EVIDENCE UPDATE · SEPTEMBER 2026

Repeated Low-Level Red-Light Therapy

Strong randomized efficacy is now complemented by multicentre real-world follow-up extending up to five years, initial randomized evidence outside East Asia, and a broader retinal-safety literature.

EFFICACY
STRONG RANDOMIZED EVIDENCE
LONG-TERM
REAL-WORLD · UP TO 5 YEARS
SAFETY
EXPANDED · DEVICE-SPECIFIC
GENERALISABILITY
INITIAL NON-EAST-ASIAN RCTs
CURRENT VERIFIED REGISTRY · SEPTEMBER 2026 · REF. 1–23

New: three-year EyeRising / RLRL versus orthokeratology cohort.

Ref. 23, published 10 September 2026, is peer-reviewed original research: a retrospective, single-centre, nonrandomized comparison of 86 children aged 6–16 during three years of active treatment. EyeRising / RLRL (n = 40) was associated with substantially less axial elongation than orthokeratology (n = 46) in this cohort; the design does not establish causal superiority.

0.00 ± 0.28 MM

EyeRising / RLRL mean axial change at 36 months

+0.45 ± 0.20 MM

Orthokeratology mean axial change; P < 0.001

40.00% VS 2.17%

Axial shortening ≥ 0.05 mm

82.5% VS 37.0%

Complete control (< 0.10 mm/year)

Previous verified registry: August 2026 · Ref. 1–22. Data status: 17 September 2026.

REF. 23 · FULL PUBLICATION ↗PMID 42720885 ↗
PREVIOUS VERIFIED REGISTRY · AUGUST 2026 · REF. 1–22

What changed.

BEFORE

Short-term randomized efficacy was already established, but the published evidence base was dominated by East Asian cohorts and shorter clinical follow-up.

NOW

Multicentre clinical observation extends up to five years. Australia and Spain add randomized evidence beyond East Asia. Updated systematic reviews, retinal imaging studies and device-specific safety analyses broaden the evidence base.

REF. 5 · Gabriella Bulloch ↗REF. 6 · María José Fernández Fidalgo ↗REF. 8 · Zhang J ↗REF. 12 · Lee-Yuan Lin ↗REF. 22 · Yanxian Chen ↗

Mechanism

What is proposed, and what remains a proposal.

Mechanistic evidence is broader, not settled. RLRL delivers repeated short exposures to low-level red light through a prescribed ophthalmic device. Treatment effects do not, by themselves, identify the causal pathway.

HUMAN BIOMARKER EVIDENCE

Human RCT synthesis supports treatment-associated changes in choroidal thickness as a reproducible biomarker response.

REF. 18 · Clara Martinez-Perez ↗
ANIMAL / MECHANISTIC EVIDENCE

Experimental work in lens-induced myopic chicks reports changes in retinal metabolic pathways. This is not human clinical evidence.

REF. 19 · Chengjie He ↗

These findings strengthen biological plausibility. Neither establishes a single causal mechanism responsible for myopia control in children.

Dose and device are part of the intervention

RLRL is not defined by wavelength or colour alone.

The RLRL intervention described within this platform’s clinical framework is the Eyerising Myopia Management Device (EMMD) used according to its defined treatment protocol and IFU.

The device itself, optical output, beam profile, treatment duration, engineering controls, software safeguards and prescribed dosing protocol form part of the intervention.

A different red-light source is therefore not the same treatment simply because it emits light in a similar spectral range.

Randomized clinical evidence

The foundational multicentre trial remains the reference point. Later trials address prevention, direct comparison with atropine 0.01%, and initial evidence beyond East Asia. Separate publications are not necessarily independent cohorts.

REF. 1 · FOUNDATIONAL MULTICENTRE RCT

Effect of Repeated Low-Level Red-Light Therapy for Myopia Control in Children: A Multicenter Randomized Controlled Trial

0.13 vs 0.38 mm

Adjusted axial elongation · 12 months

0.26 mm

Reported adjusted between-group difference
95% CI 0.20–0.31 mm

−0.20 vs −0.79 D

Adjusted refractive progression · 12 months

264 children aged 8–13 were randomized; 246 were analysed. RLRL plus single-vision spectacles was compared with spectacles alone for 12 months. The published model estimate is reported as 0.26 mm; subtracting the rounded arm means gives 0.25 mm.

The trial supports one-year axial and refractive efficacy. Single blinding, no sham arm, a Chinese cohort and specific device exposure limit inference. No severe adverse events, BCVA functional loss or OCT structural damage were observed during this trial; that does not establish long-term retinal safety or safety of unrelated red-light emitters.

DOI 10.1016/j.ophtha.2021.11.023 ↗PMID 34863776 ↗PUBLISHER / SOURCE ↗
Read study detailsHide study detailsREF. 2 · RCTEffect of Repeated Low-level Red Light on Myopia Prevention Among Children in China With Premyopia: A Randomized Clinical Trial
STUDY TYPE
RCT
POPULATION
278 Chinese children with premyopia
INTERVENTION / COMPARATOR
RLRL / Usual activities
FOLLOW-UP
12 months
KEY FINDING
Reduced myopia incidence in the studied premyopic population.
WHAT IT SUPPORTS
Premyopia prevention in children selected for elevated myopia risk.
MAIN LIMITATION
Selected high-risk Chinese school population; not universal preventive efficacy.
DOI 10.1001/jamanetworkopen.2023.9612 ↗PMID 37099298 ↗PUBLISHER / SOURCE ↗FULL TEXT ↗
Read study detailsHide study detailsREF. 3 · RANDOMIZED CROSSOVER TRIALEffect of Repeated Low-Level Red Light Versus 0.01% Topical Atropine on Myopia Progression: A Randomized Crossover-Controlled Trial
STUDY TYPE
RANDOMIZED CROSSOVER TRIAL
POPULATION
91 children aged 6–12
INTERVENTION / COMPARATOR
RLRL / Atropine 0.01%
FOLLOW-UP
13 months including washout
KEY FINDING
RLRL was compared with atropine 0.01%; the study did not test concurrent exposure.
WHAT IT SUPPORTS
Direct comparison of RLRL and atropine 0.01%, not their concurrent use.
MAIN LIMITATION
Crossover and washout interpretation; small single-centre cohort. Ref. 4 reports the initial period of the same trial, not an independent population.
DOI 10.1167/tvst.14.4.22 ↗PMID 40266603 ↗FULL TEXT ↗
Read study detailsHide study detailsREF. 4 · RANDOMIZED COMPARATIVE STUDYThe Effect of Repeated Low-Level Red Light Versus 0.01% Atropine Treatment on Axial Length and Choroidal Parameters in Children with Myopia
STUDY TYPE
RANDOMIZED COMPARATIVE STUDY
POPULATION
91 children aged 6–12
INTERVENTION / COMPARATOR
RLRL / Atropine 0.01%
FOLLOW-UP
6 months
KEY FINDING
Axial-length and choroidal outcomes from the initial six-month period of the crossover trial.
WHAT IT SUPPORTS
Axial-length and choroidal responses during RLRL versus atropine 0.01%.
MAIN LIMITATION
Single-blind and short-term; initial six-month period of the crossover trial reported in Ref. 3. Do not double-count participants.
DOI 10.1007/s40123-025-01169-0 ↗PMID 40478390 ↗PUBLISHER / SOURCE ↗FULL TEXT ↗
Read study detailsHide study detailsREF. 5 · PILOT RCTEfficacy of repeated red-light laser therapy for myopia control in Australian children: a pilot randomised controlled trial
STUDY TYPE
PILOT RCT
POPULATION
34 Australian multi-ethnic children aged 8–13
INTERVENTION / COMPARATOR
RLRL / Single-vision spectacles
FOLLOW-UP
12 months
KEY FINDING
Initial randomized efficacy evidence from a 34-child Australian multi-ethnic pilot.
WHAT IT SUPPORTS
Initial randomized efficacy evidence in an Australian multi-ethnic population.
MAIN LIMITATION
Only 34 children; does not establish equivalent efficacy across ethnicities.
DOI 10.1080/08164622.2026.2648328 ↗PMID 41951208 ↗PUBLISHER / SOURCE ↗
Read study detailsHide study detailsREF. 6 · RCT · COMBINATIONRepeated low-level red-light therapy combined with orthokeratology for myopia control in Spain: a randomised controlled study
STUDY TYPE
RCT · COMBINATION
POPULATION
Spanish/Caucasian children aged 10–13
INTERVENTION / COMPARATOR
RLRL / Orthokeratology alone
FOLLOW-UP
12 months
KEY FINDING
Greater axial-length control with RLRL plus orthokeratology than with orthokeratology alone.
WHAT IT SUPPORTS
Randomized Spanish/European evidence for adding RLRL to orthokeratology.
MAIN LIMITATION
Small, single-site, non-blinded combination trial; not European RLRL-monotherapy replication.
DOI 10.1136/bjo-2025-328347 ↗PMID 41266129 ↗

Clinical observation now extends to five years.

Published multicentre clinical observation now extends beyond the earlier two-year horizon and reaches up to five years.

  1. 12 MONTHS

    Foundational randomized efficacy

    REF. 1 · Yu Jiang ↗
  2. ≥3 YEARS

    Multicentre real-world evidence

    REF. 7 · Yanping Chen ↗
  3. UP TO 5 YEARS

    Multicentre real-world observation

    REAL-WORLD OBSERVATIONAL EVIDENCE
    REF. 8 · Zhang J ↗
  4. LARGE REAL-WORLD COHORT

    2,825 participants · 20 hospitals · up to 36 months

    REF. 9 · Yanxian Chen ↗
  5. 3-YEAR DIRECT COMPARATIVE COHORT

    EyeRising / RLRL vs orthokeratology · 86 children · observational, not randomized

    REF. 23 · Aiqin Nie ↗

The multicentre evidence includes participants with differing follow-up durations. “Up to five years” does not mean every participant completed five years.

Read study detailsHide study detailsREF. 7 · REAL-WORLD OBSERVATIONAL STUDYThree-year efficacy and safety of repeated low-level red-light therapy for myopia control: a multicentre real-world study
STUDY TYPE
REAL-WORLD OBSERVATIONAL STUDY
KEY FINDING
Clinical, OCT and ERG observations extend to treatment durations of at least three years.
WHAT IT SUPPORTS
Multicentre observations across treatment durations including ≥3 years; clinical, OCT and ERG assessment.
MAIN LIMITATION
Observational duration strata, not a three-year randomized comparator; continuation/selection bias.
DOI 10.1136/bjo-2025-328687 ↗PMID 41558834 ↗
Read study detailsHide study detailsREF. 8 · RETROSPECTIVE REAL-WORLD COHORTFive-year efficacy and safety of repeated low-level red light therapy for myopia control in children: a multicenter, real-world study
STUDY TYPE
RETROSPECTIVE REAL-WORLD COHORT
KEY FINDING
Published real-world observation extends up to five years across 12 clinical sites.
WHAT IT SUPPORTS
Published multicentre clinical observation extends up to five years across 12 clinical sites.
MAIN LIMITATION
Journal pre-proof; unequal follow-up and nonrandomized design. Not all participants were observed for five years; not a five-year RCT.
DOI 10.1016/j.aopr.2026.06.002 ↗PUBLISHER / SOURCE ↗
Read study detailsHide study detailsREF. 9 · PROSPECTIVE REAL-WORLD COHORTEfficacy of red light for myopia control from age 2 to 24 with diverse treatment periods: A real-world study
STUDY TYPE
PROSPECTIVE REAL-WORLD COHORT
KEY FINDING
Routine-care outcomes in 2,825 participants across 20 hospitals, with treatment periods up to 36 months.
WHAT IT SUPPORTS
2,825 participants, 20 hospitals, ages 2–24 and treatment periods up to 36 months.
MAIN LIMITATION
Broad routine-care cohort; no long-term randomized comparator; does not establish international generalisability.
DOI 10.1016/j.pdpdt.2026.105481 ↗PMID 42009154 ↗PUBLISHER / SOURCE ↗

Evidence beyond East Asia

Australia

SMALL RANDOMIZED MULTI-ETHNIC PILOT

Initial direct efficacy evidence in a non-Chinese population. The pilot included 34 children: an important geographic addition, not proof of uniform efficacy across all ethnicities.

REF. 5 · Gabriella Bulloch ↗

Spain

EUROPEAN / CAUCASIAN RANDOMIZED EVIDENCE

Greater axial-length control with RLRL plus orthokeratology than orthokeratology alone. The small combination trial is not a European monotherapy-versus-SVL replication.

REF. 6 · María José Fernández Fidalgo ↗

What changed

Evidence is no longer exclusively East Asian.

SYNTHESIS LAYER

Comparative evidence

Recent systematic reviews and network meta-analyses consistently support a substantial efficacy signal for RLRL, while certainty, device heterogeneity and follow-up duration differ between outcomes.

DIRECT OBSERVATIONAL COMPARISON · Eyerising / EMMD-specific evidence

Ref. 23 directly compares EyeRising / RLRL with orthokeratology during three years of active treatment (40 vs 46 children). This retrospective, nonrandomized cohort is distinct from network meta-analysis, randomized trials and combination therapy. Its 36-month axial change was 0.00 ± 0.28 mm vs +0.45 ± 0.20 mm (P < 0.001); causal superiority and post-treatment persistence cannot be inferred.

REF. 23 · FULL PUBLICATION ↗

Network comparisons

Refs. 10–11 combine systematic review with network meta-analysis. Comparisons may include indirect evidence and depend on the compatibility of populations, interventions and common comparators. A network ranking is not a universal head-to-head RCT.

REF. 10 · Diana Chabané Schmidt ↗REF. 11 · Zetong Zheng ↗

Conventional meta-analysis

Refs. 12–13 synthesize randomized RLRL efficacy and, where assessed, clinical safety. Outcome certainty, duration and device differences must remain visible; pooled effects do not prove interchangeability.

REF. 12 · Lee-Yuan Lin ↗REF. 13 · Chen Liu ↗
Read study detailsHide study detailsREF. 10 · SYSTEMATIC REVIEW · NETWORK META-ANALYSISEfficacy of interventions for myopia control in children: A systematic review with network meta-analyses
STUDY TYPE
SYSTEMATIC REVIEW · NETWORK META-ANALYSIS
KEY FINDING
Network synthesis compares myopia-control interventions using direct and indirect evidence.
WHAT IT SUPPORTS
Broader comparative synthesis of interventions for myopia control.
MAIN LIMITATION
Network comparisons may include indirect evidence; rankings depend on transitivity and heterogeneous protocols.
DOI 10.1111/aos.17496 ↗PMID 40219611 ↗FULL TEXT ↗
Read study detailsHide study detailsREF. 11 · SYSTEMATIC REVIEW · NETWORK META-ANALYSISEfficacy comparison of atropine, orthokeratology and repeated low-level red-light therapy for myopia control in children: a systematic review and network meta-analysis
STUDY TYPE
SYSTEMATIC REVIEW · NETWORK META-ANALYSIS
KEY FINDING
Comparative synthesis includes 41 randomized trials and 6,434 eyes.
WHAT IT SUPPORTS
Comparative synthesis of RLRL, atropine and orthokeratology: 41 RCTs / 6,434 eyes.
MAIN LIMITATION
Bayesian network comparisons combine direct and indirect evidence; not a single head-to-head trial.
DOI 10.1136/bjo-2025-327366 ↗PMID 40610049 ↗FULL TEXT ↗
Read study detailsHide study detailsREF. 12 · SYSTEMATIC REVIEW · META-ANALYSISDuration-Dependent Efficacy and Clinical Safety of Repeated Low-Level Red-Light Therapy for Paediatric Myopia: A Systematic Review and Meta-Analysis
STUDY TYPE
SYSTEMATIC REVIEW · META-ANALYSIS
KEY FINDING
Randomized efficacy and clinical-safety findings vary with follow-up duration and outcome certainty.
WHAT IT SUPPORTS
Duration-dependent randomized efficacy and clinical safety synthesis.
MAIN LIMITATION
Follow-up and outcome certainty differ; comprehensive longer-term retinal safety remains needed.
DOI 10.1111/ceo.70105 ↗PMID 41846466 ↗PUBLISHER / SOURCE ↗FULL TEXT ↗
Read study detailsHide study detailsREF. 13 · SYSTEMATIC REVIEW · META-ANALYSISExploring the efficacy of repeated low-level red-light therapy in retarding childhood myopia progression: updated systematic review and meta-analysis
STUDY TYPE
SYSTEMATIC REVIEW · META-ANALYSIS
KEY FINDING
Pooled randomized outcomes cover axial length, refraction and subfoveal choroidal thickness.
WHAT IT SUPPORTS
Updated pooled randomized evidence for axial length, refraction and subfoveal choroidal thickness.
MAIN LIMITATION
Devices, comparators and follow-up vary; pooled efficacy does not validate unrelated red-light emitters.
DOI 10.3389/fmed.2026.1713885 ↗PMID 41658589 ↗PUBLISHER / SOURCE ↗FULL TEXT ↗

Combination therapy

Clinical evidence for adding RLRL to optical myopia control has expanded. The design and population matter: randomized evidence, pooled adjunctive evidence and retrospective rapid-progressor cohorts answer different questions.

Read study detailsHide study detailsREF. 6 · RCT · COMBINATIONRepeated low-level red-light therapy combined with orthokeratology for myopia control in Spain: a randomised controlled study
STUDY TYPE
RCT · COMBINATION
POPULATION
Spanish/Caucasian children aged 10–13
INTERVENTION / COMPARATOR
RLRL / Orthokeratology alone
FOLLOW-UP
12 months
KEY FINDING
Greater axial-length control with RLRL plus orthokeratology than with orthokeratology alone.
WHAT IT SUPPORTS
Randomized Spanish/European evidence for adding RLRL to orthokeratology.
MAIN LIMITATION
Small, single-site, non-blinded combination trial; not European RLRL-monotherapy replication.
DOI 10.1136/bjo-2025-328347 ↗PMID 41266129 ↗
Read study detailsHide study detailsREF. 20 · META-ANALYSIS · COMBINATIONAdjunctive repeated low-level red-light therapy enhances structural outcomes in optical myopia control: A meta-analysis
STUDY TYPE
META-ANALYSIS · COMBINATION
KEY FINDING
Eight-study synthesis examines adjunctive RLRL with orthokeratology or DIMS.
WHAT IT SUPPORTS
Eight-study synthesis of adjunctive RLRL with orthokeratology or DIMS versus optical monotherapy.
MAIN LIMITATION
Combination efficacy does not establish compatibility with every device instruction for use.
DOI 10.1016/j.pdpdt.2026.105512 ↗PMID 42140330 ↗PUBLISHER / SOURCE ↗
Read study detailsHide study detailsREF. 21 · RETROSPECTIVE COHORT · NOT RCTAxial Length Control Using Repeated Low-Level Red Light Combined with Orthokeratology Compared with Orthokeratology Alone in Rapidly Progressing Myopic Children
STUDY TYPE
RETROSPECTIVE COHORT · NOT RCT
KEY FINDING
Retrospective comparison in 72 rapidly progressing children; corrected analyses must be read with the corrigendum.
WHAT IT SUPPORTS
RLRL plus orthokeratology in 72 rapidly progressing children aged 8–14; propensity/IPTW analyses.
MAIN LIMITATION
Retrospective allocation. A June 2026 corrigendum corrects per-protocol analyses; read both records.
DOI 10.2147/OPTH.S571867 ↗PMID 41858975 ↗PUBLISHER / SOURCE ↗FULL TEXT ↗CORRIGENDUM ↗
CLINICAL COMBINATION EVIDENCE ≠ DEVICE IFU COMPATIBILITY

Positive combination trials do not override a device’s instructions for use. For the cited Eyerising device, a dilated pupil and medicines such as atropine remain contraindications; concurrent use is not permitted. Trials comparing RLRL with atropine do not test simultaneous exposure.

WHY CONCURRENT USE IS CONTRAINDICATED →

Safety: four distinct evidence layers

Clinical and retinal imaging evidence has broadened substantially. It is neither a single all-clear nor proof of safety of other red-light emitting devices.

CLINICAL / FUNCTIONAL SAFETY

Longer and more structured observation

Randomized and real-world studies assess visual acuity, adverse events, OCT and, in dedicated follow-up, ERG. These are strengthened and often reassuring clinical observations, not proof of zero rare-event risk.

REF. 1 · Yu Jiang ↗REF. 7 · Yanping Chen ↗REF. 8 · Zhang J ↗REF. 12 · Lee-Yuan Lin ↗
RETINAL / CHORIORETINAL SAFETY

Imaging beyond visual acuity

Ref. 15 specifically examines chorioretinal circulation and clinical safety. Ref. 16 examines cone mosaic and microvasculature using adaptive-optics scanning laser ophthalmoscopy. Endpoints and study design must accompany interpretation.

REF. 15 · Zhaoxin Jiang ↗REF. 16 · Yu Yue ↗
PREPRINT · NOT PEER REVIEWED · DEVICE-SPECIFIC

Radiometric analysis of the EMMD

Schulmeister and Marshall analyse the Eyerising Myopia Management Device and the exposure parameters covered by their model. The threshold-based, laboratory analysis is not a human long-term safety study and cannot be generalized to other red-light emitting devices.

REF. 17 · Karl Schulmeister ↗
HIGH-RESOLUTION RETINAL IMAGING · ADDITIONAL INDEPENDENT EVIDENCE

Structural signals must remain in view

Liao et al. (2025), a retrospective multicentre cohort of 99 children, found an association between prior RLRL exposure and reduced paracentral cone density with subtle imaging abnormalities. This is a safety signal, not proof of irreversible retinal damage.

DOI 10.1001/jamaophthalmol.2025.0835 ↗PMID 40272813 ↗PUBLISHER / SOURCE ↗

The newer adaptive-optics study by Yu Yue et al. (Ref. 16) adds cone-mosaic and microvascular assessment. High-resolution retinal imaging has produced both reassuring observations and structural signals whose clinical significance remains uncertain. Differences in design, exposure, devices, baseline characteristics and imaging methodology require careful interpretation.

REF. 16 · Yu Yue ↗

A dilated pupil is a contraindication, not a caveat

Device instructions list a dilated pupil and medicines such as atropine among contraindications. The expanded evidence base does not cancel those restrictions.

OPEN THE SAFETY NODE →
06

Monitoring

Monitoring remains part of the intervention, not an optional add-on. Review axial biometry, refractive progression, ocular health, adherence and transient visual symptoms; use retinal imaging where clinically indicated.

Intervals should be defined before treatment starts, not reconstructed afterwards, and axial biometry should be repeated under comparable conditions so that a rate — not a single value — can be read.

READ AN AXIAL LENGTH IN THE LAB →
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Rebound, cessation and tapering

DIRECT CESSATION EVIDENCE · ADDITIONAL INDEPENDENT EVIDENCE

Stopping and continuing are different exposures

Xiong et al. followed participants after the original trial. Continued treatment sustained benefit, while a modest rebound was reported after cessation. The post-trial selection and attrition limit inference. This is evidence about cessation, not randomized validation of a tapering schedule.

DOI 10.1111/ceo.14149 ↗PMID 36054314 ↗PUBLISHER / SOURCE ↗
EXPERT OPINION · NOT A TAPERING TRIAL

A proposed tapering framework

A 2026 peer-reviewed Expert Opinion proposes gradual reduction of treatment frequency with continued monitoring rather than treating abrupt cessation as the only option.

REF. 22 · Yanxian Chen ↗
HISTORICAL AND CONTEXT EVIDENCE · OUTSIDE THE VERIFIED REGISTRY

Earlier evidence remains part of the record

Safety signals are not erased by longer follow-up

The earlier retinal-damage case report remains relevant: a single case cannot estimate incidence. Ostrin and Schill’s radiometric study, Red light instruments for myopia exceed safety limits, identified exposure-limit concerns in two specific instruments. Those instruments were not the Eyerising EMMD; safety measurements from those optical systems must not be transferred to EMMD.

RETINAL-DAMAGE CASE · PMID 37227712 ↗OSTRIN & SCHILL · DEVICE ANALYSIS ↗EARLIER SAFETY REVIEW ↗

Previous combination and cessation context

The earlier RLRL–orthokeratology trial remains a separate combination study. LAMP phase 3 concerns atropine continuation and washout; it does not validate an RLRL tapering schedule or concurrent atropine–RLRL use.

EARLIER RLRL + ORTHOKERATOLOGY TRIAL ↗LAMP PHASE 3 · ATROPINE CONTEXT ↗

Evidence Update · Verified references 1–23

Current verified registry: September 2026 · Ref. 1–23. Previous verified registry: August 2026 · Ref. 1–22. Ref. numbers are stable identifiers, not display order; DOI identifies each publication. Additional Liao and Xiong records remain unnumbered.

25 records shown

10 SEP 2026
REF. 23

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

Aiqin Nie, Jing Xie, Yingshi Zou, Ming-Ming Yang, Yanxian Chen, Mingguang He · Ophthalmology and Therapy. Published 10 September 2026.

EyeRising / EMMD · PEER-REVIEWED ORIGINAL RESEARCH · RETROSPECTIVE OBSERVATIONAL COMPARATIVE STUDY

During 3 years of active treatment, RLRL was associated with substantially less axial elongation than orthokeratology in this cohort.

STUDY / COMPARATOR

Single-centre, nonrandomized cohort of 86 children aged 6–16: EyeRising / RLRL n = 40; orthokeratology n = 46.

36-MONTH AXIAL CHANGE

0.00 ± 0.28 mm vs +0.45 ± 0.20 mm; P < 0.001. Axial shortening ≥ 0.05 mm: 40.00% vs 2.17%. Complete control (< 0.10 mm/year): 82.5% vs 37.0%.

SAFETY

No serious treatment-related adverse events; BCVA remained stable. Transient glare: 1/40; afterimages: 40/40, all resolved within 5 minutes, with no discontinuations. One transient focal OCT finding after 24 months resolved by 36 months without visual-acuity loss or treatment interruption; causality was not established.

CONFLICT OF INTEREST

Aiqin Nie, Jing Xie, Yingshi Zou, Ming-Ming Yang and Yanxian Chen: nothing to disclose. Mingguang He: director and shareholder of Eyerising Ltd and Eyerising International Pty Ltd.

MAIN LIMITATIONS

Retrospective, single-centre, nonrandomized Chinese cohort selected for adherence and complete follow-up. Final measurements were during active treatment; no washout or post-treatment assessment. Persistence after cessation and causal superiority are unknown; generalisability to other populations is uncertain.

PROTOCOL USED IN THIS STUDY

EyeRising device by Suzhou Xuanjia Optoelectronics Technology Co., Ltd.; 650 ± 10 nm; two 3-minute sessions daily, 7 days per week, at least 4 hours apart, during 3 years of active treatment. This describes the study protocol, not a universal or current regional IFU.

SOURCE / DOI / PMID
DOI 10.1007/s40123-026-01494-y ↗PMID 42720885 ↗PUBLISHER / SOURCE ↗
2026
REF. 07

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

Yanping Chen, Wei Wang, Ruilin Xiong, et al. · British Journal of Ophthalmology. 2026;110(9):1028–1035.

STUDY TYPE

REAL-WORLD OBSERVATIONAL STUDY

KEY FINDING

Clinical, OCT and ERG observations extend to treatment durations of at least three years.

WHAT IT SUPPORTS

Multicentre observations across treatment durations including ≥3 years; clinical, OCT and ERG assessment.

MAIN LIMITATION

Observational duration strata, not a three-year randomized comparator; continuation/selection bias.

SOURCE / DOI / PMID
DOI 10.1136/bjo-2025-328687 ↗PMID 41558834 ↗
2026
REF. 06

Repeated low-level red-light therapy combined with orthokeratology for myopia control in Spain: a randomised controlled study

María José Fernández Fidalgo, Victoria D. Ferigo Ferrel, Yue Wu, et al. · British Journal of Ophthalmology. Final issue: 2026;110(7):771–777.

STUDY TYPE

RCT · COMBINATION

KEY FINDING

Greater axial-length control with RLRL plus orthokeratology than with orthokeratology alone.

WHAT IT SUPPORTS

Randomized Spanish/European evidence for adding RLRL to orthokeratology.

MAIN LIMITATION

Small, single-site, non-blinded combination trial; not European RLRL-monotherapy replication.

SOURCE / DOI / PMID
DOI 10.1136/bjo-2025-328347 ↗PMID 41266129 ↗
2026
REF. 20

Adjunctive repeated low-level red-light therapy enhances structural outcomes in optical myopia control: A meta-analysis

Nian Zhang, Yayan You, Rui Li, Bingjie Shi. · Photodiagnosis and Photodynamic Therapy. 2026;59:105512.

STUDY TYPE

META-ANALYSIS · COMBINATION

KEY FINDING

Eight-study synthesis examines adjunctive RLRL with orthokeratology or DIMS.

WHAT IT SUPPORTS

Eight-study synthesis of adjunctive RLRL with orthokeratology or DIMS versus optical monotherapy.

MAIN LIMITATION

Combination efficacy does not establish compatibility with every device instruction for use.

SOURCE / DOI / PMID
DOI 10.1016/j.pdpdt.2026.105512 ↗PMID 42140330 ↗PUBLISHER / SOURCE ↗
2026
REF. 09

Efficacy of red light for myopia control from age 2 to 24 with diverse treatment periods: A real-world study

Yanxian Chen, Yue Wu, Lili Wang, Zhuoting Zhu, et al. · Photodiagnosis and Photodynamic Therapy. 2026;59:105481.

STUDY TYPE

PROSPECTIVE REAL-WORLD COHORT

KEY FINDING

Routine-care outcomes in 2,825 participants across 20 hospitals, with treatment periods up to 36 months.

WHAT IT SUPPORTS

2,825 participants, 20 hospitals, ages 2–24 and treatment periods up to 36 months.

MAIN LIMITATION

Broad routine-care cohort; no long-term randomized comparator; does not establish international generalisability.

SOURCE / DOI / PMID
DOI 10.1016/j.pdpdt.2026.105481 ↗PMID 42009154 ↗PUBLISHER / SOURCE ↗
2026
REF. 16

Safety analysis of repeated low-level red light therapy on cone mosaic and microvasculature by adaptive optics scanning laser ophthalmoscopy

Yu Yue, Ni Zhang, Ke-Yu Liu, Yuan-Yuan Zhong, Han Wang, Shu-Lin Liu, Wen-Juan Wan, Yan-Lai Zhang, Wen-Li Deng. · Photodiagnosis and Photodynamic Therapy. 2026;59:105473.

STUDY TYPE

CROSS-SECTIONAL SAFETY STUDY

KEY FINDING

Adaptive-optics imaging assesses cone mosaic and retinal microvasculature.

WHAT IT SUPPORTS

Adaptive-optics assessment of cone mosaic and retinal microvasculature.

MAIN LIMITATION

Cross-sectional imaging; not a long-term randomized safety study and not proof of zero rare-event risk.

SOURCE / DOI / PMID
DOI 10.1016/j.pdpdt.2026.105473 ↗PMID 41974297 ↗PUBLISHER / SOURCE ↗
2026
REF. 05

Efficacy of repeated red-light laser therapy for myopia control in Australian children: a pilot randomised controlled trial

Gabriella Bulloch, Ziyi Qi, Yuri Yin-Moe Aung, et al. · Clinical & Experimental Optometry. 2026.

STUDY TYPE

PILOT RCT

KEY FINDING

Initial randomized efficacy evidence from a 34-child Australian multi-ethnic pilot.

WHAT IT SUPPORTS

Initial randomized efficacy evidence in an Australian multi-ethnic population.

MAIN LIMITATION

Only 34 children; does not establish equivalent efficacy across ethnicities.

SOURCE / DOI / PMID
DOI 10.1080/08164622.2026.2648328 ↗PMID 41951208 ↗PUBLISHER / SOURCE ↗
2026
REF. 19

Repeated low-level red light modulates retinal metabolic alterations in lens-induced myopic chicks

Chengjie He, Yanjing Huang, Shiran Zhang, Jingni Li, Jiangbo Liang, Jingyi Peng, Yue Wu, Ying Hong, Ying-Feng Zheng, Mingguang He. · Journal of Photochemistry and Photobiology B. 2026;278:113432.

STUDY TYPE

ANIMAL / MECHANISTIC STUDY

KEY FINDING

Retinal metabolic changes were studied in lens-induced myopic chicks, not children.

WHAT IT SUPPORTS

Retinal metabolic responses in lens-induced myopic chicks.

MAIN LIMITATION

Animal evidence, not human clinical efficacy or proof of a metabolic mechanism in children.

SOURCE / DOI / PMID
DOI 10.1016/j.jphotobiol.2026.113432 ↗PMID 41967278 ↗PUBLISHER / SOURCE ↗
2026
REF. 12

Duration-Dependent Efficacy and Clinical Safety of Repeated Low-Level Red-Light Therapy for Paediatric Myopia: A Systematic Review and Meta-Analysis

Lee-Yuan Lin, Cheng-Hao Hsu, Hung Su, et al. · Clinical & Experimental Ophthalmology. 2026;54(5):630–652.

STUDY TYPE

SYSTEMATIC REVIEW · META-ANALYSIS

KEY FINDING

Randomized efficacy and clinical-safety findings vary with follow-up duration and outcome certainty.

WHAT IT SUPPORTS

Duration-dependent randomized efficacy and clinical safety synthesis.

MAIN LIMITATION

Follow-up and outcome certainty differ; comprehensive longer-term retinal safety remains needed.

SOURCE / DOI / PMID
DOI 10.1111/ceo.70105 ↗PMID 41846466 ↗PUBLISHER / SOURCE ↗FULL TEXT ↗
2026
REF. 22

Expert Opinion on Myopia Tapering: Strategies for Managing Myopia Progression

Yanxian Chen, Zhuoting Zhu, Yuri Yin-Moe Aung, Yuzhou Zhang, Yueye Wang, Jason CS Yam, Mingguang He. · Ophthalmic Epidemiology. 2026;33(3):306–309. Epub 18 Feb 2026.

STUDY TYPE

EXPERT OPINION · NOT A TAPERING TRIAL

KEY FINDING

Expert-proposed reduction of treatment frequency with continued monitoring; not a validated tapering trial.

WHAT IT SUPPORTS

Expert-proposed gradual reduction of treatment frequency with continued monitoring.

MAIN LIMITATION

No randomized validation of an optimal RLRL tapering schedule or superiority over abrupt cessation.

SOURCE / DOI / PMID
DOI 10.1080/09286586.2025.2612156 ↗PMID 41705331 ↗
2026
REF. 14

Clinical efficacy and cost-effectiveness of four myopia control interventions in children: a single-center retrospective study

Daohuan Kang, Lu Yuan, Carla Lanca, et al. · Scientific Reports. 2026;16:9126.

STUDY TYPE

RETROSPECTIVE COMPARATIVE STUDY

KEY FINDING

One-year mean axial change: 0.06 mm with RLRL versus 0.42 mm with single-vision lenses; observed difference −0.36 mm.

WHAT IT SUPPORTS

Four-strategy, single-centre clinical and cost-effectiveness comparison in 206 children.

MAIN LIMITATION

Nonrandomized allocation; one-year horizon; economics are specific to the study setting.

SOURCE / DOI / PMID
DOI 10.1038/s41598-026-40199-x ↗PMID 41691040 ↗PUBLISHER / SOURCE ↗FULL TEXT ↗
2026
REF. 13

Exploring the efficacy of repeated low-level red-light therapy in retarding childhood myopia progression: updated systematic review and meta-analysis

Chen Liu, Yating Zhou, Zongyue Zhan, Xiaofeng Li. · Frontiers in Medicine. 2026;13:1713885.

STUDY TYPE

SYSTEMATIC REVIEW · META-ANALYSIS

KEY FINDING

Pooled randomized outcomes cover axial length, refraction and subfoveal choroidal thickness.

WHAT IT SUPPORTS

Updated pooled randomized evidence for axial length, refraction and subfoveal choroidal thickness.

MAIN LIMITATION

Devices, comparators and follow-up vary; pooled efficacy does not validate unrelated red-light emitters.

SOURCE / DOI / PMID
DOI 10.3389/fmed.2026.1713885 ↗PMID 41658589 ↗PUBLISHER / SOURCE ↗FULL TEXT ↗
2026
REF. 21

Axial Length Control Using Repeated Low-Level Red Light Combined with Orthokeratology Compared with Orthokeratology Alone in Rapidly Progressing Myopic Children

Alkut Elham, Xiangjun Meng. · Clinical Ophthalmology. 2026;20:571867.

STUDY TYPE

RETROSPECTIVE COHORT · NOT RCT

KEY FINDING

Retrospective comparison in 72 rapidly progressing children; corrected analyses must be read with the corrigendum.

WHAT IT SUPPORTS

RLRL plus orthokeratology in 72 rapidly progressing children aged 8–14; propensity/IPTW analyses.

MAIN LIMITATION

Retrospective allocation. A June 2026 corrigendum corrects per-protocol analyses; read both records.

SOURCE / DOI / PMID
DOI 10.2147/OPTH.S571867 ↗PMID 41858975 ↗PUBLISHER / SOURCE ↗FULL TEXT ↗CORRIGENDUM ↗
2026
REF. 08

Five-year efficacy and safety of repeated low-level red light therapy for myopia control in children: a multicenter, real-world study

Zhang J, Yu J, Zou H, Xu Y. · Advances in Ophthalmology Practice and Research. 2026.

STUDY TYPE

RETROSPECTIVE REAL-WORLD COHORT

KEY FINDING

Published real-world observation extends up to five years across 12 clinical sites.

WHAT IT SUPPORTS

Published multicentre clinical observation extends up to five years across 12 clinical sites.

MAIN LIMITATION

Journal pre-proof; unequal follow-up and nonrandomized design. Not all participants were observed for five years; not a five-year RCT.

SOURCE / DOI / PMID
DOI 10.1016/j.aopr.2026.06.002 ↗PUBLISHER / SOURCE ↗
2026
REF. 17

An analysis of retinal safety when using a Laser based low-level red light therapy device for myopia

Karl Schulmeister, John Marshall. · medRxiv. 2026.

STUDY TYPE

PREPRINT · NOT PEER REVIEWED · DEVICE-SPECIFIC

KEY FINDING

Radiometric / laboratory safety analysis of EMMD using modelled exposure thresholds; not a long-term clinical safety study.

WHAT IT SUPPORTS

Laboratory/radiometric analysis of the Eyerising Myopia Management Device (EMMD).

MAIN LIMITATION

Version 1 preprint; modelling and selected exposure thresholds for one device, not a clinical long-term safety cohort.

DEVICE
Eyerising Myopia Management Device (EMMD)
STATUS
PREPRINT · NOT PEER REVIEWED · DEVICE-SPECIFIC
SOURCE / DOI / PMID
DOI 10.64898/2026.05.05.26352503 ↗PUBLISHER / SOURCE ↗
2026
REF. 18

Impact of Myopia Control Interventions on Choroidal Thickness in Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Clara Martinez-Perez, Ana Paula Oliveira. · Ophthalmology Science. E-published 17 Dec 2025; issue 2026;6(2):101039.

STUDY TYPE

SYSTEMATIC REVIEW · META-ANALYSIS

KEY FINDING

Human choroidal-thickness synthesis includes 11 randomized trials and 2,190 eyes.

WHAT IT SUPPORTS

Human biomarker evidence: choroidal-thickness changes across 11 RCTs / 2,190 eyes.

MAIN LIMITATION

Treatment-associated biomarker response does not establish a single causal mechanism. Online December 2025; issue 2026.

SOURCE / DOI / PMID
DOI 10.1016/j.xops.2025.101039 ↗PMID 41584097 ↗PUBLISHER / SOURCE ↗FULL TEXT ↗
2025
REF. 11

Efficacy comparison of atropine, orthokeratology and repeated low-level red-light therapy for myopia control in children: a systematic review and network meta-analysis

Zetong Zheng, Xue Jiang, Rongxin Chen, Li Dong. · British Journal of Ophthalmology. 2025;109(11):1215–1220.

STUDY TYPE

SYSTEMATIC REVIEW · NETWORK META-ANALYSIS

KEY FINDING

Comparative synthesis includes 41 randomized trials and 6,434 eyes.

WHAT IT SUPPORTS

Comparative synthesis of RLRL, atropine and orthokeratology: 41 RCTs / 6,434 eyes.

MAIN LIMITATION

Bayesian network comparisons combine direct and indirect evidence; not a single head-to-head trial.

SOURCE / DOI / PMID
DOI 10.1136/bjo-2025-327366 ↗PMID 40610049 ↗FULL TEXT ↗
2025
REF. 04

The Effect of Repeated Low-Level Red Light Versus 0.01% Atropine Treatment on Axial Length and Choroidal Parameters in Children with Myopia

Xuena Pang, Aicun Fu, Guangying Zheng, Weiqun Wang, Mei Zhong, Lili Shang, Minghang Chang, Xuemin Jin. · Ophthalmology and Therapy. 2025;14(8):1739–1754.

STUDY TYPE

RANDOMIZED COMPARATIVE STUDY

KEY FINDING

Axial-length and choroidal outcomes from the initial six-month period of the crossover trial.

WHAT IT SUPPORTS

Axial-length and choroidal responses during RLRL versus atropine 0.01%.

MAIN LIMITATION

Single-blind and short-term; initial six-month period of the crossover trial reported in Ref. 3. Do not double-count participants.

SOURCE / DOI / PMID
DOI 10.1007/s40123-025-01169-0 ↗PMID 40478390 ↗PUBLISHER / SOURCE ↗FULL TEXT ↗
2025
ADDITIONAL

Cone Density Changes After Repeated Low-Level Red Light Treatment in Children With Myopia

Xinyi Liao, et al. · JAMA Ophthalmology. 2025;143(6):480–488.

STUDY TYPE

RETROSPECTIVE MULTICENTRE COHORT

KEY FINDING

In 99 children, prior RLRL exposure was associated with reduced paracentral cone density and subtle imaging differences.

MAIN LIMITATION

Association does not establish irreversible damage; functional significance and causality remain uncertain.

SOURCE / DOI / PMID
DOI 10.1001/jamaophthalmol.2025.0835 ↗PMID 40272813 ↗PUBLISHER / SOURCE ↗
2025
REF. 10

Efficacy of interventions for myopia control in children: A systematic review with network meta-analyses

Diana Chabané Schmidt, Anders Hvid-Hansen, Nina Jacobsen, et al. · Acta Ophthalmologica. 2025.

STUDY TYPE

SYSTEMATIC REVIEW · NETWORK META-ANALYSIS

KEY FINDING

Network synthesis compares myopia-control interventions using direct and indirect evidence.

WHAT IT SUPPORTS

Broader comparative synthesis of interventions for myopia control.

MAIN LIMITATION

Network comparisons may include indirect evidence; rankings depend on transitivity and heterogeneous protocols.

SOURCE / DOI / PMID
DOI 10.1111/aos.17496 ↗PMID 40219611 ↗FULL TEXT ↗
2025
REF. 03

Effect of Repeated Low-Level Red Light Versus 0.01% Topical Atropine on Myopia Progression: A Randomized Crossover-Controlled Trial

Xuena Pang, Xuemin Jin, Aicun Fu, et al. · Translational Vision Science & Technology. 2025;14(4):22.

STUDY TYPE

RANDOMIZED CROSSOVER TRIAL

KEY FINDING

RLRL was compared with atropine 0.01%; the study did not test concurrent exposure.

WHAT IT SUPPORTS

Direct comparison of RLRL and atropine 0.01%, not their concurrent use.

MAIN LIMITATION

Crossover and washout interpretation; small single-centre cohort. Ref. 4 reports the initial period of the same trial, not an independent population.

SOURCE / DOI / PMID
DOI 10.1167/tvst.14.4.22 ↗PMID 40266603 ↗FULL TEXT ↗
2025
REF. 15

Safety of and chorioretinal circulation during repeated low-level red-light therapy for myopic children

Zhaoxin Jiang, Shuyu Chen, Renchun Wang, Jin Ma. · Clinical & Experimental Ophthalmology. 2025;53(2):119–132. Epub 5 Nov 2024.

STUDY TYPE

RCT · RETINAL SAFETY

KEY FINDING

Dedicated clinical-safety and chorioretinal-circulation assessment in myopic children.

WHAT IT SUPPORTS

Dedicated assessment of clinical safety and chorioretinal circulation.

MAIN LIMITATION

Safety inference is limited to the studied protocol, observation period and measured endpoints.

SOURCE / DOI / PMID
DOI 10.1111/ceo.14462 ↗PMID 39501548 ↗
2023
REF. 02

Effect of Repeated Low-level Red Light on Myopia Prevention Among Children in China With Premyopia: A Randomized Clinical Trial

Xiangui He, Jingjing Wang, Zhuoting Zhu, et al. · JAMA Network Open. 2023;6(4):e239612.

STUDY TYPE

RCT

KEY FINDING

Reduced myopia incidence in the studied premyopic population.

WHAT IT SUPPORTS

Premyopia prevention in children selected for elevated myopia risk.

MAIN LIMITATION

Selected high-risk Chinese school population; not universal preventive efficacy.

SOURCE / DOI / PMID
DOI 10.1001/jamanetworkopen.2023.9612 ↗PMID 37099298 ↗PUBLISHER / SOURCE ↗FULL TEXT ↗
2022
ADDITIONAL

Sustained and rebound effect of repeated low-level red-light therapy on myopia control: A 2-year post-trial follow-up study

Ruilin Xiong, et al. · Clinical & Experimental Ophthalmology. 2022;50(9):1013–1024.

STUDY TYPE

POST-TRIAL FOLLOW-UP

KEY FINDING

Direct cessation evidence: continued treatment sustained benefit; a modest rebound was reported after stopping.

MAIN LIMITATION

Selected post-trial groups and substantial attrition; not a randomized tapering-versus-abrupt-stop comparison.

SOURCE / DOI / PMID
DOI 10.1111/ceo.14149 ↗PMID 36054314 ↗PUBLISHER / SOURCE ↗
2022
REF. 01

Effect of Repeated Low-Level Red-Light Therapy for Myopia Control in Children: A Multicenter Randomized Controlled Trial

Yu Jiang, Zhuoting Zhu, Xingping Tan, et al. · Ophthalmology. 2022;129(5):509–519.

STUDY TYPE

RCT

KEY FINDING

Adjusted axial elongation at 12 months: 0.13 vs 0.38 mm; reported adjusted between-group difference 0.26 mm.

WHAT IT SUPPORTS

Foundational 12-month efficacy versus single-vision spectacles.

MAIN LIMITATION

Single-blind; no sham arm; Chinese cohort; device-specific exposure.

SOURCE / DOI / PMID
DOI 10.1016/j.ophtha.2021.11.023 ↗PMID 34863776 ↗PUBLISHER / SOURCE ↗
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