TRILUMINA THERAPEUTIC LASER SYSTEM

K023935 · Texas Applied Biomedical Services · NHN · Jan 28, 2003 · Physical Medicine

Device Facts

• Record ID: K023935
• Device Name: TRILUMINA THERAPEUTIC LASER SYSTEM
• Applicant: Texas Applied Biomedical Services
• Product Code: NHN · Physical Medicine
• Decision Date: Jan 28, 2003
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 890.5500
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

The TriLumina Therapeutic Laser System is a non-heating infrared lamp and is indicated for adjunctive use in the temporary relief of hand and wrist pain associated with Carpal Tunnel Syndrome.

Device Story

The TriLumina Therapeutic Laser System is a hand-held, battery-operated, non-invasive, athermal infrared laser device. It utilizes three gallium-aluminum-arsenide (GaAlAs) continuous wave diodes emitting near-infrared light at 830 nm, with a visible red LED guide beam. The device delivers 30 mW per diode; an automatic timer manages a 30-second activation cycle to deliver 3 Joules of energy. Operated via an on/off switch and pressure-sensitive switches, the device is intended for use in clinical or home settings to provide temporary pain relief. By applying photonic energy to tissue, the device aims to alleviate hand and wrist pain associated with Carpal Tunnel Syndrome, serving as an adjunctive therapy.

Clinical Evidence

No clinical data provided; bench testing only.

Technological Characteristics

Hand-held, battery-operated infrared lamp. Emits near-infrared light at 830 nm using three GaAlAs continuous wave diodes. Power output: 30 mW per diode. Non-collimating beam (approx. 1x3 mm at lens). Includes visible red LED guide beam. Timer-controlled 30-second activation cycle delivering 3 Joules of energy. Mechanical pressure switches for activation.

Indications for Use

Indicated for adjunctive use in the temporary relief of hand and wrist pain associated with Carpal Tunnel Syndrome.

Regulatory Classification

Identification

An infrared lamp is a device intended for medical purposes that emits energy at infrared frequencies (approximately 700 nanometers to 50,000 nanometers) to provide topical heating.

Special Controls

*Classification.* Class II (special controls). The device, when it is an infrared therapeutic heating lamp, is exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 890.9.

Predicate Devices

• MicroLight 830 Laser System (K010175)
• Acculaser Pro Low Level Laser System (K020657)
• MedX LCS System (K021985)

Submission Summary (Full Text)

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023935

JAN 2 8 2003

## 510(k) PREMARKET NOTIFICATION SUMMARY

112

(per 21 CFR 807.92)

### TriLumina Therapeutic Laser System

#### I. Applicant:

USALaser Therapeutics Inc. 10115 Merrimac Road Richmond, VA 23235 1 804 320-4616

Contact Person: M. Joyce Heinrich Texas Applied Biomedical Services, Inc. 713 / 777-5477 telephone 713 / 734-5671 facsimile [e-mail] e-mail

Date Prepared:

November 25, 2002

#### II. Device Name

| Proprietary Name: | TriLumina Therapeutic Laser System |
|----------------------|------------------------------------|
| Common / Usual Name: | Low Energy Therapeutic Laser |
| Classification Name: | Infrared Lamp (21 CFR 890.555) |
| Product Code: | NHN |

#### III. Predicate Device

The TriLumina Therapeutic Laser System is substantially equivalent to other low level therapeutic lasers currently in commercial distribution. These predicate devices include the MicroLight Corporation of America, Inc. MicroLight 830 Laser System (K010175), Acculaser, Inc. Acculaser Pro Low Level Laser System (K020657) and the MedX LCS System (K021985). These devices were cleared for introduction into interstate commerce via the FDA's 510(k) Notification process. The Trilumina Therapeutic Laser has the same intended use as and similar technological characteristics to the predicate devices.

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K023935 2/2

#### IV. Intended Use of the Device

The TriLumina Therapeutic Laser System is a non-heating infrared lamp and is indicated for adjunctive use in the temporary relief of hand and wrist pain associated with Carpal Tunnel Syndrome.

#### V. Description of the Device

The TriLumina Therapeutic Laser is an innovative, safe, easy to use, hand-held, battery operated, non-invasive, athermal low energy infrared laser device. The TriLumina Therapeutic Laser contains three gallium-aluminum-arsenide continuous wave diodes operating in the near infrared at a wavelength of 830 nanometers and a visible red light emitting diode is used as a quide beam. The device has a power output of 30 milliwatts for each GaAlAs diode with a noncollimating beam of dimensions of approximately 1 by 3 millimeters at the lens.

The Laser has an "On / Off" switch to control the power to the device and two pressure switches that when pressed energize the laser diodes. A timer automatically times the 30 second activation cycle and the delivery of 3 Joules of energy.

### Summary of the technical characteristics of the TriLumina Therapeutic VI. Laser System to the referenced predicate devices.

The TriLumina Therapeutic Laser System and the aforementioned predicate devices are infrared lamps as defined in 21 CFR 890.5500. These devices utilize infrared diodes to emit infrared photonic energy to the tissue.

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Image /page/2/Picture/1 description: The image shows the seal of the Department of Health & Human Services (HHS). The seal features the HHS logo, which consists of a stylized caduceus with three intertwined snakes and a staff. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES • USA" is arranged in a circular pattern around the logo. The seal is black and white.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JAN 2 8 2003

USA Laser Therapeutics, Inc. c/o M. Joyce Heinrich Texas Applied Biomedical Service, Inc. 12101 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------Houston, Texas 77047-1601

Re: K023935

Trade/Device Name: TriLumina Therapeutic Laser System Regulation Number: 890.5500 Regulation Name: Lamp, non-heating for adjunctive use in pain therapy Regulatory Class: Class II Product Code: NHN Dated: November 25, 2002 Received: November 26, 2002

Dear Ms. Heinrich:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food. Drug. and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA), You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA mav publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing

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Page 2 - Ms. M. Joyce Heinrich

(21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050. This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at [phone]. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number [phone] or [phone] or at its Internet address

http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely yours,

iriam C. Provost

Col Celia M. Witten, Ph.D., M.D. Director Division of General, Restorative and Neurological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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# STATEMENT OF INDICATIONS FOR USE

510(k) Number (if known):

Ko23931 Pending

Device Name:

TriLumina Therapeutic Laser System

Indications for Use:

The TriLumina Therapeutic Laser System is indicated for adjunctive use in the temporary relief of hand and wrist pain associated with Carpal Tunnel Syndrome.

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED) Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use: OR (Per 21 CFR 801.109)

Over the Counter Use: (Optional Format 1-2-96)

(Division Sign-Off)

510(k) Number

iriam C. Provost

livision of General, Restorative nd Neurological Devices

TriLumina Therapeutic Laser 510(k) Premarket Notification November 25, 2002

000013