A Brief History of the Military Photomedicine Program

  • Published
  • By Howard Schlossberg and Robert White
  • Air Force Office of Scientific Research
ARLINGTON, Va. --  The Greek physician Hippocrates, the father of modern medicine, was responsible for a scientific or rational approach to medicine. Like all great thinkers, he was ahead of his time, categorizing illnesses and introducing medical terminology still in use today. Due to his efforts, the practice of medicine took a great leap towards its modern construct. Today, modern medicine stands to benefit significantly with another revolutionary invention--the laser.

Yes--the laser has been in use for medical procedures going back to very early efforts beginning in 1962, not long after Theodore Maiman demonstrated the first working laser, which grew out of the pioneering work of Charles Townes who, in 1954, accomplished the first stimulated emission device with microwaves. But even though these early ruby crystal based lasers could cut diamonds with unprecedented precision, they were not adequate for surgical application, being that human tissue was far less forgiving than the hardest material known to man. Laser surgery required a lasing material that produced an appropriate degree of intensity, and the first lasing medium that fit that bill was argon, where the ionized argon laser was ideal for retinal applications such as photocoagulation--cauterizing ocular blood vessels in the eye resulting in a number of therapeutic benefits.

But it was not until the early 1980s that a number of changes in the nature of medical laser research occurred. That decade witnessed increasing interest in the mechanisms of laser-tissue interactions, and new clinical applications based on these interactions came into use. One of the driving forces behind this change was the initiation of the Medical Free Electron Laser (MFEL) Program by the Department of Defense (DoD) in 1985. Although the program was specifically aimed at FEL applications, the novel pulse structure of the FEL led to an increased interest in pulsed laser effects, which in turn led to an increased understanding of laser/tissue interactions based on conventional pulsed lasers. Interestingly enough, the free-electron laser had its genesis in AFOSR funded basic research and was intensely studied as part of the "Star Wars" missile defense program, but from the beginning, many scientists realized that free electron laser technology could be an important new tool for a wide range of basic research, including possibly biomedical applications, which led directly to the establishment of the MFEL program.

Now known as the Military Photomedicine Program (MMP), this 25 year effort has a long history of accomplishment in studying and developing light-based medical knowledge and technology. For the last dozen years the program has been focused on applications to combat casualty care and broad military medicine uses.

MMP is a competitive program primarily funding broad-based grants to university based medical centers, with several smaller individual investigator grants. The program is heavily multi-disciplinary, with numerous collaborations between physical and biological scientists, engineers and physicians. Currently, MMP supports three university based centers: the Wellman Center for Photomedicine at the Massachusetts General Hospital in Boston; the Beckman Laser Institute at the University of California, Irvine and Stanford University in Palo Alto California. Close collaboration is maintained with military medical centers and individual military physicians, with funding from the program sometimes provided to enhance transitions to military practice.

What is significant is that over the years the MFEL Program pioneered the use of pulsed laser and other optical technologies in medical diagnostics and therapeutics, including a number of broadly applicable, "platform" technologies, with major civilian as well as military importance. It is estimated that several million medical procedures per month trace their origins to the MFEL program. Civilian applications have been spun-off to other funding sources such as the National Institutes of Health, various foundations, as well as private companies. In addition, numerous successful start-up companies have evolved from MFEL funded research and technology.

Some of the important platform technologies devised under the program include:
  • Optical Coherence Tomography (OCT). OCT is broadly and routinely used in eye diagnostics. An estimated 16 million diagnostic procedures were performed in 2010. The MMP is currently funding and developing technology for diagnostics and treatment of airway disease and injury.
  • Photochemical tissue bonding, which could ultimately do replace sutures in many procedures. Currently it is in various stages of research, development and clinical trials for a variety of applications.
  • Photodynamic therapy for non-cancer applications has been a mainstay of the program. A major success of the program was in the treatment of wet age-related macular degeneration, now in clinical use. New treatments in infection and infectious disease (including drug resistant diseases) have been pioneered by the program.
  • Bioluminescent imaging, invented and developed in various forms under the program, uses transfer of modified luciferase genes (which produce the protein that makes fireflies light-up). It has become a major technology for studying infection, wound healing and other cellular interactions.
  • The plasma electron avalanche knife (PEAK) is a new broad-based surgical tool with important benefits in terms of precision cutting with bleeding control and minimal localized tissue damage.
Two additional emerging platform technologies include miniature imaging endoscopes to provide images through a single fiber via a standard needle, and optical nerve stimulation, which has benefits over electrical in that single nerves can be stimulated and there are no direct contact effects.

The MFEL/MMP program has consistently fulfilled its mandate "to fund high-risk, potentially high-reward research of military and civilian relevance," by supporting a wide range of research and development over the years resulting in revolutionary advances in military and civilian medical care, to include laser surgery, battle injury monitoring and diagnosis, imaging, wound bonding/healing and disease containment.