Author: Claude (AI), from PubMed abstracts · Reviewed by: Dr Mina Abdelmseih · Reviewed: 2026-11-15 · Review due: 2027-11-15

Educational content only. Not personalised medical advice. Clinical decisions remain the responsibility of the treating clinician.

Repeated low-level red-light therapy for myopia

Repeated low-level red-light (RLRL) therapy delivers 650-nm red light from a desktop device for 3 minutes, twice daily, to slow myopia progression in children [S1]. Trials report large short-term effects, but the 2025 Cochrane review rates the evidence as very low certainty [S9], and long-term retinal safety has not been established [S8] [S12].

Key points - In the first multicentre RCT (2022), RLRL reduced 12-month axial elongation by 0.26 mm and refractive progression by 0.59 D versus single-vision spectacles [S1]. - Cochrane (2025): RLRL may reduce 1-year progression by 0.80 D and axial elongation by 0.33 mm, but with very low-certainty evidence [S9]. - RLRL reduced myopia incidence in children with premyopia (40.8% vs 61.3% at 12 months) [S3]. - Rebound occurs after stopping, with faster axial elongation than in controls [S2] [S10]. - No permanent vision loss has been reported, but one child had a reversible fall in acuity with OCT changes; baseline and follow-up fundus imaging and OCT are advised [S8].

Evidence last checked: 2026-10-17 (PubMed abstracts).

Red flags

• Reduced vision, scotoma or prolonged afterimage during treatment. Stop the device and examine the retina. A reversible decline in visual acuity with OCT abnormalities was reported in one patient, resolving 4 months after stopping [S8]. The afterimage in reported studies resolved within 6 minutes [S8].
• Unsupervised use or devices of unknown power. Trials used class I devices of specified power under parental supervision [S1]; powers tested ranged from 0.29 mW to 1.20 mW [S1] [S4].
• Stopping without follow-up. Axial length rebounded after cessation [S2] [S10].

Recognise it: who was studied

• Children aged 8 to 13 years with -1.00 to -5.00 D [S1]; 6 to 12 years with -6 D to +3 D [S5]; 6 to 16 years with high myopia of at least -4.0 D [S6].
• Children with premyopia (-0.50 to +0.50 D and a myopic parent) in Shanghai primary schools [S3], and -0.50 to +0.75 D in a 2-year trial [S10].
• Nearly all trials were in China; a small RCT in Spain (26 children) studied RLRL with orthokeratology [S11].

Confirm it: before and during treatment

• Fundus photography and OCT before and during therapy, with home monitoring of visual acuity and afterimage duration, are recommended by a safety systematic review [S8].
• Efficacy trials measured cycloplegic refraction and axial length [S1] [S6].

Manage it

Before acting on this section, check the national and local guidelines, product information and regulatory approvals that apply where you practise. See the medical disclaimer.

Tier A (primary care / no specialist)

• RLRL is not a primary care treatment: it needs retinal imaging for safety monitoring [S8]. Correct the refractive error and refer for myopia assessment where available.

Tier B (general eye clinic)

• Discuss RLRL as an emerging option with very low-certainty evidence [S9].

Tier C (specialist centre)

1. Regimen used in trials (as reported in [S1]): 650-nm light, about 1600 lux, 0.29 mW for a 4-mm pupil, 3 minutes per session, twice daily at least 4 hours apart, 5 days per week, at home under parental supervision. A 7-day regimen was used in high myopia [S6]; a meta-analysis found 5- and 7-day regimens comparable [S12]. Follow local device regulation; regimens are not a prescription.
2. Expected effect. - Pooled 12-month effect versus control: +0.68 D and -0.30 mm, greater with higher baseline myopia; moderate certainty for refraction, lower certainty for axial length [S12]. - In high myopia, mean axial length changed by -0.06 mm with RLRL vs +0.34 mm with control; 53.3% had axial shortening of more than 0.05 mm [S6]. - Daily LLRL for 1 year: -0.11 mm vs +0.26 mm axial change [S5]. - Powers of 0.37, 0.60 and 1.20 mW were all effective over 6 months [S4].
3. Prevention in premyopia. 12-month incidence 40.8% vs 61.3% (relative reduction 33.4%) [S3]. Over 2 years, axial elongation was 0.17 mm less than controls [S10].
4. Continuing versus stopping. Children who continued RLRL in year 2 had 0.12 mm axial elongation; those who stopped had 0.42 mm, versus 0.28 mm in controls [S2]. After 1 year of cessation in premyopic children, axial elongation was faster than in controls [S10].
5. Combination with orthokeratology. In Spanish children, RLRL plus ortho-K gave -0.124 mm axial change vs +0.102 mm with ortho-K alone at 12 months [S11].
6. Safety monitoring. Side effect incidence was 0.088 per 100 patient-years; longer studies are needed [S8].

Refer when

Pitfalls

• Treating short-term axial shortening as proof of long-term benefit: trials are mostly 12 to 24 months [S8] [S12].
• Omitting retinal baseline imaging and follow-up [S8].
• Stopping abruptly without monitoring for rebound [S2] [S10].
• Generalising from Chinese trials: data from other populations are very limited [S11].

Evidence notes

• Certainty conflicts between reviews: very low certainty for refraction in Cochrane [S9] vs moderate certainty in a 2026 meta-analysis [S12].
• Median study duration in the safety review was 9 months, longest 24 months [S8]; another review noted that more data are needed on safety [S7].
• The 2-year follow-up analysed only 57.3% of eligible children, with small subgroups [S2].
• The premyopia trial was disrupted by COVID-19 [S3].
• The authors of [S5] state that independent confirmation is needed.
• Not covered by these sources: device regulation, cost, long-term effects and effects on pathological myopia.

Related articles

• Low-dose atropine for myopia control
• Optical myopia control: spectacle lenses, contact lenses and orthokeratology

References

See the numbered source list below. Each marker [S#] links to its PubMed and DOI record.