Three-year red light RLRL therapy for myopia: real-world data

Paper title: Three-year efficacy and safety of repeated low-level red-light therapy for myopia control: a multicentre real-world study

Authors: Yanping Chen ¹, Wei Wang ¹, Ruilin Xiong ¹, Fang Yu ², Shaoxin Pan ³, Jing Dong ⁴, Jian Zhang ^1, Zhuoting Zhu ⁵, Xiaohu Ding ¹, Bin Wang ⁴, Yanxian Chen ^{6 7,} Henry Ho-Lung Chan ⁶, Kai Yip Choi ⁶, Sonia Seen Hang Chan ⁶, Yingfeng Zheng ¹, Danli Shi ^{6 7}, Yuri Aung ⁸, Shoji Kishi ^9, Kyoko Ohno-Matsui ¹⁰, Mingguang He ^{11 7 12}.

1. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, Guangdong, China.
2. Shenzhen Guangming District People's Hospital, Shenzhen, Guangdong, China mingguang_he@yahoo.com 253910137@qq.com.
3. The Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China.
4. The First Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia, China.
5. Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.
6. School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China.
7. Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Hong Kong, China.
8. Imperial College London, London, England, UK.
9. Maebashi Central Eye Clinic, Maebashi, Japan.
10. Department of Ophthalmology and Visual Science, Institute of Science Tokyo, Tokyo, Japan.
11. School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China mingguang_he@yahoo.com 253910137@qq.com.
12. InnoHK, Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong, China.

Date: August 2026 

Reference: Chen Y, Wang W, Xiong R, Yu F, Pan S, Dong J, Zhang J, Zhu Z, Ding X, Wang B, Chen Y, Chan HH, Choi KY, Chan SSH, Zheng Y, Shi D, Aung Y, Kishi S, Ohno-Matsui K, He M. Three-year efficacy and safety of repeated low-level red-light therapy for myopia control: a multicentre real-world study. Br J Ophthalmol. 2026 Aug 20;110(9):1028-1035. doi: 10.1136/bjo-2025-328687. PMID: 41558834.

[Link to abstract]

Repeated low-level red-light (RLRL) therapy uses a home-based desktop device delivering low-level red laser light to slow axial elongation in myopic children. While randomized controlled trials (RCTs) have established efficacy over 1 to 2 years compared with single-vision spectacles, longer-term efficacy and safety beyond 2 years, and performance in routine clinical settings, had not been established.

This retrospective, multicenter, observational cohort study used stratified random sampling to select 362 myopic children and adolescents (aged 7 to 18 years) from 924 eligible patients treated with RLRL therapy between 2018 and 2023 at three tertiary hospitals in China. Participants were grouped by treatment duration (≥0.5–1 year, ≥1–2 years, ≥2–3 years, and ≥3 years) and assessed cross-sectionally at a single follow-up visit, without an untreated or spectacle-wearing control group. Outcomes included “satisfactory myopia control” rates (defined as annual axial elongation ≤0.10 mm), annual axial length and refraction change, visual acuity, adverse events, electroretinogram (ERG) findings, and optical coherence tomography (OCT)/fundus imaging. All were using the Eyerising Myopia Management Device.

Key findings were as follows.

• Satisfactory myopia control (annual axial elongation ≤0.10 mm) was achieved in 72.53% of participants treated for 3 years or more, compared with 88.89% to 89.01% in those treated for 1 to 2 years.
• Mean annual axial length change shifted from -0.22 mm/year in the shortest treatment group (average 0.7 yrs of treatment) to +0.06 mm/year in the group treated for 3 years or more (average 3.75 yrs of treatment).
• Mean annual cycloplegic spherical equivalent change was +0.02 D/year (refractive stability) in the group treated for 3 years or longer.
• All participants maintained best-corrected visual acuity of 20/25 (6/7.5) or better, with no losses of 2 or more lines in any group.
• No serious adverse events occurred, and ERG parameters showed no differences across treatment-duration groups.
• Four children (1.1%) showed ellipsoid zone discontinuity on OCT, none with associated visual acuity loss (all 20/20 or better) or functional abnormality (such as persistent afterimages), and reversible on discontinuation.

This real-world cohort, drawn from 362 children treated across three Chinese tertiary centers, suggests the myopia control benefit of RLRL therapy reported in earlier RCTs can extend into routine clinical use well beyond the 1- to 2-year window covered by most prior trials, informing discussions with families about continuing therapy long-term.

Younger baseline age was independently associated with both lower likelihood of satisfactory control and greater axial elongation, a pattern that could partly reflect natural age-related eye growth rather than a true loss of treatment effect, relevant to how expectations are set for younger patients versus older adolescents.

No serious adverse events, best-corrected visual acuity loss, or duration-related ERG changes were observed, supporting continued confidence in RLRL's functional safety profile with extended use. Ellipsoid zone discontinuities on OCT were detected in a small proportion of patients without accompanying visual acuity loss, visual symptoms or ERG abnormality, suggesting that routine OCT surveillance during long-term therapy could be considered as an additional monitoring tool alongside visual acuity testing.

Because this was an observational cohort without a spectacle-wearing or sham-treatment comparison group, the true magnitude of RLRL's effect against untreated myopia progression over 3 years cannot be established from this data alone. Controlled studies would help confirm these real-world estimates against a proper comparator, but the benchmark of “satisfactory myopia control” being 0.10mm or less axial elongation indicates a strong absolute result. 

Retinal imaging and function testing were performed only at follow-up rather than at baseline, so whether the findings observed represent a change from each child's own starting point remains unclear.

The clinical significance of the ellipsoid zone discontinuities seen on OCT remains an open question. Whether these microstructural changes fully resolve, recur, or carry any long-term implication for retinal health remains to be confirmed, and the proposed mechanism remains hypothetical.

Whether the decline in efficacy with longer treatment duration reflects a true waning of biological effect, the influence of younger baseline age in the longer-duration group, or other factors tied to who continues treatment over many years is not yet resolved, since participants were not followed prospectively as individuals across the full duration range.

As this cohort was drawn entirely from Chinese treatment centers, how these long-term patterns apply to children of other ethnic backgrounds or geographic settings remains to be established.

Background: To evaluate the efficacy and safety of repeated low-level red-light (RLRL) therapy for controlling myopia progression over 3 years in real-world settings.

Methods: This multicentre cohort study included participants currently undergoing RLRL treatment, identified from electronic medical databases in three hospitals (myopic children and adolescents aged 7–18 years, who were prescribed RLRL therapy from 1 June 2018 to 1 June 2023), using stratified random sampling based on RLRL treatment duration (≥0.5–1 year, ≥1–2 years, ≥2–3 years and ≥3 years), with approximately 90 participants in each group. All participants voluntarily received RLRL therapy twice a daily (3 min/session, ≥4-hour interval), 5–7 days/week.

Results: Among 362 participants, 90 were treated for ≥0.5–1 year (median 0.64 year), 91 for ≥1–2 years (median 1.40 years), 90 for ≥2–3 years (median 2.30 years) and 91 for ≥3 years (median 3.65 years). The satisfactory myopia control rate (defined as annual axial elongation ≤0.10 mm) was 72.53% (95% CI 62.17 to 81.37) over ≥3 years of RLRL treatment, with annual axial length change of 0.06 mm/year (95% CI 0.03 to 0.08). No subjective visual function damage was documented by best-corrected visual acuity, and no treatment duration-dependent changes in objective full-field electroretinogram were observed. A minimal, reversible optical coherence tomography change was noted in four eyes which did not impact visual function.

Conclusions: This real-world study demonstrates that RLRL therapy provides promising long-term efficacy and safety in myopia control over 3 years among Chinese myopic children and adolescents.

[Link to abstract]