GEH1032

MODERN TECHNOLOGY IN
MEDICINE AND HEALTHCARE

Chan Taw Kuei

Department of Physics

Chapter 2
Lasers in Medicine and Surgery
 Chapters
Chapter 1: Endoscopy: Internal Optical Imaging using Endoscopes

Chapter 2: Lasers in Medicine and Surgery

Chapter 3: Sonography: Imaging using Ultrasound

Chapter 4: Radiography and CT: 2D and 3D imaging using X-Rays

Chapter 5: Nuclear Medicine: 3D imaging using Radioisotopes

Chapter 6: Magnetic Resonance Imaging (MRI)

Chapter 7: Radiation Therapy: Cancer therapy using radiation

Chapter 8: Nanomedicine: Nanotechnology in Medicine

GEH1032 Sem 2 2020-21 TK Chan

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 Chapter 2: Lasers in Medicine and Surgery

Introduction and Physics Lasers Medical Applications

Diabetes Stimulated Emission
The Eye Eye Conditions and Treatment
Population Inversion
Age and Diabetes related Eye Diabetic Retinopathy
Conditions Principle of Lasers
Glaucoma
Laser Surgery: Introduction Properties of Lasers
Laser Treatment Effectiveness
Nature of Light Types of Effects Cataracts
induced by Lasers
Classical Description
Quantum Description Other Medical Applications
Photocoagulation
Visible Light and its Colours Photovaporisation LASIK
White light Photoablation and Removal of unwanted tattoo
Absorption and Emission Spectra Photomechanical effects Laser Safety
Quantum Model of Atom Laser Penetration

Energy levels Color-specific Absorption

Ground and excited states
Selective Surgery on
Pauli Exclusion Principle the Eye
Electron Transitions
GEH1032 Sem 2 2020-21 TK Chan
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 Diabetes Mellitus
• Diabetes refers to a family of diseases that result in the blood sugar level to be consistently
too high. If not managed or controlled properly, diabetes may result in complications that lead to
disabilities that will significantly reduce the quality of life and are very difficult and costly to treat.

Global burden of Diabetes

• It is estimated that diabetes affects more than 420 million adults worldwide in 2014. The prevalence of
diabetes has risen rapidly over the past decades, with the number of people affected in 2014 being
about four times that in 1980. Diabetes is estimated to be the 7th leading cause of death in 20163.
• Diabetes is the direct cause of 1.6 million deaths in 20153 (plus an additional 2.2 million deaths due to
its complications), of which 80% occurs in low and middle income countries. 43% of all deaths due
to high blood glucose levels occur prematurely, before the age of 70.
• Singapore has the second-highest proportion of diabetics among developed nations1. In 2017, about
606,000 Singapore residents are affected by diabetes2 (1 in 9 residents) and by current projections, this
number is expected to rise to 1 million by 2050.
• Consequently, the number of complications caused by diabetes is rising in Singapore. In 2014, 50% of
all heart attack patients had diabetes, 67% of new kidney failure cases were due to diabetes and 40% of
stroke patients suffer from diabetes. There are over 1,200 amputations per year due to complications
arising from diabetes, roughly 3 per day2. FYI
Sources: World Health Organization Global Report on Diabetes 2016
GEH1032 Sem 2 2020-21 TK Chan Ministry of Health Singapore 4
 Insulin and Insulin Resistance
• Insulin is a hormone that allows cells to absorb glucose in the blood and use it as an energy source.
Essentially, it acts as a key that opens a door (or a channel) for glucose to enter a body cell so that it can
be used to generate energy for the cell. When the glucose level is too high, insulin encourages the liver,
muscles and fat cells to store the excess glucose in the form of glycogen as an energy reserve.

• Insulin acts to regulate the glucose level in the blood 1 .

• However, body cells may become insensitive to the action

of insulin. When this happens, the muscle, fat, and liver cells
do not respond properly to insulin and therefore are unable
to readily absorb glucose from the bloodstream. This is
known as insulin resistance. When this happens, more
and more insulin is required to do the same job.

• The exact cause and mechanism of insulin resistance are not entirely understood. The major risk factors,
however, are well-established: poor diet, excess weight, physical inactivity and smoking1 , 2. Insulin
resistance is a major risk factor for type 2 diabetes. Note: Insulin resistance ≠ diabetes! Insulin
resistance is reversible, but type 2 diabetes is not.

• Insulin resistance has no obvious symptoms in many cases. People may suffer from insulin resistance for
years without knowing it.
GEH1032 Sem 2 2020-21 TK Chan Sources: Understanding Diabetes: A Biochemical Perspective, Richard F. Dods, Wiley 2013 , National Institute of Diabetes and Digestive and Kidney Diseases, US Department of Health and Human Services
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 Common Types of Diabetes
Type 1 Diabetes
In type 1 diabetes, the immune system malfunctions and attacks the insulin-producing cells in the
pancreas, severely affecting the insulin production by the body. As such, people with type 1 diabetes
require daily injection of insulin in order to survive. Type 1 diabetes is usually diagnosed at a young
age (e.g. children and adolescents), which is why it was previously known as juvenile diabetes.

Type 2 Diabetes
Type 2 diabetes is primarily caused by insulin resistance, where the body can no longer effectively
use insulin to regulate the glucose level in the blood. Approximately 90% – 95% of all cases of
diabetes worldwide are of this type.

Gestational Diabetes
This type affects some women only during pregnancy, who have very high levels of glucose in their
blood and their bodies are unable to produce enough insulin regulate the blood glucose level.

Other Types: E.g. Impaired Glucose Tolerance (IGT), Impaired Fasting Glycaemia (IFG), Latent Autoimmune Diabetes
(LADA) Or Type 1.5, Idiopathic Diabetes (T1B), Hybrid etc. FYI

GEH1032 Sem 2 2020-21 TK Chan

Sources: World Health Organization Global Report on Diabetes 2016
Understanding Diabetes: A Biochemical Perspective, Richard F. Dods, Wiley 2013
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 Risk Factors for Type 2 Diabetes
• Overweight and Obesity
The factor that poses the greatest and clearest risk for type 2 diabetes is excess body fat. Being
overweight (23 < BMI < 27.4) and obese (BMI > 27.5) have caused a large portion of the global
incidences of diabetes.
In particular, some studies suggest that the presence of a large amount of abdominal fat 1 , 2 , 3
(i.e. for people with large waistlines) increases the risk for insulin resistance, high blood pressure,
imbalanced cholesterol, and cardiovascular diseases (CVD).

• Unhealthy diet
High intake of saturated and total fat, as well as insufficient dietary fibre intake have been shown
to increase the risk. Recent evidence has also linked high intake of sugar-sweetened beverages
with an increased risk of type 2 diabetes.

• Physical Inactivity 1
• Smoking 2
• Old age 3
• Family History
GEH1032 Sem 2 2020-21 TK Chan
“More than 80% of type 2 diabetes can be prevented or delayed
by reducing the risk factors that may lead to its development
and adopting healthier lifestyles“
--- World Health Organisation ---
Sources: World Health Organization Global Report on Diabetes 2016
Understanding Diabetes: A Biochemical Perspective, Richard F. Dods, Wiley 2013
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 Complications of Diabetes
• Prolonged hyperglycemia causes damage to blood vessels1 , 2 and nerve cells3, 4. Diabetes
increases the risk for many serious health conditions and is a leading cause of blindness,
amputation and kidney failure.
• Some common types of complications (not exhaustive) are:

• Cardiovascular Diseases (CVD)

Diabetes increases the risk of coronary artery disease, heart attack, stroke and atherosclerosis
(narrowing of blood vessels), leading to 50% – 80% of deaths for people with diabetes.

• Foot Complications (Diabetic Foot)

Nerve damage (peripheral neuropathy) due to diabetes may lead to conditions involving the
feet: e.g. loss of feeling, calluses, ulcers and gangrene which may lead to amputations.

• Kidney Damage (Nephropathy)

Diabetes may lead to the damage of the millions of tiny blood vessel clusters in the kidney that
filter waste from blood. This may lead to chronic kidney disease (CKD) and eventually end stage
renal disease (ESRD, also called kidney failure), which requires dialysis and kidney transplant.

• Eye Complications
Diabetes causes increases the risk of glaucoma, cataracts and diabetic retinopathy.
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* Source: World Health Organisation
 Prevention and Management of Diabetes
• Prevention of (type 2) diabetes begins with proper understanding and recognition of the importance of
good diet, active lifestyle and proper weight management as early in life as possible.
• People with early stages of diabetes can lead a normal life if their diabetes is well managed. However, the
effectiveness of disease management ultimately depends on whether the individual complies with the
doctor’s recommendations and treatment.
• Apart from medical intervention (e.g. regular medical exams, medication, surgery etc.), some of the
general recommendations to prevent and manage diabetes are through personal lifestyle changes:
▪ Adopt a healthy diet
Maintain a healthy weight and a diet low in free sugars and saturated fats with adequate intake of
dietary fibre. For overweight and obese patients, weight loss through lower calorie intake.
Official recommendation: limiting saturated fatty acid intake to less than 10% of total energy intake and achieving adequate intakes of
dietary fibre (minimum daily intake of 20 g) through regular consumption of wholegrain cereals, legumes, fruits and vegetables. Intake of
free sugars should be less than 10% of total energy intake. FYI

▪ Regular physical activity

Studies suggest that physical activity lowers insulin resistance and improve blood glucose control.
Official recommendation: adults aged 18–64 years should do at least 150 minutes of moderate-intensity aerobic physical activity (e.g.
brisk walking) or at least 75 minutes of vigorous-intensity aerobic physical activity (running) spread throughout the week, or an
equivalent combination of both. FYI

▪ Avoid tobacco smoking and harmful use of alcohol

GEH1032 Sem 2 2020-21 TK Chan Sources: World Health Organization Global Report on Diabetes 2016
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 The Eye

The clear front window of the eye. The cornea transmits and focuses light into
Cornea
the eye.
The colored part of the eye. The iris helps regulate the amount of light that
Iris
enters the eye.

Lens The transparent structure inside the eye that focuses light rays onto the retina.

Optic The optic nerve connects the eye to the brain. It carries the impulses formed
Nerve by the retina to the brain, which interprets them as images.
The dark center in the middle of the iris. The pupil determines how much light
Pupil is let into the eye, changing size to accommodate the amount of light that
the eye is exposed to.
The nerve layer that lines the back of the eye. The retina senses light and
Retina
creates impulses that are sent through the optic nerve to the brain.
Vitreous The clear, jelly-like substance that fills the middle of the eye. It maintains the
Humour shape of the eye.
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 The Retina
Retina

Choroid
Sclera
• The retina is a stack of several layers that contain photoreceptor cells known as the rod and cone cells.
These cells absorb light using photopigment molecules.
• There are 3 different types of cone cells, each with a different photopigment that has a unique colour
absorption property, generating different signal responses to blue, green and red wavelengths. These
different cone cells work in combination to handle color vision.
• The spectral response of rod cells essentially covers the whole visible spectrum; they therefore
respond to all visible light. Rod cells are extremely sensitive and they handle vision in low light.
• Both cone and rod cells absorb photons and perform a process known as phototransduction, where
an electrical signal is generated. This signal is then propagated through the amacrine and ganglion
cells and sent to the brain via the optic nerve.
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 Age and Diabetes related Eye Conditions
• Both diabetes and ageing may cause various eye conditions which affect vision and may
lead to blindness.

• Some of the common conditions involving the eye that we shall cover are:
• Diabetic Retinopathy (Non-proliferative and Proliferative)
• Glaucoma
• Cataracts

• If the eye condition is not properly managed, severe damage to the retina or optic nerve
may occur and vision may be partially or totally lost. This is in many cases permanent and
irreversible. No treatment can then reverse the damage and allow the patient to regain the
vision that is lost.

• However, with early diagnosis, proper treatment, medication and lifestyle changes,
severe damage may be prevented. In severe cases, treatment prevents further damage
and allowing the patients to preserve whatever vision that they still retain.
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 Laser Surgery on the Eye
• Laser surgery on the eye is the most common form of treatment for many eye conditions at
moderate to severe stages.

• During laser surgery, a laser beam is used to make incisions, destroy abnormal tissues or seal
leaking blood vessels.
• Advantages of using lasers to perform eye surgery:
➢ Very high precision and accuracy

➢ Lasers delivers only a small amount of energy to the eye

during surgery, reducing risks of complications.
Eye surgery
➢ Relatively quick with no need for general anesthesia.
Healthandbeautywoman.com
➢ No need to cut open the eye in many procedures.

➢ Different wavelengths may be used for selective surgery on different eye structures.

• Disadvantages of using lasers:

➢ High equipment and maintenance cost

➢ Certain new procedures may not be covered by government/state subsidies or insurance

providers, resulting in higher out of pocket expenses to patients.
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 But what are Lasers?

http://dailydiy.com/2009/06/05/125mw
-green-laser-pointer-by-sky-lasers/

How do they work?

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 Classical description of Light: Electromagnetic Wave
• In classical physics, light is considered as an electromagnetic wave that possesses
a wavelength and frequency.
• An electromagnetic wave is a wave that is made up of alternating electric (E) and
magnetic (B) fields. These fields travel together at the speed of light.

• The speed of light is different in different media (depending on the refractive

index n). In vacuum, the speed of light is denoted as c with a value of 3.0 108 m/s.
Here, we shall assume that the speed of light in air is also c.
• The frequency f and wavelength  of light are related by: v = c = f .
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 Quantum description of Light: Photons
• In quantum physics, light is considered as a stream of particles called photons.
• Even though they are particles, photons possess wavelength and frequency.
• Photons are massless, but they possess energy and momentum.

Energy of a photon
hc
E = hf =

where h = Planck’s constant
= 6.62610–34 m2 kg / s

c = Speed of light = 3.0108 m / s

f = Frequency of light (Hz)
 = Wavelength of light (m)
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 Example: Energy of a photon
Question:
What is the energy of a photon that has a wavelength of 500 nm?

Solution:

E =
hc
=
( 6.626 10 −34
) (
m 2 kgs −1  3.0 108 ms −1 ) = 3.98  10−19 Joules
 (500 10 −9
m )
Converting to electron volts (eV) where [ 1 eV = 1.60210–19 Joules ],

−19 3.98 10−19

E = 3.98  10 Joules = −19
eV = 2.49 eV
1.602 10

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 Light : Wave or Particle?

So is Light a wave or made up of particles??

Light has properties of both wave and particles.

It depends on the type of experiment

conducted
(Wave – Particle Duality)

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 The Visible Spectrum
Colours of Visible Light

Visible spectrum
• Visible light has different colours, ranging from violet to red, exactly what one would
see in a rainbow.
• Different colours correspond to an electromagnetic wave (or photons) with a different
wavelengths and frequencies.
• As a rough guide, visible light has a wavelength that range from:
400 nm (Violet)  700 nm (Red)
• Note that visible light only make up a very small portion of the full electromagnetic
spectrum, most of which are not visible to the eye.
GEH1032 Sem 2 2020-21 TK Chan Note: 1 nm = 10 − 9 m = 0.000000001 m 19
 White Light and the Colour Spectrum
• White light refers to visible light that possess a complete range of colours. In other words,
white light consists of ALL wavelengths within the visible spectrum.

• White light is given out by very hot objects, where their

temperature has exceeded a certain threshold, i.e. they have
gone “white hot”, e.g. filament lamps.

• The different colours cannot be separately seen by the eye, but

can be displayed as a continuous colour spectrum by a prism.
http://images.wisegeek.com/light-bulbs.jpg

http://faculty.virginia.edu/consciousness/new_page_6.htm

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 Absorption and Emission Spectra
• The sun is hot enough to give off white light. It is reasonable to expect
that sunlight, if passed through a prism, will produce a continuous,
complete colour spectrum.

• However, when sunlight is passed through a prism on the surface of

the Earth, its colour spectrum reveals dark, discrete lines.
The sun (heavily filtered)
• This means that for some mysterious reason, specific wavelengths of light corresponding
to these dark lines are missing.

• Similar discrete dark lines can be found in the infrared and ultraviolet region of the
electromagnetic spectrum as well. Some of these lines are also present in the spectra of
other stars.

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 Absorption and Emission Spectra - FYI
• The English chemist William Hyde Wollaston was the first to notice these
discrete dark lines in 1802. However, he did not think that these lines were
very significant.

• 12 years later in 1814, the German physicist Joseph von Fraunhofer

rediscovered these dark lines and performed extensive analysis on them.
He catalogued more than 500 lines in the colour spectrum of the sun. www.fraunhofer.de/

These lines are now known as Fraunhofer lines. Fraunhofer

http://www.chemteam.info/Electrons/Spectrum-History.html

• Fraunhofer spent a great deal of time studying

these lines, but he was never able to explain why
these lines exist. In fact, these lines cannot be
explained by the physics that existed at that time.
Fraunhofer’s drawing of the absorption lines

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 Absorption and Emission Spectra
• The dark lines in the solar spectrum may be reproduced in the laboratory.

• A beam of white light with a complete colour

spectrum (from a hot object) is made to pass
through a region filled with Hydrogen gas.

• After emerging from the Hydrogen gas, the

resulting spectrum has dark lines, i.e. some of
Hydrogen
the wavelengths were removed. Gas

vacuum
• This means that the Hydrogen gas selectively
absorbs certain discrete wavelengths from the
light passing through it, resulting in an
absorption spectrum (dark lines within a
continuous spectrum).
http://www.daviddarling.info/encyclopedia/A/absorption_spectrum.html

• At the same time, the gas also emits the same set of discrete wavelengths of light (that it has
absorbed), which can be measured from a different direction. This results in an emission
spectrum (bright lines within a dark background).

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 Absorption and Emission Spectra
• This same set of lines from Hydrogen are found in the (absorption) spectrum of our sun and all
other stars. This means that the white light generated from within the sun or the star passes first
pass through Hydrogen gas in its own atmosphere before reaching Earth  the light that emerges
from the sun will contain these discrete missing wavelengths.

Absorption spectrum
Hydrogen
Emission spectrum

• The sunlight must also pass through different gases in the Earth’s atmosphere (e.g. Nitrogen,
Oxygen etc.) before being observed on the surface of the Earth. Each of these gases absorb their
own set of wavelengths, creating extra lines in the absorption spectra when it is finally measured
by an observer on Earth.

• It was then discovered that different gases each absorb/emit a unique set of wavelengths. Each
set of spectra can therefore serve as a sort of “fingerprint” for each gas 1. Lines of some gases

GEH1032 Sem 2 2020-21 TK Chan

1 Kirchhoff and Bunsen, 1859 24
 Emission Spectra of common Gases

GEH1032 Sem 2 2020-21 TK Chan http://spiff.rit.edu/classes/phys312/workshops/w10b/spectra/spec_rev_orientation.gif 25

 Discovery of Helium - FYI
• During a solar eclipse in 1868, a bright yellow emission line was observed from the
sun’s atmosphere which could not be identified from emission experiments carried
out in the laboratory.

• It was assumed that it was a new element. This new element is present in the sun’s
atmosphere but it is not naturally found on Earth.

• The new element was named helium from the word helios, the Greek word for sun.

• On Earth, helium was later artificially isolated from a sample of uranium mineral in
1895, proving that the element actually do exist.
FYI

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 Quantum Physics
• The absorption and emission spectral lines cannot be explained by physics that existed at the
start of the 20th century. At that time, physics essentially comprises of what is now known as
classical physics. This in part led to two major developments in the early 20th century that
ushered in the era of modern physics:
a) Einstein’s theory of relativity
b) Quantum Physics

• These new fields led to explaining what an atom was, and led to advances in physics, chemistry,
biology, technology (including Lasers) that we have today.

• However, Quantum Physics was a difficult theory to imagine:

➢ It was completely different to the classical theory of electromagnetism which had been very
successful in explaining most phenomena observed in electromagnetism up to that point.
➢ It is difficult to imagine what a photon is:
A particle with no mass, but has a wavelength λ, a frequency f, energy = hf, momentum, and
is always travelling at the speed of light [in vacuum, 𝑐 = 3.0108 ms−1].

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 The Atom
• The atom consists of electrons, and a tiny core called the nucleus.

• Electrons are negatively charged particles with an extremely small

mass. They are commonly viewed as orbiting around the nucleus.

• Electrons are responsible for all chemical reactions, chemical

bonding, absorption/emission spectra as well as lasers due to
electron transitions, etc.

• The atomic nucleus forms the core of the atom. It is positively The popular view of the atom
charged and does not participate in chemical reactions.

• The nucleus is much heavier than an electron and is confined to a very small volume in the
middle of the atom. Note: the size of an atom is determined by the size of the of the orbit
of the electrons as they move around the nucleus.

• Atomic Physics refers to the field of physics that concerns the orbiting electrons of the atom
(and not the atomic nucleus).

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 Bohr’s Quantum Model of the Atom
• In 1913, Niels Bohr developed a model of the atom that provided an explanation of the
emission and absorption lines seen in experiments.
• His model (originally for hydrogen) assumed that electrons moved in circular orbits
around a heavy nucleus (a proton in the case of hydrogen).

Rules of the Model

n=3
• The electrons can only exist in specific,
Electron
discrete orbits. Such orbits are also known as n=2
allowed orbits.
• Each discrete, allowed orbit has an associated n=1
energy value. Nucleus

• If an electron exists within a particular orbit, it E1= −13.606 eV

must assume an energy equal to the
associated energy of that orbit. E2= −3.401 eV
Electron orbits
• By convention, the energy of each orbit are E3= −1.512 eV
expressed in electron volts (eV) and have
negative values.
Note : 1 eV = 1.6 10−19 Joules 29
GEH1032 Sem 2 2020-21 TK Chan
 Energy Levels in an Atom
• Instead of drawing circular orbits each time, we may also use the energy level diagram to
represent the electron orbits.

• Each horizontal line in the energy level diagram

represents an allowed orbit of the atom and
these lines are known as energy levels.

• Every energy level of an electron within an atom

has an integer label “ n ”*.

• The lowest allowed energy level has n = 1, the

first excited level has n = 2, the second excited
level has n = 3 and so on …

• Generally, the assigned energy of the energy level

n is represented by En

• The lowest allowed energy state is therefore represented by E1.

GEH1032 Sem 2 2020-21 TK Chan

* “n” is known as known as the Principal Quantum Number 30
 Ground states and Excited states

Hydrogen atom in Hydrogen atom in Hydrogen atom in

its ground state the 1st excited state the 2nd excited state

• An atom is in a ground state when all its electrons occupy their respective
lowest possible energy states.
• An atom is in an excited state if it is NOT in the ground state.
• There exist certain conditions that restrict the total number of electrons that
may occupy any given energy state: Pauli’s Exclusion Principle.
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 Pauli Exclusion Principle
• Hydrogen is the lightest and has the simplest atom of all elements. It is also one of the most
important elements in medical physics, since the human body is mostly made up of water.

• An atom of Hydrogen has only 1 electron orbiting the nucleus.

• In general, however, other heavier elements have atoms that have more than one electron
orbiting the nucleus. For these atoms, there are restrictions with regards to the occupation
of energy levels by electrons.

• One important restriction is the Pauli Exclusion Principle, which is a rule in quantum
mechanics which sets a limit to the number of electrons that are allowed within each
energy level.
Energy state Maximum number of electrons
• The table on the right shows the
maximum number of electrons n=1 2
allowed in each energy state up n=2 8
to n = 3:
n=3 18
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 Example: Sodium Atom in the Ground State
• The sodium atom has 11 electrons.
n=3

• The figure on the right show the sodium atom in its n=2
ground state.
n=1
• Recall that an atom in its ground state means that
all its electrons take up the lowest possible energy
states that is allowed by the Pauli Exclusion
principle.
Nucleus
• For sodium in the ground state, n = 1 (2 electrons)
Sodium atom in its
and n = 2 (8 electrons) energy levels are filled up, ground state
leaving behind one electron in the n = 3 energy
state.

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 Electron Transitions
• Electrons can “jump” from one energy level to another  Electron Transitions

• An electron may:
i. Jump to a higher energy level by absorbing a photon [Excitation event]
ii. Jump to a lower energy level by emitting a photon [De-excitation event]

• The absorbed/emitted photon has an energy that is exactly equal to the difference
between the two energy levels involved.
n=3 n=3
Excitation De-excitation
n=2 n=2
Emitted
Absorbed
n=1 n=1

Photon of energy Photon of energy

E = hf = E3 − E2 eV E = hf = E3 − E2 eV
E1 E1

E2 E2
hc
E= = hf
E3  E3
Note: Absorbing photons is not the only way for electron excitations to occur. Collisions with other fast-
moving electrons, nuclei or atoms may also cause excitation events. 34
GEH1032 Sem 2 2020-21 TK Chan
 Example: Sodium Atom in the Excited State
• We illustrate the concept of an excited state using an
example of the sodium atom.

• One electron in the energy state of n = 2 has jumped up to

the n = 3 state, leaving behind a vacancy in the n = 2 state.

• In this configuration, the electrons are no longer occupying

the lowest possible energy levels
 the atom is no longer in the ground state.
 the atom is in an excited state.
Nucleus
• An atom in an excited state is unstable. After some Sodium atom in an
time, it will return to its ground state (de-excitation). excited state
• The sodium atom may de-excite when the extra electron in the n = 3 state jumps back to
the n = 2 state and at the same time emitting a photon.

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 Worked Solution 1: De-excitation of Hydrogen Atom

Question
The table on the right shows the respective energy Energy state En
levels of Hydrogen atom up to n = 4 . n=1 −13.60 eV

What is the wavelength and the colour of the n=2 −3.401 eV

photon emitted when an electron jumps from the n=3 −1.512 eV
n = 3 to the n = 2 state?
n=4 −0.850 eV
Solution
The energy difference between the n = 3 and n = 2 states is
E = ( −1.512) − ( −3.401) = 1.889 eV
This is therefore the energy carried away by the photon. The wavelength of the photon is:

E = 1.889 1.602 10−19 J =

hc
=
( 6.626 10 )  (3.00 10 )
−34 8

 
  = 656 10−9 m = 656 nm
This is the red emission line of hydrogen.
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 Worked Solution 2: Excitation of Hydrogen Atom

Question
The table on the right shows the respective energy Energy state En
levels of Hydrogen atom up to n = 4 . n=1 −13.60 eV

What is the wavelength and the colour of the n=2 −3.401 eV

photon absorbed when an electron jumps from n=3 −1.512 eV
the n = 2 to the n = 4 state?
n=4 −0.850 eV
Solution
The energy difference between the n = 2 and n = 4 states is
E = ( −0.850 ) − ( −3.401) = 2.551 eV
For an electron to make this transition, it must absorb a photon with energy of 2.551 eV.

E = 2.551 1.602  10−19 J =

hc
=
( 6.626 10 )  ( 3.00 10 )
−34 8

 
  = 487  10−9 m = 487 nm
This is the green absorption line of hydrogen.
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 Absorption and Emission Spectra:
Direct Result of Electron Transitions in Atoms
• The absorption and emission spectral lines
are due to electron transitions between
energy levels in atoms.
• Each dark line in absorption spectra is due
to a large number of photons which are
absorbed during atomic excitation events.
• Each colour line in emission spectra is due
to a large number of photons which are
emitted during atomic de-excitation events. http://www.daviddarling.info/encyclopedia/A/absorption_spectrum.html

• A jump from a lower to a higher energy level results in photons being absorbed at specific
energies/wavelengths from a continuous spectrum of light  Absorption spectrum
• A jump from a higher to a lower energy level results in photons being emitted at specific
energies/wavelengths  Emission spectrum

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 Absorption and Emission Spectra:
A phenomenon that took 100 years to explain
• Bohr’s model of the atom was published in scientific journals in the
year 1913, more than 100 years after the discovery of the absorption
spectra (Fraunhofer lines). It incorporated ideas and concepts from
Albert Einstein and Max Planck.

• Bohr’s model paved the way for Quantum Physics to be further

developed by scientists such as Heisenberg, Schrodinger and Fermi.

• While quantum physics has proven to be an immense success that

accounts for a multitude of physical phenomena, its inherent Wikipedia

Niels Bohr
weirdness continue to stir debate on its interpretation and its
philosophical implications.

“Anyone who is not shocked by quantum theory

has not understood it”
– Niels Bohr FYI
GEH1032 Sem 2 2020-21 TK Chan 39
 Types of Photon Emissions due to Atomic Transitions
i. Spontaneous Emission
An atom in an excited state very quickly returns to its ground state with the emission of a
photon (normally around 10–8 seconds). Most atomic de-excitation events are of this type.
http://ecx.images-amazon.com/images/I/51miadYIkkL._SX300_.jpg

ii. Phosphorescence
A form of emission (i.e. atomic de-excitation)
that may continue to occur even when source
of excitation is switched off. Occurs only in a
special compounds known as phosphors.
www.layers-of-learning.com/sunlight-experiment/

iii. Fluorescence
Occurs when emission occurs only in the
presence of an excitation source, e.g. UV lamp.
Occurs only in fluorescent materials.

iv. Stimulated Emission Tonic water contains quinine, a fluorescent

compound. It absorbs UV, emits visible light.

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 Stimulated Emission:
The mechanism behind Lasers
• Consider the scenario where an electron is in an excited state E2, which is at an energy of
E = (E2 – E1) above the lowest state E1.
already
• Stimulated emission occurs when an incoming
photon with an energy that is exactly equal to E
stimulates the electron in the excited state to
return to a lower state and thereby emitting a Incoming Incoming

second photon.

• This second photon has the same energy, same New

phase and travels along the same direction.

• The original incoming photon is not absorbed. Each

stimulated emission event therefore increases the
total number of photons by one.
• Stimulated emission forms the basis of light amplification that is required for lasers to
function.
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 Population Inversion: A necessary condition for Lasers
• Atoms are normally in their ground states. If we shine photons (of the correct energy) on to
these atoms, we will observe atoms undergoing excitation from their ground states.

• However, they usually undergo de-excitation very quickly via spontaneous emission, since
excited states usually have very short lifetimes  very few stimulated emissions will occur,
since the atom is in an excited state only for a very brief period of time.

• In order to induce a large number of stimulated emissions, we need to:

➢ Create a situation where there are more atoms in excited states as compared to ground
states. This is known as population inversion.

➢ Increase the number of photons of the correct energy which will trigger stimulated
emissions. This is known as light amplification.

• For population inversion to occur, the atoms must be able to stay in special excited states
with long lifetimes, so that stimulated emissions can occur before spontaneous
emissions will occur. Such long-lifetime excited states are known as Metastable states.
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 Laser
Light Amplification by Stimulated Emission of Radiation
• Lasers uses the mechanism of stimulated emission and light amplification in order to generate
an intense and coherent beam of light.
• A tube containing an active material is placed between 2 mirrors. The atoms of the active
material contain metastable excited states. These atoms are continuously caused to reach
these metastable states by an external source of energy. Eventually, the state of population
inversion is achieved.
• With population inversion, a large number of stimulated emissions may occur. The photons
emitted by stimulated emissions may bounce back and forth many times between the mirror,
inducing even more stimulated
emission within the active material
 Light Amplification
• One of the mirror is very slightly
transparent, so as to allow a small fraction
of photons to escape as Laser output.
Laser light is very intense, coherent,
monochromatic, and highly directional.
43
 Laser Operation – A Detailed Description
For lasers, the conditions of population inversion and light amplification are necessary:
• Population inversion is the situation where there are more atoms in their excited states
than those in their ground states. For this to be achieved, the atoms of the active material
must possess a metastable state, which is an excited state with a relatively long lifetime.
• Light amplification is the process where the number of photons that is capable of
triggering stimulated emissions is increased.
The main components of a laser consists of an active material, an external source of energy for
the pumping process, and two mirrors of which one is slightly translucent. The external energy
source continuously causes excitation events in the active material, causing many atoms to
reach their metastable states. Eventually, population inversion will be achieved.
Atoms in their metastable states may first undergo spontaneous emissions, emitting photons in
random directions. Some of these photons may be emitted along a direction where they will be
reflected multiple times by the two mirrors that are on each side of the active material. These
photons will then trigger many stimulated emissions as they move within the active material.
Each stimulated emission will produce an additional photon with the same energy (i.e.
wavelength) and travels in the same direction. As these photons are forced to criss-cross the
active material multiple times due to the mirrors, the number of such photons increases
rapidly, resulting in light amplification. As one of the mirrors is slightly translucent, a fraction
of the photons are able to pass through and escape. These photons constitute the laser output.

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 Example: He-Ne Laser
Ne

He + Ne Gas

• A mixture of Helium and Neon is confined to a sealed tube as active material.

• An oscillator connected to the tube causes electrons to pass through the He and Ne gases,
causing the gas atoms to be raised to their excited states.
• Neon atoms are excited to a level E3* due to both collisions with the electrons and excited
He atoms.
• The Ne atom emits 632.8 nm photons which are amplified in the system through
stimulated emission.
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 Some Lasers Parameters
• Wavelength (Colour)
➢ The wavelength of the laser is simply the wavelength of the photons emitted by the stimulated
emission process. This is therefore determines the energy E of each individual photons.
➢ The wavelength determines the colour of the laser (if it is visible) e.g. a blue laser may have a
wavelength of 488 nm, green at 514 nm, red at 633 nm etc.

• Power
➢ Power is the total laser energy output per second, in Watts (i.e. J s–1). This gives a rough guide
as to how damaging or destructive such a laser can be. High power lasers (several kilo Watts)
are used in the industry to cut metal plates into specific shapes very quickly and precisely.

• Intensity and Power Density

➢ The intensity I refers to the rate at which laser energy is delivered to a unit area on a
surface. The term Power Density has the same definition. It gives a measure of “brightness”.
➢ A beam of laser of the same power may be focused into beam spots of different sizes, resulting
in different intensity (i.e. power density) and hence inducing different types of effects.
➢ Do not confuse beam intensity I with photon energy E. They are completely different
quantities that can be varied independently of each other.
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 Types of Effects Induced by Lasers
• Photothermal effects are most commonly used in the medical applications of lasers.
Upon exposure to a beam of laser, laser energy is deposited in tissues and heat is
generated, causing the temperature of the tissue to rise.
• As the power density increases beyond photothermal effects, the effects of
photoablation and photodisruption may occur.

Power density (watts/cm2) Tissue effect

< 10 watts/cm2 Gentle heating, negligible effect

10 – 100 watts/cm2 Photocoagulation (Photothermal)

100 watts/cm2 to 1 MW/cm2 Photovaporisation (Photothermal)

1 – 1000 MW/cm2 Photoablation

> 1000 MW/cm2 Photomechanical

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 Photocoagulation
• Most major structural tissues in the body e.g. muscles, skin, connective tissues, and blood vessel walls
are made up of structural proteins (e.g. collagen). Proteins are complex large molecules made up
mainly of C, O and H, but with traces of other elements. Other types of proteins (e.g. enzymes and
hormones) carry out vital functions in every cell.

• To carry out their task, all protein molecules

must fold into a very specific 3-dimensional
structure.

• When heated to temperatures above around 50C, Protein in its normal Denatured
3D structure. protein
the protein unfolds into random coils (denatures) and
loses its ability to carry out its function. This process is called coagulation. If the coagulation process is
induced by laser exposure, it is known as Photocoagulation.

• When coagulation occurs in human tissue, the tissue is essentially ‘cooked’. Cells in the coagulation
region are killed, and proteins are destroyed.

• Photocoagulation has excellent hemostatic property, i.e. ability to stop bleeding. A blood vessel that is
subjected to photocoagulation initiates a complicated sequence of events that involves the denaturing
of collagen within the blood vessel wall, eventually constricting and sealing the (leaking) blood vessel 1.
The damaged blood cells in the region also induce blood clotting that aids the process.
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 Photovaporisation
• When the absorbed energy density is sufficiently high (temperature > 100 C), water in
the tissue boils off and is removed. This essentially vapourizes and removes the tissue.
Such a process is known as Photovaporisation.

• Photovaporisation can be used for making incisions (cutting of the tissue) or delicate
removal of thin layers of tissue.

• Small laser spot sizes and tight control of laser beam spot positioning allow for incisions
that are extremely precise  Very suitable for eye surgery!

• Large area laser spot sizes are used for vaporising larger areas of tissue in a more
controlled way.

• Coagulation usually occurs around the photovaporisation site, since the temperature at
the edges of the damaged region is lower (i.e. within the photocoagulation regime).
 This is beneficial because this seals any blood vessels and reduces bleeding.

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 Photomechanical Effects
• The use of laser power exceeding those required for photothermal effects results in
photoablation and photomechanical effects.

• Photoablation effect – (e.g. LASIK)

➢ Lasers at ultraviolet (UV) wavelengths cause the disassociation (i.e. breakup) of
molecules in tissues. This destroys and removes tissues without any heating effect.
➢ Used in laser refractive surgeries such as Lasik.

• Photomechanical effect – (e.g. Nd:YAG laser treatment of complications of

cataract surgery)
➢ Uses very short laser pulses at extremely high power densities (1010–1012 Wcm−2)
with very tiny laser spots.
➢ At such a high power density, the laser induces a phenomenon known as dielectric
breakdown (for lasers, also called optical breakdown) within the tissue. It generates
plasma (a fundamental state of matter), that causes tiny explosions at that site.
➢ These tiny explosions cause shockwaves that quickly expel and remove tissues.
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 Laser Penetration into Tissues
• Generally, laser light does not just stop abruptly at the surface of tissues. It may move past the surface
and enter the tissue. As the laser moves within the tissue, its energy is absorbed by the tissue and its
intensity decreases exponentially. This process depends on the colour (wavelength) of the light as well
as the type and properties of the tissues.
• The relationship between the intensity of light Ix at a depth x
beneath the surface of the absorbing tissue is:
x x
−
I x = I0 e
−
L  Ix
= e L x
I0 I0
Ix
where
I0 = Incident laser intensity on the surface, before entering
the tissue,
Ix = Intensity at a depth x
L
L = Penetration depth
• The penetration depth L is defined as the distance beneath the surface where the intensity of the laser
falls to e−1 (i.e.  0.37) of its incident value (i.e. when x=L, Ix = I0(e−1)  0.37I0). It describes how fast
the light intensity decreases with increasing depth x within an absorbing tissue. The smaller the
penetration depth L, the faster the decrease in laser intensity within the tissue, and the stronger the
absorption of laser energy by the tissue.
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 L
L

(Blue)
(Near IR)
(Far IR)

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 Color-specific Absorption of Laser
• Materials may exhibit selective absorption of wavelengths, where they absorb only
certain range of wavelengths, and allow the other wavelengths to pass through (i.e.
transmitted) or be reflected.
• Such selective absorption occurs due to molecules which are excited to higher energy
states by absorbing photons of a particular range of wavelengths. Other wavelengths
outside of this range have very little effect.
• E.g. Shining white light though a solution containing molecules which absorb ‘blue’
photons. The ground state of the molecules in the solution are excited to higher energy
states by absorbing photons in the blue region of the EM spectrum.

• The colour of the solution would

appear to be made up of those
colours that are not absorbed.
• In this case, it will appear reddish-
yellow. E.g. Lycopene in tomatoes,
beta carotene in carrots.

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 Selective Surgery on the Eye
• Due to the color specific absorption in different tissues in the eye, lasers can be used to
target different tissues that preferentially absorbs different wavelengths of lasers.

• The lens, cornea and the vitreous humour transmit visible light. They absorb very little laser
energy with visible wavelengths, hence visible light lasers have very little effect on these
structures. If we wish to perform surgery on the cornea, we cannot use visible wavelengths.
Instead, UV wavelengths are used, as the cornea strongly absorbs UV light.

• The retina has a strong absorption to visible light. Surgery on the retina using lasers are
therefore usually performed using visible wavelengths. This also minimizes collateral damage
on lens, cornea and vitreous humour.
Visible UV
laser laser
• Green and yellow lasers are strongly absorbed
by blood, and so they could be used for photo-
coagulation, stopping blood flow and sealing of
blood vessels.

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 Diabetic Retinopathy
• The retina contains many blood vessels, with the arteries delivering blood to the retina, coursing
through the capillaries and into the veins, eventually reaching the central retinal vein.

• Diabetic Retinopathy (DR) occurs when blood vessels in the eye is damaged by the high blood
sugar levels in diabetic patients, leading to swelling or blood leakage.

• DR occurs in two main stages:

➢ Non-proliferative Retinopathy (NPDR)
The blood vessels in the retina bulge, leaking fluid and blood. This results in swelling and
thickening of the macula, the part of the retina responsible for central, clear vision. This
process is known as diabetic macula edema. When this happens, vision is affected.

➢ Proliferative Retinopathy (PDR)

As the condition worsens, the damaged blood vessels eventually fail, depriving the retina of
nutrients. When this happens, the body causes new, abnormal blood vessels to grow, which
may extend into the vitreous (neovascularization). These abnormal blood vessels are fragile
and will burst and leak blood into the vitreous, blocking vision. In severe cases the retina may
even detach from the back of the eye. This may lead to permanent vision loss.

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 Diabetic Retinopathy
• Treatment for early stages of DR involves controlling the level of blood sugar, pressure and cholesterol
via lifestyle and diet adjustments, along with medication. Studies have shown that good control of blood
sugar levels slow the onset and progression of DR1, reducing the need for surgery.

• Early diagnosis and treatment of DR are important as uncontrolled progression of the diseases will lead to
severe and irreversible loss of vision.

• Advanced stages of DR such as macular edema and proliferative DR may require laser surgery. Generally
there are two major types of laser surgery:
Focal photocoagulation
This is commonly used for non-proliferative DR. A low-intensity laser is used at a few spots to seal (burn)
off blood vessels in the macula that is leaking and that may be causing the swelling (edema).

Scatter (pan-retinal) photocoagulation

This method is commonly used for proliferative DR. Laser is used at 1000 – 2000 spots over a large area of
retina but not at the macula. Prevents the growth of the new, abnormal (fragile) blood vessels that will
eventually burst and cause leakage.

• Very severe cases of proliferative DR with extensive bleeding in the vitreous will require surgical removal
of the portions of vitreous that contains the blood (vitrectomy) along with scatter photocoagulation.
These treatment may need to be repeated after a period of time due to possible recurrence of bleeding.

GEH1032 Sem 2 2020-21 TK Chan 1 Source: Diabetes Care 37, 17–23 (2014) 56
 Glaucoma
• At the front of the eye between the cornea and the lens, a liquid known as the aqueous humor is
continuously produced by the ciliary body and drained through the trabecular meshwork.
• The aqueous carries nutrients to parts of the eye without blood supply (e.g. lens) and removes their waste
products. It also maintains an appropriate pressure within the eye for correct shape and optical properties
of the eye.
• If the drainage of aqueous through the trabecular
meshwork is impaired, it leads to a buildup of pressure
within the eye. This abnormal pressure may damage the
optic nerve and cause blindness.
• Glaucoma refers to a group of diseases that damage the
optic nerve, most commonly due to abnormally high eye
pressure as described above.
Ciliary Body
• Treatment of early Glaucoma involves medicine that
lower eye pressure, e.g. by producing less aqueous or Cornea
improving drainage through trabecular meshwork.
• Laser treatment involves tiny burns to the trabecular Lens
meshwork to improve drainage (trabeculoplasty),
creating a hole through the iris (iridotomy), or creating
burns to the ciliary body to reduce aqueous production
(cyclo-photocoagulation), depending on the specific 57
form of Glaucoma that is being treated.
GEH1032 Sem 2 2020-21 TK Chan
 Aqueous Flow - FYI

Ciliary Body

Trabecular Meshwork

Lens Cornea

Trabecular Meshwork

Ciliary Body
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 Laser Treatment is NOT a Cure.
• For severe cases of Diabetic Retinopathy and Glaucoma, damage to the
retina/optic nerve that has already occurred are in many cases irreversible.

• Laser treatment may prevent further loss of vision.

➢ We may perform laser surgery, using very tight controls on the laser
parameters to produce the correct wavelength at the correct power density
over a correct laser exposure duration to create the correct effect of the
correct extent on the correct structure within the eye, in order to preserve
whatever vision that still remains.

• However, it may not be possible to allow patients to recover the vision that has
already been lost, particularly when permanent damage has occurred at the
retina. In such cases, our aim is to prevent further deterioration of vision.

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 Cataracts
• Cataracts refer to the condition where:
− the lens of the eye becomes clouded, due to formation of protein aggregation1 (clumps) within the lens
− or when the lens gradually change to a yellow/brown colour, affecting the colour vision

• Risk factors include ageing, diabetes and high levels of exposure of the eyes to ultraviolet light.

• Treatment may involve the surgical removal of the

lens and permanently replacing it with an artificial
lens (usually performed on an outpatient basis).

• A local anesthetic is applied and a small, precise

incision (cut) is made at the side of the cornea as well
as on the lens capsule. An ultrasound emitting probe
is then inserted to break up the lens into small
fragments that are then removed by vacuum suction (phacoemulsification).

• Traditionally, the incision and ultrasound probe insertion are performed by hand. However, recent
developments has allowed surgeons to perform Laser-Assisted Cataract Surgery, where pulsed
femtosecond lasers are used to make the incisions as well as to fragment the lens, instead of only using
ultrasound. The rest of the cataract surgery procedure remains the same, hence the term laser- assisted.

• Advantages include the extremely high precision and accuracy offered by laser incisions with less laser
energy being used. In addition, the laser softens the lens during fragmentation, facilitating their removal.
GEH1032 Sem 2 2020-21 TK Chan Source: Current Opinion in Ophthalmology 22, 43 – 52 (2011) and www.aoa.org/ 60
 Other Medical uses of Laser: LASIK
• Refractive surgery refers to the surgical procedure on the eye that corrects common vision
problems.
• LASIK (Laser ASsisted In-situ Keratomileusis) is a
surgical procedure that aims to correct:
➢ Myopia (short sightedness),
➢ Hyperopia (long sightedness)
➢ Corneal Astigmatism (problem in light focus UV
caused by irregularly shaped cornea)

• A thin flap is created on the cornea using either a

blade or a laser. The flap is folded back and a UV laser
is used to precisely modify the shape of (i.e. sculpts)
the cornea under the flap. The flap is then placed
back into its original position where it heals in place.
https://www.eyedoctorophthalmologistnyc.com/

• The aim of Lasik is to allow people to conduct everyday tasks without having to wear glasses or
contact lenses. However, it may not result in perfect vision and the procedure may not be suitable
for every person. There is also a possibility for after-surgery complications.1,2, 3
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 Other Medical uses of Laser: Removal of Unwanted Tattoos
• Many tattoo inks have broad absorption greater than 600nm wavelengths, where the absorption of
melanin in the skin and haemoglobin in the blood is small. Laser absorption of melanin (that gives
skin its colour) is to be avoided as it may incur hypopigmentation (loss of skin color).
• Nd:YAG lasers operating at 532nm, or the ruby laser (694nm) can be used to fade black and blue
tattoo pigments with little damage to the nearby skin. Alexandrite lasers are also shown to be able
to clear green pigments, though bright colors such as yellow and orange are more difficult to treat.
• Tattoo removal treatments usually require multiple treatments (up to 10).

• Laser tattoo removal does carry risk of complications1,

such as pain, blistering, crusting, bleeding and scarring.
• Complications may also include ghost images, hypo-
and hyper-pigmentation, as well as allergic reactions to
both the pigments as well as their removal 2, 3, 4.
FYI

Before treatment After 4 treatments After 5 treatments

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 Laser Safety

http://sites.psu.edu/thebigbangtheory/wp-content/uploads/sites/1331/2012/10/lasersafetyfigure3.jpg

• Lasers are Dangerous!

They can cause blindness, and there is legislation which limits http://www.phillips-safety.com/media/wysiwyg/web/Category/Laser-Frames-Cat.jpg

the use of lasers. The higher the power of the laser, the more
the rules and regulations.

• Correct goggles can help protect eyes from lasers.

Different goggles provide protection for different laser
wavelengths. Correct goggles must be used!
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