What's holding back Israeli laser technology for medical use?

Improving eyesight in 10 minutes. Speeding up the healing of damaged nerve cells. Stretching the skin, whitening the teeth, accelerating the mending of bones, erasing pimples, fighting baldness and helping people quit smoking. What do all these have in common? They can all be treated with beams of light.

Well, not ordinary beams of light, but laser beams: sources of light that concentrate energy at high intensity. The laser was invented in the 1960s and is now a hot field not only in communications and defense, but also in medicine.

The medical laser industry generates sales in the hundreds of millions of dollars annually. In the Israeli market lasers are used for aesthetic procedures and surgery - mainly eye operations that let us toss away our glasses. But in fields such as dentistry and physiotherapy, Israel lags behind the West in laser use.

The equipment, after all, is expensive to buy and maintain. Doctors who use the technology complain about budgetary problems when they have to fix the machines. When laser equipment breaks down, it often stays that way. The safety regulations for the devices also makes the transition difficult.

Goodbye to the drill

In cosmetics, permanent hair removal by laser has captured the market. Experts say the industry in Israel earns millions of shekels annually. Other skin problems are also treated with lasers.

But despite the laser's advantages, doctors are not rushing to use it.

"The laser provides a solution for conditions that were hard to treat in the past, or were untreatable, but only a minority of skin doctors use it," says Achi Friedman, a specialist in sexually transmitted diseases.

He mentions laser treatments for stretch marks, scars and rosacea (the widening of blood vessels that causes redness), and adds that treatments have improved for hair removal and skin problems on the face.

"Along with the advantages of the laser, there is a problem of cost. A new laser device costs about $100,000," says Friedman. "The lifespan of equipment is five to seven years, so after five years its financial value declines. It can be used, but the industry will already be offering more advanced machinery."

Another field that has adopted the laser is dentistry. The limited maneuverability inside the mouth and the laser's precision have spurred many dentists to abandon the drill. Instead they disinfect root canals and remove decay with a laser. Another advantage is that the treatment does not require anesthesia.

But due to the cost, most dentists are still using traditional instruments. "Students don't receive training in dental work with the laser," says Uri (not his real name), who recently finished dental studies at the Hebrew University of Jerusalem. "In the clinic at Hadassah University Hospital there are now three laser machines; two have been out of order for a long time. Repairing them is apparently so expensive it simply isn't worthwhile."

"When I began using the laser a decade ago I told myself that within 10 years, 50% of dentists would follow in my footsteps, but I was way off base," says Emil Litvak, a dentist who uses the laser. "In Israel there are now another two to three dentists who use a laser. The health maintenance organizations won't pay for it and private doctors think it's too expensive."

Litvak, who also imports laser equipment, says that in 2009 two laser machines for dentistry were sold every day in the United States, and that relative to Israel's size, one machine a month should have been sold here. In fact, one machine is sold a year.

"Despite the benefits, dentists are not switching over to this machinery due to ignorance, conservatism and tightfistedness. When I began the transition, in Israel, the laser was considered charlatanism - even the Health Ministry came out against me," says Litvak.

"Since then the FDA [the U.S. Food and Drug Administration] has approved the technology and tens of thousands of dentists around the world have adopted the method. In the past five to seven years, hundreds of studies have been published all over the world proving beyond a doubt that the use of the laser in dentistry is preferable to conventional treatment.

"Patients who are treated with a laser don't go back to the drill; they call the treatments a 'restorative experience.' But when a laser machine costs about 25,000 euros, not everyone goes that way."

"The technology may be good, but for now it isn't accessible," adds a well-known dentist in Tel Aviv who uses the traditional instruments. Also, safety measures and regulations burden the dentist switching over to laser treatments.

Treating cancer with light?

Laser operations were already performed 25 years ago, but in the past decade the fields of treatment have expanded. Prof. Aryeh Ziegler predicts a revolution in the treatment of cancer with lasers.

"There are studies in the field of particle acceleration with a laser, as part of the process for treating cancer. The laser beam provides a large amount of energy in a very short period of time, creating an acceleration of particles that is translated into an application for treating cancer," he says.

"Even today there is an accelerator that makes such a process possible, but it's very expensive and is found in five or six medical centers around the world. If there is such a development, it will be possible to treat cancer in a more focused and efficient way."

Doctors have high hopes that the laser will help cure damaged nerve cells. Bullet wounds, car and work accidents and sports injuries all see damage to peripheral nerves, damage that can lead to paralysis. One researcher in the field is Dr. Shimon Rochkind, head of the unit for regenerating peripheral nerves at the Tel Aviv Sourasky Medical Center. He is studying the treatment of damage to peripheral nerves with low-intensity lasers.

His research demonstrates that 780-nanometer laser beams reinforce and accelerate the regeneration and growth of nerve fibers after damage or undergoing reconstruction.

"The process of rehabilitating patients with nerve damage today includes physiotherapy, occupational therapy and electrical stimulation, and its main purpose is to preserve the muscle and the range of movement," explains Rochkind.

"So far, no clinical therapy has been found that reinforces and accelerates the recovery of the nerve. The research indicates that treatment with a laser beam of a certain frequency significantly accelerates and increases the nerve's growth and regeneration process. That means restoring movement to the upper or lower extremities and a significant reduction in the rehabilitation period."

Declining number of skeptics

There are also low-intensity lasers ("soft lasers"), which are used mainly to accelerate natural bodily processes.

"The laser accelerates the process of natural recovery because of its ability to accelerate blood circulation," explains Zvi Friedman, a physiotherapist who frequently uses the laser. "Rib fractures cannot be repaired, and the recommendation to patients is to 'wait six weeks and don't breathe deeply.' With laser treatments there's an improvement after only a week."

He says lasers, for example, help reduce swelling and pain when closing skin sores.

In the past there were great doubts about the benefit of these treatments. "When you cut tissue or remove tooth decay, you see what you're doing. With a soft laser it's a guess. It's like when the control group in a certain experiment says that the medication has an effect," says a surgeon who asks not to be named. But he says that the skeptical voices have been diminishing in recent years. "The laser has become popular worldwide, and you can see it in the best medical centers."

According to Zvi Friedman, "In Sweden the laser is used to treat cancer patients. Although the laser doesn't cure cancer, the treatment dilates the blood vessels and accelerates blood circulation. In that way the medications administered to treat cancer are absorbed better and you can use smaller doses," says Friedman.

One of the major forecasts in the field concerns diabetes, which some observers consider the plague of the 21st century. "Laser treatment can accelerate blood flow, enabling better absorption of insulin, which will promote more efficient rehabilitation of cells that have been destroyed," explains Friedman.

No more polishing your pate

Another use of lasers is for treating baldness. When a man goes bald due to problems with the hormone dihydrotestosterone, there is a decline in blood flow to the follicles, the hair's source of nutrition, and the hair weakens and falls out. The manufacturers claim that lasers accelerate blood circulation and strengthen the connection between the hair and the head.

Zvi Friedman uses the laser as a substitute for acupuncture in treatments to help people quit smoking. "This is an effective treatment for anyone who really wants to stop smoking, not because 'my wife told me to.' In Britain the treatment is popular and costs a lot of money."

And if the laser doesn't do all the work, things can be done to make its job easier. Tattoos, for example, can be totally removed using a laser, not just blurring them as is done at present. This depends on using advanced tattooing techniques that enable the total removal of a tattoo.

The figures show that half of people with tattoos consider removing them at some point, so this product should become more popular - but their use is very limited because virtually everyone who gets a tattoo doesn't believe he'll regret it in the future. As long as that's the situation, lasers can't help those who want to remove tattoos from their bodies completely.

Future machines will be smaller and multipurpose. "There are already machines that can use various beam lengths - and therefore can perform various treatments such as a laser to smooth facial skin or treat stretch marks. All you have to do is switch the arm of the machine," says Achi Friedman.

Home laser machines are already being sold for hair removal and physiotherapy, including the treatment of pains and injuries. These are low-intensity devices compared to medical equipment and cost about NIS 2,000. In Israel hundreds of such units have been sold.

However, this trend is also expected to lead to problems. "Clients are not familiar with the device, its manufacturers, reliability, quality and level. In addition, people forget the safety aspect," Friedman says.

"Today there are doctors who are qualified to perform laser treatments in Israel, and there's a reason for that. There have been cases of damage resulting from improper treatments using the device. The danger is that people who buy the home device will use it incorrectly or at wrong intervals."