Low-Level Red-Light Therapy And Axial Length Reversal In High Myopia: A Systematic Review
Published 2026 - 44th Congress of the ESCRS
Reference: POSUS004 | Type: Free paper | DOI: 10.82333/0cyb-v620
Authors: Mrs Razita Aulia Azkia* 1 , Ms Izdihar Putri 1 , Mrs Ria Deneska 1
1Ophthalmology Department,Universitas Airlannga,Surabaya,Indonesia
Purpose
Repeated Low-Level Red-Light (RLRL) therapy is increasingly used for myopia control. A randomised trial showed it can achieve 76.8% efficacy in controlling axial length (AL) elongation and 87.7% in slowing spherical equivalent (SE) progression in mild to moderate myopia. However, no comprehensive review exists on its use in children with high myopia.
Setting
This study aims to evaluate the incidence and degree of AL shortening and SE reduction after RLRL therapy in children and adolescents with high myopia, including visual acuity outcomes, structural changes, prognosis, and safety.
Methods
A comprehensive literature search was conducted using PubMed, ScienceDirect, and the Cochrane Library up to 2025. Inclusion criteria comprised randomized controlled trials and prospective clinical studies involving children with high myopia (defined as spherical equivalent refraction ≤ –6.00 D), treated with RLRL therapy. Data extraction focused on axial length change, spherical equivalent change, visual acuity, and surrogate structural outcomes. Four eligible studies were included, totaling 613 pediatric participants.
Results
All included studies applied 650 nm RLRL therapy twice daily for 3 minutes per session, with power ranging from 0.29–2.0 mW and follow-up of 6–12 months. Compared with single-vision spectacles or sham devices, RLRL consistently reduced axial elongation, with several studies reporting axial shortening (–0.11 to –0.06 mm), while controls showed elongation (+0.13 to +0.34 mm). Spherical equivalent improved in RLRL groups (+0.06 to +0.23 D) but worsened in controls (–0.75 to –0.86 D). Visual acuity was maintained or improved, and surrogate OCT markers (rEZR, rPOSR) increased post-treatment. Across studies, 23–59% of RLRL-treated participants experienced axial shortening greater than 0.05 mm. No serious adverse events were reported.
Conclusions
RLRL therapy appears safe and effective in slowing or reversing axial elongation in high myopia among children. It offers a promising non-invasive approach for managing progressive myopia.