Safe Use of Laser Devices in Human Subjects 注意使用激光裝置的安全 －保障消費者的安全與利益

The use of high power laser/intense pulsed light by non-medical personnel Dr. Henry Chan Associate Professor Department of Medicine University of Hong Kong

Key points 1.We believe it is of the public interest for the government to regulate the use of high power laser/intense pulsed light source to be used by clinicians only. 2.Other western countries already have regulations to control their use. 3.Laser/IPL are “high-tech” knife. 4.Most public are not aware of the danger associated with the use of such devices and majority support further regulation. 5.Consumer Council or hotline

History and background  Laser - light amplification by stimulated emission of radiation  1960: laser was first used for skin diseases  Different objects preferential absorbs different types of light.  By selecting the right wavelength, one can selectively destroy the object without affecting the surrounding tissue.

Laser Radiation of a fixed wavelength. Intense pulsed light source (IPL)  Consists a fixed range of wavelength, target at different depth will be affected.  The selectivity of IPL is decreased and much higher energy is often needed to achieve the clinical result.

Treatment of skin diseases  Congenital port-wine stain  Freckle  Tattoo  Laser hair removal  Laser resurfacing

Before

After

Why government should regulate the use of high power laser

1.Medical/Dental practitioners are best to determine clinical end point  To achieve the optimal clinical response, one needs to assess the tissue reaction so that the right energy can be used.  Mis-use of laser/IPL energy can lead to Under-treatment (no effect) Over-treatment (leading to complication such as pigmentary disturbance or even scarring)

before Before

After week 1 After 7 days

2.Medical/Dental practitioners are best to detect and manage complications  Laser surgery, like other form of surgical procedure, is associated with known complications.  The importance of detecting and managing complications Leads to a better clinical outcome Reduces the morbidity associated with the complication

3.Medical/Dental practitioners are best to observe laser safety Inappropriate observation of laser safety could lead to  Blindness  Burn injury  Even fire

4.Medical/Dental practitioners are best to diagnosis disease and offer treatment options other than laser  Medical/dental practitioners are best to diagnosis disease states and offer treatment options that may or may not necessary for laser.  E.g. patients with cancer should be treated with excision rather than laser.

Naevi

Solar damage

Our experiences Most of the young ladies are often too embarrassed to voice their compliant out openly.  Case 1 A young girl received some sort of light source to remove moles and developed multiple keloids in the forearms.  Case 2 A young lady in the entertainment business was off work for a year due to hyperpigmentation developed in her arms after laser hair removal.

A local telephone survey (Department of Medicine, University of Hong Kong) looking at the use of high power light/intense pulse light source by beauty salon  Aim To assess the public awareness of the complications associated with the use of these high power laser/intense pulse light source To assess public opinion regarding regulation in the controlling the use of such device by clinician only  Subjects: 601 females (age range: 15-65)

Classification of laser radiation levels Class I: are not considered to be hazardous. Class IIa: are not considered to be hazardous if viewed less or equal to 1000 seconds but are considered to be a chronic viewing hazard for greater than 1000s. Class II: are considered to be a chronic viewing hazard. Class IIIa: are considered to be an acute viewing hazard if viewed directly with optical instruments. Class IIIb: are considered to be an acute hazard to the skin and eyes from direct radiation. Class IV: are considered to be an acute hazard to the skin and eyes from direct and scattered radiation.

Key points 1.We believe it is of the public interest for the government to regulate the use of high power laser/intense pulsed light source to be used by clinicians only. 2.Other western countries already have regulations to control their use. 3.Laser/IPL are “high-tech” knife. 4.Most public are not aware of the danger associated with the use of such devices and majority support further regulation. 5.Consumer Council or HKMA