If you're like most of the world, you associate medical lasers with aesthetic and ophthalmic procedures, courtesy of network news, daily papers, and magazines. Resurface your skin! Throw away your glasses and contacts! Never shave again! So far so good, but the reality is that many of the most powerful laser-based therapeutic and diagnostic techniques are still relatively unknown outside of medical circles.
For example, lasers offer a treatment for wet age-related macular degeneration (AMD), one of the leading causes of blindness in adults over 55. In wet AMD, the central portion of the retina, called the macula, becomes overgrown by fibrovascular tissue that leaks fluid, which reduces vision and eventually leads to blindness. Photodynamic therapy (PDT) offers an effective course of treatment for wet AMD. In PDT, the patient is injected with a photosensitive dye that has an affinity for the fibrovascular tissue. When the tissues are exposed to infrared light at the absorption peak of the dye, the excited photosensitizer generates singlet oxygen and reactive oxygen intermediates, which damage the endothelial cells of the abnormal vessels, stopping the leakage for a period of weeks or months. Unlike photocoagulation treatments, which leave the patient with a permanent blind spot, the PDT approach can be repeated.
On the research front, lasers are being used experimentally as powerful tools for the treatment of strokes. Laser tissue soldering and welding, under development as an alternative to sutures, provide faster healing with less inflammation than conventional methods. Other exciting emerging medical laser applications that have received or are near FDA approval include treatment of skin conditions such as psoriasis and acne.
According to Irving Arons, managing director of Spectrum Consulting (Peabody, MA), the global medical laser market for 2001 should reach $2.5 billion, up 13.6% from the total laser sales for 2000. Surgical lasers make up the largest segment at $810 million in 2000, slated to grow 17% to reach to $950 million in 2001. Ophthalmic lasers follow, rising 5% from $600 million in 2000 to reach $630 million in 2001.
Interestingly, lasers for conventional surgery are becoming less popular; the bulk of the number cited above is made up of lasers for cosmetic surgeries (skin resurfacing, tattoo and hair removal, etc.). "Lasers are being favored less by surgeons for cutting tissue," says Charlie Whelan, industry analyst at Frost & Sullivan (San Antonio, TX), who notes the growing popularity of electrosurgery, an economical technique in which current running through a wire heats the surface sufficiently to burn through tissue. "But cosmetic surgery is huge."
"Actually, cosmetic applications have been the only thing driving sales for the last three to five years," says Kathy Kincade, a writer who has specialized in the medical laser field for 10 years. "The bottom line is the consumer-driven application for which you can identify large populations so that ultimately you have enough procedures being done and systems being sold to lower the price of the technology. That seems to be the route to success.
"Nobody really makes a lot of money in this business," Kincade continues. "The problem is that to make money in the medical laser business, you can't be a one-trick pony. The smaller players really struggle because they can't make enough money with a single application or product line." She cites the recent sale of Coherent Medical Group (Santa Clara, CA) to ESC Medical, (now Lumenis Ltd.; Yokneam, Israel) as a sign of the times. "Even some like Coherent who had a broad product line just weren't getting a really fast turnaround from their investment anymore."
Scott Baily, senior vice president and senior analyst at Bluestone Capital (New York, NY), agrees. "In the mature segments, prices come down and unless you have a diverse product line in order to maintain margins, most laser companies are not that profitable." According to him, it's all about niche markets. "It's so competitive," he says. "The market and technology leaders in the laser industry are those players who have unique products." Baily, along with several other analysts, sees the dental market as taking off. "I think it's going to be one of the big growth markets in the next few years," he says. Like Kincade, he sees consumer-driven applications as the key. "The reason we're seeing this big groundswell is that all across the country you're getting press now for painless dentistry. It's becoming a patient-driven purchase."
Consumer demand for an array of innovative medical technologies will continue to drive the industry forward in future. Look for similar advances and demand in photonic-based medical diagnostics (see oemagazine, February 2001, page 26). Indeed, despite the current condition of the economy, the medical photonics market in general looks strong. "It's certainly been an up and down industry," says Arons. "It appears to be in an upsurge right now." oe