Choosing a Laser for the Veterinary Clinic

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CHOOSING A LASER FOR THE VETERINARY CLINIC The Pilot™ laser is FDA-cleared, ISO-certified (13485:2003; 9000); FDA 510(k) Number: K100143 The 9W Pilot™ Laser is unique in the marketplace in that it can be used to perform a wide variety of procedures, namely surgical, therapeutic, dental and acupuncture in both the animal and human markets, where other lasers are limited to either surgical-only or therapeutic-only uses. In addition, the unique, patented optical fiber management system allows you to maintain a constant power output for the life of the laser – something no other diode laser is capable of doing! The Pilot™ Laser is manufactured in Salt Lake City, UT by CAO Group, Inc. (CAO) under the direction of Dr. Densen Cao, PhD. CAO offers design, development, manufacturing, marketing and sales of innovative medical, dental, veterinary, forensic, and solid state lighting products. CAO Group is headquartered in the Salt Lake City, Utah area with research, development, and manufacturing facilities in both West Jordan, Utah and Langfang (Beijing) China. All facilities are FDA registered and ISO 9000/EN 13485 certified. CAO Group is the largest diode laser manufacturer in the world, with over 10,000 units manufactured and sold. The Pilot™ Laser in Veterinary Surgery Providing an alternative to traditional surgery, Pilot™ surgical hand-pieces handle similarly to a scalpel and are extremely effective for common soft-tissue procedures. In contrast to electrosurgery devices that cannot be used for dental, optical, and/or orthopedic surgery involving implants, the Pilot™ laser can be safely used in each of these procedures: • Ophthalmologic applications (glaucoma laser surgery) • Dental and oral surgery applications • Declawing (relatively blood-free and pain-free) • Neutering and spaying • Mass and tumor removal • Biopsy • Soft palate surgery • Stenotic (pinched) nostrils resection • Eyelid surgery, and more Endoscopic Surgery - Laser Assisted Endoscopic Surgery for Minimally Invasive Procedures: In contrast to CO2 lasers, the Pilot™ laser can be used for endoscopic surgery since its laser light travels through a 400-micron silica fiber that can be inserted into endoscopic equipment. This allows the diode laser to reach sites where a CO2 laser cannot reach, resulting in a wider range of surgical procedures and options. Benefits include rapid recovery, less trauma and pain, reduced need for anesthesia, and minimal blood loss. Laser-Assisted Arthroscopy: Minimally invasive camera-assisted surgery in joints, bursa, or tendon sheaths. It is used to remove bone chips, treat OCD, or to address joint or tendon sheath infections. It is also used as a

diagnostic tool in areas that cannot be seen with any other imaging modality, such as damage to the cruciate ligaments, menisci, or articular cartilage of the stifle. Laser-Assisted Laparoscopy: Laparoscopy utilizes camera-assisted technology to provide minimally invasive surgery in the thorax or abdomen regions, such as removal of intra-abdominal cryptorchid, testicles, or ovaries. It minimizes the pain associated with the procedure, decreases the chances of post-operative complications, and allows a faster healing time Benefits to the Surgeon: • Multiple surgical capabilities: Laser surgery improves many surgical procedures by making them simpler and reducing risk; this enables surgeries that are not practical with conventional methods. • Enhanced visibility of the surgical field: The laser light seals capillaries and small blood vessels as it cuts, thereby dramatically reducing bleeding. This results in a much clearer and drier surgical site. • Increased precision and control: The focal spot size of the beam may be adjusted down to a small fraction of a millimeter or expanded for a much wider coverage. The laser power may be set for rapid removal of relatively large tissue amounts, or adjusted to remove only one cell layer at a time. • Reduction of surgery time: The hemostatic effect of the laser beam and the improved visibility of the surgical field often reduce the duration of the surgery. Benefits to the Patient: • Less Pain: The animal feels less pain after laser surgery because laser surgery seals the nerve endings as it "cuts". • Less Bleeding: Since the laser seals small blood vessels during surgery, it can reduce the amount of time required for surgery and anesthesia, thereby reducing the risk of complications. • Less Swelling: The laser can precisely remove diseased or unhealthy tissue without being as invasive to surrounding healthy tissue as in traditional surgery • Reduced Risk of Infection: Lasers offer a reduced risk of infection because they seal the skin as they cut, thereby reducing the chance of bacterial infection • Quicker Recovery: Because there is less pain, bleeding, and swelling with laser surgery, this leads to quicker recovery than with traditional surgery. Dental Procedures (Surgical & Therapeutic): The Pilot™ Laser is used for treating many dental conditions, including: • Gingivitis • Periodontal Disease • Post-Surgical Oral Pain • Hard and Soft Tissue Debridement and Contouring • Dental Surgery • Deciduous Tooth Extraction • Broken Tooth Extraction • Root Canal Treatment • Removal of Gingival Hyperplasia and Epulides

• Gingival Tissue Procedures in Esthetic Dentistry • Laser-Assisted Gingivectomy • Wound Healing of Periodontal Pockets • Oral Soft Tissue Management Periodontitis is a relatively common disease; various therapies have been recommended for its treatment, which includes nonsurgical, antimicrobial, and surgical therapy; in recent years, lasers have been used for all the three above-mentioned purposes with great success. Laser Therapy Procedures: • Reduces recovery time from injury and illness • Does not mask symptoms but corrects muscle-related problems by directly treating them • Enhances performance without medication and inherent side-effects • Alleviates pain and soreness from strenuous activity • Reduces stress levels, both physical and psychological • Improves respiratory, digestive, immune, and neural systems • Increases venal and lymphatic circulation • Prevents additional injury (saving money, as well as pain and trauma to the animal) • Ultimately improves the animal’s quality of life Treatment for Specific and Non-Specific Disorders: • Acute & Chronic Otitis • Hip Dysplasia • Anal Glands • Common Geriatric-Related Conditions • Hot Spots • Dermatological Disorders • Lick Granulomas • Cystitis • Sinusitis • Rhinitis • Stomatitis • Soft Tissue Injuries • Muscle Strains & Tears • Sore Muscles & Joints • Degenerative Joint Conditions • Tendon & Ligament Injuries • Invertebral Disc Disease • Osteoarthritis • Healing of Muscle Sprains & Ruptures • Overall Pain & General Malaise • Neurological Pain • Peripheral Neuropathy • Chronic, Non-Healing Wounds • Pre & Post-Operative Treatment • Anti-Inflammatory Treatment

• Vasodilation, Improved Blood Circulation • Anti-inflammatory Treatment Needle-free Acupuncture The World Association of Laser Therapy (W.A.L.T.) has determined that acupuncture points can be stimulated by photobiostimulation (Laser Acupuncture), a painless and sterile acupuncture technique. Laser Acupuncture The intensity of the stimulation from the Pilot™ HED (High Energy Density) optical fiber has been shown to have biological effects similar to those of metal needles and have a broad range of photobiostimulative effects. The cerebral and peripheral effects of laser needle acupuncture have been scientifically proven in studies and articles published in many peer-reviewed publications. Acupuncture treatments with lasers are completely painless, free from side effects, and very popular with all veterinary patients! Many clinicians and at least one research study comparing laser acupuncture and classic metal needles show that Laser Acupuncture produces superior results. With Laser Acupuncture, points are chosen in accordance with classical acupuncture protocols. Good therapeutic results are achieved in the treatment of back pain, joint pain, soft tissue injuries, osteoporosis, respiratory and neurological disorders and many other conditions. Pain Therapy A particular approach in pain therapy is to employ low-dose Transcutaneous Optical Nerve Stimulation (TONS). The optical fiber tip is placed on the painful area and activated in a lowpower level of around 1W. In addition producing analgesic effects thought to be similar to those of TENS (electrical nerve stimulation), laser irradiation induces an increase of cellular energy in the target tissue by increased ATP synthesis, greater oxygenation and enhanced capillary blood flow. Orthopedic and Physiotherapeutic Indications Orthopedic conditions that respond positively to Laser Acupuncture treatment include cervical syndromes, epicondylitis, fibromyalgia, osteoporosis, osteoarthritis, humerus scapularis, spinal syndromes, tendinitis, and more. Pilot™ Laser Optical Fiber Management System™ The unique Pilot Laser Fiber Management System™ offers distinct advantages when treating a large number of patients. In a high-volume clinic, a therapy laser might be used for prolonged time periods (for example, 20 patients/day times 20 minutes per patient equals 400 minutes, or 6 hours and 45 minutes or more of use in one day). As a result of the high level of heat discharge at the fiber tip (approximately 300° C depending on maximum power setting), all diode lasers experience gradual decay of the fiber-optic cable tip over prolonged usage of several days to several months.

Because of this, the CAO Group has developed a unique motorized fiber management system that allows the laser operator to ‘refresh’ the cable tip through the simple method of stripping approximately ¼” of the protective cover from the 20’ of 400 micron quartz/silica fiber provided, and cleaving the stripped portion of the silica fiber to create a fresh tip. This method of ensuring a ‘fresh’ fiber tip is unique to the Pilot™ laser, and is not available from any other laser manufacturer. Recently the Pilot™ laser was taken to one of the busiest chiropractic clinics in the U.S., where more than 100 patients are treated daily. This clinic focuses on back decompression and deeptissue laser therapy as primary treatment modalities, and utilizes ten decompression tables and eight 10W therapy lasers of another brand. A study was done utilizing the NOVA II lasermetering device by Ophir™, where maximum power output and laser calibration were tested on all eight of the 10W lasers as well as the Pilot™ laser. The results were surprising, and showed that all but one of the 10W lasers were emitting maximum power output far below their designated range, and noticeably less than the 9W Pilot™ laser, primarily due to calibration and fiber decay issues common to all class IV diode lasers. Seven of the eight-10W lasers ranged in maximum power output from 5.8W to 8.3W, while the 9W Pilot™ laser power output was steady at 8.8 W. The clinic was not able to be without even one of their lasers for the three weeks it took to send the laser back to the factory to have the fiber-optic cable tip refreshed, nor were they happy about spending up to $1,500 every time a fiber tip needed servicing. The same process that required the clinic to be without one of their 10W lasers for up to three weeks and pay $1,500 every time a fiber-optic cable tip needed servicing, can be done in as little as 3-5 minutes at zero cost with the Pilot™ laser, saving the clinic thousands of dollars in servicing costs and lost revenue. Unlike other lasers, the Pilot™ laser provides constant maximum power output due to the patented Fiber Management System™ process, which allows a laser operator to ‘refresh’ the fiber tip anytime a laser power output drop-off is suspected. Comparisons with other class IV lasers: The following information addresses concerns regarding comparisons between the Pilot™ laser and other competitor models: The attached Biphasic Dose Response document illustrates the concept that to achieve desired dosages it is more important to consider longer treatment times rather than higher power levels, contrary to claims made by K-Laser™ and Companion™ (LiteCure™) laser. The power output comparison charts are important to understand and consider, especially as KLaser™ and Companion™ both include built-in ‘protocols’ and a control screen with their lasers. It is important to note that every time you use a diode laser you experience power drop-off at the optical fiber tip. After a period of regular use your laser will inevitably drop below the FDAestablished 20% +/- calibration range, and your built-in protocols will be meaningless because the power level settings will be erroneous. Every diode laser experiences fiber degradation to the

point that, after several months of regular use the laser will only be able to deliver a small portion of the energy that is being generated by the laser module. This is unavoidable with every diode laser that uses optical fiber cable as a means of delivering laser energy except for the Pilot™ laser. The Pilot Laser is the only diode laser available that offers you a fiber management system (please note attached ‘Output Power Comparison’ document). While K-Laser™ and LiteCure™ will charge you up to $1,500 each time you need to refresh your optical fiber tip (and you will need to do it several times per year), the Pilot™ Laser allows you to refresh the tip weekly, or even daily, for several years at no cost. When the fiber cartridge is depleted, simply install a replacement cartridge without the need to return the laser to the manufacturer. We offer a 30-day money back guarantee, and manufacture our laser here in Salt Lake City, UT. If you ever experience a service-related issue your laser will not be shipped overseas for repair as is done with our competitors. We are also the largest diode laser manufacturer in the world, with over 10,000 units shipped. Pilot™ Laser vs. Companion™ & K-Laser™  Price:  Pilot Laser™: $12,997  K-Laser™: $25,000  Companion™ Laser: $30,000  Uses: Companion™ Laser & K-Laser™ - Therapy Only Pilot Laser™ - Therapy, Surgery, Dental, Acupuncture  Optical Fiber Management: Companion™ Laser, K-Laser™ – not available, For maximum power output must send handpiece back to manufacturer every 2 months for handpiece replacement, at cost of $1,500 Pilot Laser™ - 20' of optical fiber is included on motorized spool within laser case - user can refresh optical fiber tip daily for years before replacement is necessary; fiber replacement cost $495, can be done onsite, no need to ship back to manufacturer  Wavelength: Companion™ & K-Laser - 810nm, 960nm; Pilot Laser™ - 810 nm (additional wavelengths are not required and "provide little to no additional therapeutic benefits"*
* Ying-Ying Huang, Massachusetts General Hospital, Boston, MA James D. Carroll THOR Photomedicine Ltd, 18A East Street, Chesham, HP5 1HQ, UK Michael R. Hamblin, MIT Division of Health Sciences and Technology, Cambridge, MA

 Power Level: Companion™ Laser - 15W; K-Laser™ - 12W; Pilot Laser™ - 9W Maximum recommended power levels: standard surgery 8W; dental surgery/therapy 5W>; acupuncture 1W - 1.5W; deep tissue laser therapy 7.5W>

"Therapeutic dosage levels at higher power levels are counterproductive and cause photobioinhibition, rather than photobiostimulation"*
* Ying-Ying Huang, PHD, Massachusetts General Hospital, Boston, MA James D. Carroll, PHD, THOR Photomedicine Ltd, 18A East Street, Chesham, HP5 1HQ, UK Michael R. Hamblin, PHD, MIT Division of Health Sciences and Technology, Cambridge, MA

Why should a doctor pay $20,000 - $30,000 or more for a therapy-only laser? The laser diodes and optical fiber cables that all diode laser manufacturers use are practically identical in design and origin, and wavelength and power levels are all in the same range. Only empirical evidence exists to suggest multiple wavelengths, ultra-high power levels, built-in protocols, and glitzy control screens are beneficial to patients. In reality, those items are extraneous, and do nothing to increase patient response to the treatment provided, but are very effective in separating doctors from their hard-earned money. In addition, those high-priced lasers are only capable of therapeutic procedures, with no ability to perform surgical, endoscopic, laparoscopic, dental, or acupuncture procedures.

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