August 10, 2026
By Hashim A. Khan, OD, PhD, FAAO, Dipl-AAO
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Repeated low-level red-light (RLRL) therapy has emerged as an alternative approach for slowing myopia progression in children, with multiple clinical studies reporting reduced axial length (AL) elongation and favorable refractive outcomes. A limited number of investigations have compared RLRL with other myopia control strategies, such as orthokeratology, low-dose atropine and defocus incorporated multiple segments (DIMS) lenses, in head-to-head trials.
In a recent randomized clinical trial, Zhang et al compared the effect of RLRL to orthokeratology and DIMS spectacle lenses in children and adolescents (age 8–13 years) with a baseline refractive error ranging between -1.00D to -5.00D.
One hundred and twenty-eight children were randomized to RLRL (n=43), OrthoK (n=43), or defocus spectacle lenses (n=42). RLRL was administered via a 650nm photobiomodulation device for three minutes twice daily with a minimum four-hour interval between sessions. OrthoK lenses were worn overnight, while defocus spectacle lenses were worn for a minimum of 10 hours daily. AL was assessed using non-contact A-scan ultrasound at three, six and 12 months.
RLRL demonstrated progressive and superior AL control at all timepoints: at three months (−0.07mm vs +0.03mm and −0.02mm), six months (−0.09mm vs +0.15mm and +0.09mm), and 12 months (−0.05mm vs +0.27mm and +0.17mm; all p<0.001). Efficacy was consistent across gender, age and myopia severity subgroups.
Limitations include small sample size, a homogenous single-center Chinese cohort restricting generalizability, short one-year follow-up, lack of safety data and adverse event reporting and safety concerns including phototoxicity risk and rebound AL growth upon cessation.
ABSTRACT
Efficacy of Repeated Low-Level Red Light in the Prevention and Control of Myopia among Children and Adolescents
Xue Zhang, Zirui Liu, di Zhang, Zhuang Xiong
Objective
To evaluate the efficacy of repeated low-intensity red light (RLRL), orthokeratology (ortho-k) lenses, and defocus spectacle lenses in controlling axial length (AL) elongation in children and adolescents with myopia.
Study Design
Prospective randomised controlled trial.
Place and Duration of the Study
Ophthalmology Centre of Heilongjiang Hospital of Beijing Children’s Hospital, Harbin, China, from January 2023 to May 2024.
Methodology
A total of 128 myopic children aged 6-18 years were enrolled and randomly assigned to the RLRL group (43 cases), the ortho-k lens group (43 cases), and the defocus spectacle lens group (42 cases). Changes in AL were observed at baseline and at the one-year follow-up.
Results
There were no significant differences in age, AL, and refractive error among the three groups at baseline (p >0.05). Follow-up showed that the RLRL group had significantly better AL control efficacy at three months, six months, and one year compared to the ortho-k lens group and the defocus spectacle lens group (***p <0.001). Subgroup analysis revealed no significant impact of gender, age, and myopia severity on the changes of AL (p >0.05), confirming the universal applicability of RLRL treatment in inhibiting AL elongation.
Conclusion
RLRL outperforms ortho-k lenses and defocus spectacle lenses in controlling AL elongation in myopic children, demonstrating promising clinical application prospects. In future, large-sample, multicentre, long-term follow-up studies are needed to verify its efficacy.
Key Words
Myopia, Repeated low-intensity red light, Orthokeratology lenses, Defocus spectacle lenses.
DOI: 10.29271/jcpsp.2025.09.1196
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Hashim Ali Khan is a current PhD candidate working on Adult Myopia with Prof. Padmaja Sankaridurg, Dr. Nina Tahhan, and A/Prof. Thomas Naduvilath, at the Brien Holden Vision Institute, University of New South Wales, Sydney. |
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