
- The American Institute of Medical Laser Applications, a national leader in laser education and ethics, offers CE courses at aimla.org.
- The website laser-therapy.us provides a searchable collection of technical publications, books, videos and other resources on the use of lasers for photobiomodulation.
- The authoritative textbook “Laser Therapy in Veterinary Medicine: Photobiomodulation” (John Wiley and Sons, 2017) was written by 37 experts and edited by Drs. Ronald J. Riegel and John C. Godbold.
- Three leading manufacturers offer educational information and studies on laser therapy. Visit companionanimalhealth.com, multiradiance.com and summuslaser.com.