APAO Showcase: The Latest on Repeated Low-Level Red Light Therapy

The 41st Asia-Pacific Academy of Ophthalmology (APAO) Congress was held from February 5 to 8, 2026, at the Hong Kong Convention and Exhibition Centre in Hong Kong, China. Newcomer to myopia control repeated low-level red-light therapy (RLRL) made a fantastic contribution to the scientific program, with over 10 abstracts and various presentations and panel discussions focused on RLRL therapy across paediatric and adult populations. Collectively, these studies encompass randomized controlled trials, real-world adherence data, advanced imaging analyses, case reports, and experimental models. Importantly, they provide crucial longer-term evidence for RLRL up to and beyond 3 years, extend current knowledge on RLRL as a standalone intervention and in combination with optical treatments such as orthokeratology, and also broaden the evidence base beyond predominantly Asian populations. Here, we provide summaries of each of these new abstracts, as well as the oral presentations and sessions focussed on RLRL therapy.

February 6^th kicked off with a symposium dedicated to exploring the potential of light therapy and particularly RLRL for myopia control. Chaired by professors Ian Morgan and Kathryn Rose, the session included discussions of various aspects of RLRL. Professor Mingguang He from Hong Kong presented the latest evidence underpinning RLRL from both an efficacy and safety perspective, including his recently published 3-year multicentre study in China. Professor Kyoko Ohno-Matsui from Japan presented her results in highly myopic adult patients, which showed axial shortening and choroidal thickening in a population that previously have not responded to other myopia control treatments. Professor Haidong Zou from China presented on his study of RLRL in high myopia and the improved efficacy response of RLRL in highly myopic children as well as adults, and the symposium finished with Professor Jason Yam, President of this year’s APAO, presenting on the launch of his global RLRL randomised controlled trial which began recruitment in late 2025 and will include 23 centres from around the world to gather multi-ethnic evidence of efficacy and safety.

The International Red Light Ophthalmic Society (IRLOS) Symposium (pictured in the cover image) marked the formal launch of a clinician-led international society focused on the responsible clinical implementation of red-light therapies in myopia management. A key theme was the need for shared clinical standards, safety frameworks, and guidance on how this emerging category should be applied in practice, moving beyond individual datasets toward broader professional oversight.

Professor Ningli Wang from China opened the symposium, followed by Professor Mingguang He and Professor Jason Yam outlining the purpose, vision, structure and membership information of IRLOS. This was followed by Professor Kyoko Ohno-Matsui sharing her research on RLRL use in highly myopic children in Japan. Emeritus Professor John Marshall from the United Kingdom discussed safety considerations for RLRL devices based on the Eyerising device – which concluded negligible risk of hazard when used as intended. Professor Junwen Zeng then spoke about the largest real-world study to date of RLRL for myopia control which recruited more than 2000 participants, and Professor Ni Zhang shed important details on the potential mechanisms underpinning RLRL and its effect on microvasculature. Finally, Dr Nellie Deen and Dr Loren Rose from Australia shared their Australian experiences, with Dr Deen discussing the completed Australian RCT of RLRL showing axial shortening and spherical refraction improvement, and Dr Rose discussing her real-world cases that have responded well to RLRL.

While the symposium did not aim to establish consensus at this stage, it laid the groundwork for future consensus development, with founding members introduced and an open invitation extended to clinicians and researchers interested in contributing to the society’s ongoing work. Together, the presentations highlighted both the growing global evidence base and the importance of clinician governance as red-light therapies continue to expand internationally.

Presented by: Mingguang He

Professor Mingguang He presented three-year real-world data on repeated low-level red-light (RLRL) therapy for myopia control from China. The study followed 362 children, grouped by how long they had been using RLRL; rates of good myopia control (defined as less than 0.10mm/year axial elongation) remained high across all treatment durations:

• 6–12 months (n=90): 89.0% achieved good myopia control, with annualised axial length change of -0.22mm.
• 2–3 years (n=90): 82.2% achieved good myopia control, with annualised change of -0.07mm.
• 3 years or more (n=91): 72.5% continued to achieve good myopia control, with annualised change of 0.06mm.

Importantly, comprehensive safety assessment found no adverse events. Full field photopic electroretinography (ffERG), which objectively evaluates overall retinal function, found no visual function damage over any level of treatment duration. On optical coherence tomography (OCT), there were 4 eyes that had linear discontinuity of their ellipsoid zone on OCT in the outer photoreceptor segment which was reversible on RLRL discontinuation.

Read the full paper here.

Authors: Maria Jose Fernandez Fidalgo, Victoria D. Ferigo Ferrel, Yuri Aung, Lisa Zhuoting Zhu, Fernando Fernandez-Velazquez

This randomized clinical trial assessed the 12-month efficacy and safety of combining repeated low-level red-light (RLRL) therapy with orthokeratology (ortho-k) in Spanish children aged 10–13 years. Children (n=26) with spherical equivalent refraction (SER) of –0.75 to –6.75 D were randomized to either combined RLRL + ortho-k or ortho-k alone. After 12 months, the RLRL + ortho-k group demonstrated axial length shortening (–0.11 mm) compared with continued but well-controlled axial elongation in the ortho-k-only group (+0.10 mm), with a between-group difference of –0.22 mm. Axial shortening greater than 0.05 mm was observed in 80% of children receiving combination therapy, compared with none in the ortho-k group. Macular thickness increases were also observed in the RLRL + ortho-k group (+0.690 μm) and the ortho-k group (+0.199 μm); an increase in macular thickness might signify beneficial structural changes that support myopia control and ocular health.¹  Overall, RLRL combined with ortho-k was safe and more effective than ortho-k alone for myopia control. Importantly, this represents the first European data for RLRL, extending findings previously reported primarily in Asian populations. Furthermore, combination treatment has traditionally centred on atropine paired with an optical intervention; these results suggest RLRL offers a novel and effective alternative adjunct to optical treatments.

Read our full science summary here, and watch our short explainer video by Dr Kate Gifford here.

Authors: Nellie Dean, Yuri Aung, Rumeysa Doger, Zeinab Fakih

This randomized controlled trial evaluated RLRL therapy for myopia control in 34 multi-ethnic Australian children aged 8–13 years over 12 months. Children were assigned to either RLRL (3 minutes twice daily, 5 days per week) or single-vision spectacles. At one year, the RLRL group showed minimal axial elongation (–0.03 mm) and slight hyperopic shift (+0.09 D), compared to 0.12 mm axial elongation and –0.21 D progression in the control group, representing a between-group difference of 0.15 mm and 0.31 D. No structural retinal changes, reduction of visual acuity, or serious adverse events were observed in the RLRL group; however, one child did withdraw from the RLRL group due to mild headaches at 3 months. RLRL appeared effective and well tolerated in this cohort. Importantly this study provides evidence that RLRL is effective and well-tolerated in multi-ethnic children, extending evidence beyond the largely China-based data that currently dominates the literature.

Access the full abstract here.

Authors: Naoki Isomura

This study investigated factors associated with axial length shortening and fundus changes following 12 months of RLRL therapy in highly myopic children aged 8–18 years. High myopes (n=26) mean age 11.2 years with baseline spherical equivalent (SE) -9.4 D and axial length (AL) 27.0 mm underwent longitudinal assessment of SE, AL, choroidal thickness, and posterior scleral morphology using OCT. On average, AL and SE were stable over 12 months (change +0.01mm and +0.28D respectively). Macular choroidal thickness increased significantly by 26 μm; 19.2% of patients showed changes in scleral curvature, with posterior scleral flattening observed as a temporal reduction and nasal increase in contour. Multivariate regression identified macular choroidal thickening and scleral curvature changes as significant predictors of AL shortening. The predictive value of these factors highlights the utility of monitoring choroidal thickness and scleral curvature changes during RLRL therapy. Clinicians could use these parameters to assess the effectiveness of the treatment and identify patients who are likely to benefit most.

Authors: Junfuku Lee, Hiroyuki Takahashi, Keigo Sugisawa, Takeshi Yoshida, Kyoko Ohno-Matsui

This prospective interventional study evaluated the short-term effects of repeated low-level red-light (RLRL) therapy in adults with high myopia. Adults (n=28) aged 21–64 years with spherical equivalent ≤ −6.00 D underwent home-based RLRL therapy for 2 months, with multimodal imaging performed at baseline, 1 month, and 2 months. Stability  in refraction was observed (-12.76 D vs -13.07 D or +0.31D); AL shortening was also observed (29.17 mm vs 29.23 mm or 0.06mm reduction). Macular choroidal thickness increased (+12.44 µm), with 82.1% of eyes showing >5% thickening and 67.9% showing >10% thickening, and a decrease in polarimetric entropy which may indicate changes in choroidal tissue properties. Uniquely, this study suggests that RLRL therapy could be a promising intervention for managing high myopia in adults as while most adults experience stable myopia, a significant proportion—especially younger adults and high myopes—may still progress and in fact have no approved on-label treatments at present to treat their continued progression.

Authors: Linlin Du, Xiangui He, Xun Xu, Bo Zhang

This randomized controlled trial investigated the effectiveness of RLRL for myopia control in children aged 6–12 years, comparing it with atropine over 12 months. Participants (n=104) were evenly randomized to receive RLRL or 0.01% low-dose atropine. After 12 months, children receiving RLRL showed minimal spherical equivalent progression (approximately −0.03 to −0.13 D) compared with greater progression in the atropine group (approximately −0.64 to −0.76 D). Axial length elongation was also significantly reduced in the RLRL group at all follow-up points, with around 0.02–0.04 mm growth at 12 months versus 0.32–0.34 mm in the control group. Overall, RLRL was highly effective in slowing both refractive progression and axial elongation in myopic children aligning with previous studies.^2,3  This study also reinforces the potential of RLRL therapy as a standalone or combination treatment for myopia management, particularly for children who may not tolerate atropine.

Access the full abstract here. 

Authors: Lisa Zhuoting Zhu, Yuri Aung

This multinational real-world study evaluated treatment compliance with repeated low-level red-light (RLRL) therapy across seven countries outside China. De-identified data from 1,012 patients showed high overall adherence with a mean compliance rate of 80.7%. Japan showed the highest compliance (85.3%) although had the largest cohort. Compliance was slightly higher in patients using RLRL for less than 12 months (81.6%) compared to those using it for 12 months or more (78.6%). In countries like Australia, New Zealand, and the UK, compliance was maintained over 12-18 months. Drop-off rates (defined as ≥30 consecutive days of non-use) were relatively low, ranging from 2.8% to 12.7% suggesting that RLRL therapy is well-tolerated and manageable. The findings highlight the practicality of implementing RLRL therapy in various countries, with sustained compliance over time.

Access the full abstract here.

Authors: Ziwei Zhao, Yanxian Chen, Mingguang He, Yue Wu

This secondary analysis of a randomized controlled trial compared changes in three-dimensional macular morphology in myopic children (n=50) aged 7–15 years treated with RLRL therapy or 0.01% atropine over 12 months. Using OCT-based analysis, children receiving RLRL significant flattening of the macula across all regions (central, temporal, inferior, superior, and nasal) compared with atropine, with the most pronounced effects centrally. RLRL treatment was also associated with region-specific changes in macular outward scleral height (MOSH), with a decrease in superior height and an increase in inferior height, alongside greater increases in macular curvature asymmetry. Neither RLRL nor low-dose atropine caused changes in retinal layer thickness, suggesting that the observed effects are primarily related to scleral and macular shape rather than the retina. This suggests that RLRL therapy may control myopia progression through mechanisms that may be distinct from atropine's which are primarily biochemical, targeting the pathways involved in eye growth⁴  rather than directly altering ocular blood flow or scleral shape.

Access the full abstract here.

Authors: Yanxian Chen

This study used ultrawide-field swept-source OCT to assess changes in posterior fundus morphology in highly myopic children (n=17) aged 6–16 years undergoing RLRL therapy over two years. Fundus Gaussian curvature (FC), which measures the shape of the posterior globe, significantly decreased after one year of RLRL therapy, indicating a flattening of the posterior eye. At the two-year follow-up, FC values returned to levels comparable to baseline, suggesting that the flattening effect diminishes over time. Eyes which were more curved (higher FC) tended to be more myopic with thinner choroids and had higher axial lengths. This study highlights the potential of RLRL therapy to induce structural changes in the posterior eye, such as flattening of the posterior globe, which may help mitigate the risks associated with high myopia including myopic maculopathy; however, these changes are temporary which may indicate a need for longer-term use of RLRL.

Access the full abstract here.

Authors: Zhuzhu Liu

This multicenter randomized trial evaluated repeated low-level red-light (RLRL) therapy for myopia prevention in Chinese children (n=175) aged 7–12 years with pre-myopia. Over 12 months, RLRL therapy (n=104) led to 29.8% of children showing a hyperopic shift in spherical equivalent refraction (SE), while 19.2% experienced axial length (AL) shortening (>0.05 mm). Overall, mean progression changes were +0.16 mm/year in AL and -0.12 D/year in SE. Children with insufficient hyperopic reserve (lower baseline refractive error) or older age benefited more from RLRL therapy. Choroidal thickening accounted for 24.5% of AL control and 37.8% of SE control. Early SFCT changes at 3 months significantly predicted AL outcomes, improving the accuracy of predictive models. This study showed two key points: RLRL therapy effectively slowed the myopic shift in pre-myopic children; and the role of choroidal thickening in mediating treatment effects and its potential as a biomarker for predicting outcomes.

Access the full abstract here.

Authors: Loren Rose

This report describes two Australian cases of rapidly progressive myopia that continued to worsen despite combination treatment with 0.05% atropine and myopia control spectacle lenses. A 10-year-old boy and girl discontinued atropine and commenced RLRL therapy following pupil normalization. They continued wearing myopia control spectacles. Over follow-up of up to 18 months, both children showed stabilization of myopia and axial length after initiating RLRL therapy, alongside marked and sustained increases in subfoveal choroidal thickness:

 Final measurements demonstrated reduced axial elongation and slight refractive improvement compared with baseline, with high treatment compliance (>90%) and no reported safety concerns. These cases suggest that RLRL therapy may be a valuable option for managing myopia in combination with myopia control spectacles, where there is lack of response to the combination of optical interventions and atropine treatment.

Access the full abstract here.