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Bartels, Kenneth E. "Laser Use Grows in Veterinary Medicine." Biophotonics International, July/August 1997.

SUMMARY

Although human applications get much more attention and financial consideration, veterinary medicine is another market for biomedical lasers. The cost as well as the debatable returns for this type technology investment have limited the veterinary applications primarily to the academic community, research institutions and specialty practices. As efficacy is proven and equipment costs decrease, however, laser surgical and diagnostic devices will become mainstream in clinical veterinary practice.

The introduction of laser technology in veterinary medicine has been heavily influenced by economic considerations, and by the fact that governmental regulation of innovative technologies is considerably less restrictive when the patients are animals rather than people.Occasionally, the reduction in restrictions has been advantageous in implementing new techniques. For some applications such as "soft" laser therapy for biostimulation (supposedly to improve healing by applying low-power red laser light), protocols and devices that are restricted for human use in the U.S. have been heavily marketed to veterinarians, often on the basis of subjective assessments and anecdotal reports. In any event, the use of lasers in veterinary medicine for photothermal, photomechanical and photochemical applications is expanding rapidly, both in research and clinical practice.Because applications for laser surgery in human medicine are expanding, the desire of physicians and hospitals to purchase state-or-the-art equipment has also increased. As hospitals acquire equipment with advanced designs and options, their used equipment becomes available for veterinarians to purchase. However, even used equipment can be expensive in the long run, since maintenance costs can exceed the initial capital investment.

As with the acquisition of any new technology, it is extremely important that laser applications in veterinary medicine reflect responsible medical and scientific use. Strategies and gimmicks that advertise new and unique equipment can also attract individuals interested in offering treatments that have little or no proven benefit.

REALIZING THE POTENTIAL

An objective approach to surgical laser procedures in veterinary medicine is essential if the potential of this technology is to be realized. "Zap and vaporize" techniques coupled with a "burn and learn" philosophy can do harm to both patient and surgeon and can easily outweigh any benefits. An effort must be made to evaluate the laser's potential benefit to patients, rather than portraying it as a marvel of the 21st century.Although the use of biomedical lasers has generated entirely new treatment concepts, a veterinarian's clinical expertise and knowledge of pathophysiology myst be the primary factors for determining whether a laser or scalpel blade is the better choice for a particular procedure.Many of the first reports of biomedical laser use in veterinary medicine involved endoscopy; fiber optics delivered Nd:YAG laser energy to treat laryngeal and upper respiratory conditions in horses, such as entrapment of the epiglottis and laryngeal cysts. Since then, both CO2 and Nd:YAG lasers hae been used in general surgery in small animals where precise dissection and control of hemorrhaging are important. These procedures have included liver biopsy and resection of liver lobes, biopsy of the spleen, partial and complete removal of the kidney, and excision and resection of intra-abdominal, intrathoracic, cutaneous and mammary tumors.Recent reports have reviewed clinical uses of laser energy for ablation and coagulation of brain tumors and superficial growths or tumors (Figure 1), treatment of eosinophilic (foamlike) scar growths and ablation of lick granulomas (the buildup of scar tissue from excessive licking) in dogs.Because advantages such as shorter recovery time, less perceived discomfort and availability of potential treatment regimes for conditions not amenable to conventional procedures, biomedical lasers are being used in the realm of exotic animal or zoo practice where hospitalization time must be minimal (Figure 2). Clinical use of the holmium (Ho:YAG) laser for ablation of intervertebral discs in dogs has also recently been instituted and shows tremendous potential (Figure 3).The use of medical lasers for veterinary ophthalmologic applications was established in the early 1980s, although it is not as common as in human practice because of the cost and differences between human and animal conditions. The Q-switched or continous-wave ophthalmic Nd:YAG, argon-ion and diode lasers have been used as photocoagulators in retinopathies, for treatment of lens-induced papillary opacification and for transcleral cyclodestruction of the ciliary body to treat glaucoma, which is very common in dogs. As experience and interest increases and lasers become more available to veterinary ophthalmologists, clinical applications will increase.

Photodynamic therapy has been used clinically in veterinary medicine by several investigators since 1985. A number of initiatives have been reported using the technique to treat dogs and cates with spontaneously occurring tumors, primarily of the skin and mouth. This exciting method of destroying tumors employs interaction of light with a photosensitizer in the presence of oxygen. It will undoubtedly play a much larger role in clinical veterinary medicine as protocols are established and photosensitizing drugs are approved by the U.S. Food and Drug Administration (FDA) for use in animals. Phythalocyanines, theophorbides, 5-aminolevulinic acid and hematoporphyrin derivatives such as Photofrin have shown the most promise.

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