Abstract
BACKGROUND: To systematically evaluate the efficacy of repeated low-level red-light (RLRL) therapy, compared to single-vision spectacles (SVS), for controlling myopia progression in children and adolescents. METHODS: A comprehensive search of electronic databases, including PubMed, Embase, Cochrane Library, was conducted up to Sept 30, 2025 according to the inclusion and exclusion criteria. The change of axial length (AL), spherical equivalent refraction (SER) and subfoveal choroidal thickness (SFCT) were main outcomes. Pooled mean differences (MD) with 95% confidence interval (CI) were calculated and heterogeneity was quantified using I(2). RESULTS: Fourteen randomized controlled trials involving 1,942 participants were included. The mean difference in AL change favored RLRL at 1 month (MD: -0.07 mm, 95% CI: -0.09 to -0.06, P < 0.00001), 3 months (MD: -0.15 mm, 95% CI: -0.18 to -0.11, P < 0.00001), 6 months (MD: -0.22 mm, 95% CI: -0.26 to -0.17, P < 0.00001), and 12 months (MD: -0.33 mm, 95% CI: -0.39 to -0.27, P < 0.00001). Similarly, RLRL significantly slowed SER progression at 3 months (MD: 0.17 D, 95% CI: 0.13 to 0.21, P < 0.00001), 6 months (MD: 0.38 D, 95% CI: 0.26 to 0.49, P < 0.00001), and 12 months (MD: 0.67 D, 95% CI: 0.53 to 0.82, P < 0.00001). Furthermore, RLRL induced a significant increase in SFCT at all time points (16.72 μm at 1 month; 19.46 μm at 3 months; 28.21 μm at 6 months; 30.86 μm at 12 months; all P < 0.00001). Heterogeneity was substantial for AL and SER outcomes but the treatment effect was consistently favorable. CONCLUSION: In conclusion, this meta-analysis suggests that RLRL therapy maybe an effective intervention for slowing myopia progression in children and adolescents in the short to medium term. Based on current evidence, it appears to be a promising and generally well-tolerated treatment option. However, long-term safety, sustained efficacy, and optimal treatment protocols require further confirmation through extended follow-up studies. TRIAL REGISTRATION: The trial was registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration ID: CRD420251139693).