The Difference Between Class III and Class IV Laser Therapy

The Trend in Laser Therapy

“The authors of Laser Therapy- Clinical Practice and Scientific Background, Dr. Jan Tun’er and Lars Hode, have performed an analysis of a number of frequently cited studies on the effects of low-power-laser therapy. Selected Quotes:

“In many of these studies, analysis uncovered one or more reasons for the negative findings reported, the most common being the use of extremely low doses.”

“The trend in laser therapy for the past 10 years has been to increase power density and dose, since this has been shown to improve therapeutic outcomes considerably.” 

“There is no point in increasing the dose if the wavelength has a low penetration factor; the penetration of the particular wavelength must be taken into account.” 

“For the moment, we must rely on our own clinical experience. That experience, however, is so encouraging that it cannot be ignored, even with lack of scientific support. It would appear that “high powered” therapeutic lasers will be able to further expand the scope of laser therapy.”

“I can see two alternatives for myself: to speak up and start a conflict within the laser community, maybe discrediting the therapy itself in the eyes of the general public or to keep quiet and let US practitioners pay a lot of money for very low-powered lasers, leaving us with dissatisfied customers and discredit from those who are supposed to use laser therapy in medicine.”

Class IV Therapy Lasers: The Next Generation of Laser Therapy

The laws of laser physics have demonstrated that the higher the wavelength, the deeper the penetration. Penetration is paramount in order to stimulate deep musculoskeletal, vascular, lymphatic, and neurological structures.

If Class III lasers are therapeutically ineffective, it is because of insufficient energy or dosage, combined with poor penetration.

Insurance Determination: Class III Therapy Lasers Are Not Effective

“While the FDA has approved the marketing of the device, many payers have

declined to provide recognize LLLT as effective treatment. Results of treatment have not been consistent so that it is difficult to state that such treatment would be necessary. Last, given the reported number of visits required to be nine to 12 visits, the cost of such treatment would be approximately $1000 to $1500. These costs appear to be somewhat unreasonable for a treatment that has not been demonstrated in the medical literature to be effective.”

Source:  Position Paper on Low Level Laser Therapy (LLLT) 12 pages

Ohio Bureau of Workers’ Compensation

“Aetna considers cold laser therapy experimental and investigational because there is inadequate evidence of the effectiveness of low-energy (cold) lasers in wound healing, pain relief, or for other indications such as musculoskeletal dysfunction, arthritis, and neurological dysfunctions.”

Source:   Aetna: Clinical Policy Bulletins, Number 0363, Subject: Cold Laser Therapy

Characteristics of Class IV Therapy Lasers

Class IV lasers offers better therapeutic outcome, based on six characteristics of this new technology:

Larger dosages of therapeutic energy. Class IV lasers can deliver up to 1,500 times more energy than Class III and consequently reduce treatment time.

Deeper penetration into the body. Leading Class III lasers only penetrate 0.5-2.0 cm2. Class IV can penetrate up to 10 cm2.

Larger treatment surface area. Class III cover a treatment area of 0.3-5.0 cm2, depending on the model and manufacturer. Class IV cover up to 77 cm2. This is important when treating large regions, such as the lumbar spine, quadriceps or hips.

Greater power density. Power density indicates the degree of concentration of the power output. This property has been shown to play a major role in therapeutic outcomes.

Continuous power supply. In Class III lasers, the power is pulsed or modulated approximately 50 percent of the time. In other words, light is permitted to pass through the probe for only 50 percent of the total operating time.

In most cases, Class IV lasers deliver a consistent amount of energy over a given time. Their power can be adjusted for acute and chronic conditions.

Superior fiber optic cables. Fiber optic cables transmit laser energy from the laser to the treatment probe (wand) at the end of the cable.

Several studies reveal that as much as 50 percent of the light energy generated by a Class III laser may be lost by the time it reaches the end of the probe.