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

1. 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

2. 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

3. Key points • 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. • Other western countries already have regulations to control their use. • Laser/IPL are “high-tech” knife. • Most public are not aware of the danger associated with the use of such devices and majority support further regulation. • Consumer Council 2929 2222 or hotline 9773 7676.

4. 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.

7. 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.

12. Treatment of skin diseases • Congenital port-wine stain • Freckle • Tattoo • Laser hair removal • Laser resurfacing

13. Before

14. After

15. Why government should regulate the use of high power laser

16. 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)

17. before Before

18. After week 1 After 7 days

19. 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

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

23. 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.

24. Naevi

25. Solar damage

26. 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.

27. 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)

30. 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.

35. Key points • 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. • Other western countries already have regulations to control their use. • Laser/IPL are “high-tech” knife. • Most public are not aware of the danger associated with the use of such devices and majority support further regulation. • Consumer Council 2929 2222 or HKMA 2527 8285.