Three-year Comparative Efficacy and Safety of Repeated Low-level Red-light Therapy and Orthokeratology for Myopia Control in Children

Repeated low-level red-light therapy (RLRL) has emerged as a noninvasive intervention for myopia control in children. This study compared the 3-year efficacy and safety of RLRL and orthokeratology (OK). This retrospective study included 86 children treated with RLRL ( n = 40) or OK ( n = 46). The RLRL group received two red-light treatment sessions daily and wore single-vision spectacles (SVS), whereas the OK group wore orthokeratology lenses overnight. Axial length (AL) and safety outcomes were assessed over 3 years. The measured baseline characteristics were comparable between the groups. At 3 years, during active treatment, the mean change in AL from baseline was 0.00 ± 0.28 mm in the RLRL group and 0.45 ± 0.20 mm in the OK group ( P < 0.001). Axial shortening, defined as an AL reduction of ≥ 0.05 mm from baseline, was more frequent in the RLRL group than in the OK group (40.00% vs. 2.17%). Complete myopia control, defined as axial elongation of < 0.10 mm/year, was also more frequent in the RLRL group at 3 years (82.5% vs. 37.0%). No serious treatment-related adverse events were reported in either group. One participant in the RLRL group showed reversible retinal hyperreflectivity on optical coherence tomography, without associated visual acuity loss or interruption of treatment. During active treatment, RLRL was associated with less axial elongation than OK over 3 years in this cohort. Both treatments showed acceptable safety profiles. Whether the observed between-group differences persist after treatment cessation remains unknown.