Myopia is recognized as a significant public health problem, particularly in East and Southeast Asia. This has led to the development and evaluation of a range of interventions to slow its progression and delay its onset. Since the publication of the 2019 International Myopia Institute's review of interventions for controlling myopia onset and progression, treatment options have continued to grow in number. This article reviews the efficacy of such interventions under five categories: optical, pharmacological, environmental (behavioral), colored light, and surgical. In summarizing the efficacy of mature technologies, only randomized controlled trials were considered, although such data are very limited for emerging treatments. The overall conclusion is that there are multiple effective interventions in most categories. Further research should aim to understand the mechanisms underlying myopia progression and the modalities that slow its progression in order to develop more effective treatments.

This meta-analysis aimed to evaluate the effectiveness of repeated low-level red-light (RLRL) therapy compared to conventional myopia treatments to guide clinical application. A comprehensive literature search was conducted using PubMed, Embase, Web of Science, and Cochrane Library databases from their inception to December 2024. To quantify changes in axial length (AL), we computed weighted mean differences (WMDs) with 95% confidence intervals (CIs). Meta-regression and subgroup analyses were used to explore heterogeneity based on intervention duration and treatment type, while publication bias and result stability were assessed using Egger’s and Begg’s tests and sensitivity analysis, respectively. Seven studies, comprising one non-randomized controlled trial, two cohort studies, and four randomized controlled trials, were included, involving 691 pediatric participants (349 in the RLRL group and 342 in the control group receiving orthokeratology and atropine). Overall, AL progression in the RLRL group was significantly lower than in the control group (WMD=–0.24 mm, 95% CI [–0.33, − 0.14], P < 0.001, I2 = 93.5%), with benefits increasing over time. At the same time, we also found that the effect of RLRL adjunctive therapy (WMD=–0.35 mm, 95% CI = [–0.46, − 0.24]) in controlling axial length growth was better than that of monotherapy (WMD=–0.19 mm, 95% CI = [–0.28, − 0.10]). Moreover, RLRL demonstrated a notable enhancement in choroidal thickness, surpassing the effects observed with both orthokeratology (OK) lenses and 0.01% atropine treatments (WMD = 30.79 μm, 95% CI = [17.28, 44.30], I2 = 72.7%, P < 0.05). The reported data from the included studies demonstrated the absence of serious adverse events. RLRL therapy may slow myopia progression more effectively than current standard treatments, but further well-designed trials with longer follow-ups are needed to confirm its clinical value.

Objective: To evaluate the differences in the efficacy of repeated low-level red-light (RLRL) therapy combined with either single-vision spectacles (SVS) or defocus incorporated multiple segments (DIMS) spectacles in slowing myopia progression in children. Methods: A total of 129 myopic children aged 6-14 years were recruited between July 2023 and February 2024. Participants had at least one eye with spherical equivalent refraction (SER) <-0.50D and astigmatism ≤ 3.00D after cycloplegia. They were divided into four groups: SVS, DIMS, RLRL combined with SVS (RCS), and RLRL combined with DIMS (RCD). The RCS and RCD groups wore spectacles and received daily RLRL therapy sessions. The primary outcome was the change in axial length (AL) at 12 months. Results: After 12 months, the mean changes of AL were: 0.26 mm (95 % CI, 0.17 to 0.35 mm) for SVS, 0.16 mm (95 % CI, 0.11 to 0.21 mm) for DIMS, -0.21 mm (95 % CI, -0.45 to 0.02 mm) for RCS, and -0.14 mm (95 % CI, -0.27 to -0.01 mm) for RCD. Significant differences were observed between groups (F = 15.18, P < 0.001). Post-hoc tests showed that the RCS and RCD groups exhibited significantly greater shortening compared to the SVS and DIMS groups (all P < 0.001). However, no significant difference was observed between the RCS and RCD groups (P > 0.05). No severe adverse events or safety concerns related to RLRL therapy were observed throughout the study. Conclusion: RLRL therapy is a potentially effective and practical approach for myopia control, demonstrating comparable efficacy when combined with either SVS or DIMS spectacles.

In this article, Eyerising International’s Dr Yuri Aung hears from four leading ophthalmologists from around the world – Dr Loren Rose (Australia), Professor Jason Yam (Hong Kong), Mr John Bolger (United Kingdom), and Professor Junwen Zeng (China) – as they share their expert perspectives on repeated low-level red-light therapy (RLRL) for myopia with case studies from a range of difficult-to-treat patients.

Purpose: This study aimed to investigate the effects of Repeated Low-Level Red Light (RLRL) therapy on axial length (AL) in myopic individuals and to identify key predictors for a good response to the treatment, with a focus on baseline ocular characteristics and treatment compliance. Methods: A total of 91 participants were enrolled, with 50 classified in the poor responders' group and 41 in the good responders' group. Baseline characteristics, including age, gender, pupil constriction diameter (PCD), intraocular pressure (IOP), spherical equivalent refraction (SER), AL, corneal curvature (ACC), and choroidal thickness (CT) were recorded. Compliance and AL changes were tracked over one year. Univariable and multivariable analyses identified factors associated with AL changes. Results: Good responders' group showed a significant AL reduction (-0.29 ± 0.16 mm, p < 0.001), while poor responders' group had an increase (+ 0.23 ± 0.12 mm, p < 0.001). Good responders' group had lower initial SER (-4.15 ± 2.87 D vs. -2.62 ± 1.80 D, p = 0.004) and longer AL (24.76 ± 1.21 mm vs. 24.15 ± 0.99 mm, p = 0.010). Both groups showed CT changes (p < 0.001), with greater increases in good responders. Univariable analysis identified initial AL and SER as predictors of a good response (both p < 0.001). Compliance showed a trend toward significance in multivariable analysis (β = -0.196, p = 0.052). Conclusion: Longer baseline AL and lower SER are key predictors of a good response to RLRL therapy. Moreover, treatment compliance showed a trend toward significance, emphasizing its crucial role in achieving optimal outcomes.

近视患病率逐年攀升，已成为全球性的重大公共卫生问题之一。目前的近视防控措施，如角膜塑形镜、离焦框架眼镜、软性离焦角膜接触镜、低浓度阿托品滴眼液均存在不足之处。重复低强度红光(RLRL)近年来成为儿童近视控制的手段之一。多项临床研究结果均表明，RLRL 照射能够抑制儿童青少年近视的快速增长。 近期一篇研究报告" Cone Density Changes After Repeated Low-Level Red Light Treatment inChildren With Myopia”(《重复低强度红光治疗后近视儿童的视锥细胞密度变化》),在近视儿童的家长中引起了广泛讨论。本文详细分析此文章研究方法及结果，探讨是否能得出RLRL会影响近视儿童黄斑视锥细胞密度的结论。

目的:探究重复低强度红光治疗控制儿童青少年近视的长期临床效果。方法:回顾性分析2017年5月一2023年7月就诊于我院眼科行重复低强度红光治疗5年的近视患儿60例(120只眼，治疗组)以及同期未接受重复低强度红光治疗的近视患儿60例(120只眼，对照组),对比两组长期的治疗效果。结果:干预后,两组患儿的平均屈光度及平均眼轴长度均有所增长，但治疗组干预2~5年的增长幅度显著小于对照组，差异具有统计学意义(P<0.05)。结论:重复低强度红光治疗控制儿童青少年近视的长期临床疗效显著，不仅能有效控制眼轴的增长，同时还能控制平均屈光度的增加，起到良好的近视防控效果，值得研究和推广。

Myopia (commonly termed nearsightedness or shortsightedness) has increased in prevalencearound the world. In addition to genetic factors, there now exists evidence of numerousenvironmental factors that contribute to myopia development. Common forms of childhoodmyopia are due to axial elongation (i.e., a longer eyeball). As a result of renewed researchactivity on myopia, some forms of early intervention slow the axial elongation process and thusthe potential severity of myopia. In some myopes, the elongation process is associated with anincreased risk of cataract, glaucoma, retinal detachment, myopic maculopathy and strabismus.At present we are unable to identify which myopes these will be. Additionally, functionaldeficits of uncorrected myopia, along with an impact on career choice can occur. It is not clearat this time if interventions to slow myopic progression can prevent or reduce thesecomplications but there are sound hypothetical reasons to believe they are likely to do so. Inthis Consensus Statement all the interventions we have described are based on studies thathave shown statistical and clinical significance and have at least 2 years of follow-up with peer-reviewed publication. We are for the first time including a separate appendix for emergingtherapies that do not meet criteria yet to be included in the actual consensus statement.

Purpose: The purpose of this study was to compare the efficacy of repeated low-level red light (RLRL) and 0.01% atropine in controlling the progression of myopia children. Methods: This randomized, single-blind, crossover-controlled trial recruited 91 myopic children aged 6 to 12 years. Participants were randomly allocated to the RLRL-atropine group (n = 46) and the atropine-RLRL group (n = 45), with intermediate washout for 1 month. Primary outcomes included changes in spherical equivalent refraction (SER) and axial length (AL), whereas the secondary outcomes included changes in subfoveal choroidal thickness (SFCT) and subfoveal choroidal vessel volume (SFCVV). Results: The 13-month data analysis involved 45 (97.8%) and 42 (93.3%) children in the RLRL-atropine and the atropine-RLRL groups, respectively. RLRL was more effective than 0.01% atropine, with a mean difference in SER of 0.54 diopter (D; 0.24 ± 0.30 D vs. -0.29 ± 0.38 D, P < 0.001) and a mean difference in AL of 0.24 mm (-0.09 ± 0.14 mm vs. 0.15 ± 0.16 mm, P < 0.001) in period 1, whereas the mean differences in SER and AL were 0.55 D (0.22 ± 0.27 D vs. -0.33 ± 0.27 D, P < 0.001) and 0.22 mm (-0.06 ± 0.13 mm vs. 0.16 ± 0.11 mm, P < 0.001) in period 2, respectively. RLRL showed increased SFCT and SFCVV than 0.01% atropine (all P < 0.001). The change in SFCT from baseline to 3 months was the crucial predictor for the growth in AL at 6 months (P < 0.05). Conclusions: Compared to 0.01% atropine, RLRL demonstrated superior effectiveness in slowing myopic progression and axial elongation in myopia children. Changes in SFCT may predict the retarding effects of RLRL on axial elongation. Translational relevance: RLRL is an effective alternative treatment for controlling myopia in schoolchildren.

Repeated low-level red-light therapy (RLRL) has recently emerged as a new type of treatment to control myopia. In our study, we aim to compare the effects of RLRL and peripheral defocus modifying spectacle (PDMSL) in Medium-High myopia. This study is a randomized controlled trial. The participants were 25 children with ≥ −4.00 diopters (D) of myopia. Groups of intervention (RLRL) and control (PDMSL) were assigned 1:1. In the RLRL group, the participant would use the device and wore single-vision spectacles daily. In the control group, the participant wore PDMSL daily. The axial length, spherical equivalent refractions, and other ophthalmic examinations were measured at baseline, one, three, six, nine, and 12 months. There were 13 children in the RLRL group, and 12 children in the PDMSL group. Spherical equivalent refraction change was 0.28 ± 0.50D and −0.79 ± 0.48D at 12 months, in both groups, respectively. There was significant difference (p < 0.001). Axial length change was −0.18 ± 0.17 mm and 0.34 ± 0.13 mm at 12 months in both groups, respectively. There was significant difference (p < 0.001). There were no adverse events reported that were related to the treatment. RLRL was more effective in myopia control. RLRL could be well tolerated, with few adverse effects related to the treatment.