Effect of Repeated Intense Foveal Red-Light Therapy in Children with Pre-Myopia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Myopia is a significant public health concern with increased risk of ocular complications. Intense Foveal Red Light (IFRL) therapy has been explored in myopia control, but its efficacy at the pre-myopic stage remains underexplored. The use of this therapy in a population without a myopia diagnosis may offer a new window for the prophylactic application of IFRL therapy. The purpose of this meta-analysis is to determine the effectiveness of IFRL therapy in children with pre-myopia. PubMed, Embase, and the Cochrane Library were systematically searched for studies investigating the effects of IFRL therapy on myopia incidence, changes in axial length (AL), choroidal thickness (CT), and cycloplegic spherical equivalent refraction (SER). Two independent reviewers screened studies, extracted data, and assessed the risk of bias. Meta-analyses were conducted using random-effects models to estimate the pooled effect sizes. Of 365 studies identified, 4 met the criteria, totaling 619 participants (mean age 8.48 years, 51.8% female). At 6 months, IFRL significantly reduced myopia incidence (Risk Difference [RD] − 0.1; 95% CI −0.15 to −0.05; <i>p</i> &lt; 0.01), with benefits persisting at 12 months (RD −0.17; 95% CI −0.26 to 0.09; <i>p</i> &lt; 0.01). IFRL also reduced AL at 6 months (Mean Difference [MD] − 0.12 mm; 95% CI −0.16 to −0.09; <i>p</i> &lt; 0.01) and 12 months (MD −0.18 mm; 95% CI −0.23 to −0.14; <i>p</i> &lt; 0.01), increased CT (MD 22.34 µm; 95% CI 5.45–39.24; <i>p</i> &lt; 0.01), and improved SER at 6 (MD 0.27 D; 95% CI 0.23 to 0.32; <i>p</i> &lt; 0.01) and 12 months (MD 0.36 D; 95% CI 0.27–0.46; <i>p</i> &lt; 0.01). IFRL effectively reduced myopia incidence, AL, and improved SER and CT. These findings support further research on its long-term efficacy and safety, particularly regarding potential adverse effects and durability of outcomes. Overall, IFRL may offer a preventive strategy for pre-myopic children.