Efficacy of Repeated Low-Level Red-Light Therapy for Slowing the Progression of Childhood Myopia: A Systematic Review and Meta-analysis

Tang, Jie; Liao, Yanling; Yan, Ning; Dereje, Shiferaw Blen; Wang, Jingjing; Luo, Yunjiao; Wang, Yuhao; Zhou, Wen; Wang, Xiaojuan; Wang, Wei

doi:10.1016/j.ajo.2023.03.036

Cited by 32 publications

(14 citation statements)

References 43 publications

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“…Nevertheless, caution is advised regarding the safety of RLRL, because the reported RCTs did not involve any independent safety monitoring. Well-designed and larger RCTs with longer follow-up periods are necessary [ 209 ]. One case reported by Liu et al raised some further uncertainty: a 12-year-old girl experienced bilateral vision loss over 2 weeks following 5 months of repeated exposure to RLRL treatment for moderate myopia in both eyes.…”

Section: Resultsmentioning

confidence: 99%

Myopia Control: Are We Ready for an Evidence Based Approach?

Eppenberger,

Grzybowski,

Schmetterer

et al. 2024

Ophthalmol Ther

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Introduction Myopia and its vision-threatening complications present a significant public health problem. This review aims to provide an updated overview of the multitude of known and emerging interventions to control myopia, including their potential effect, safety, and costs. Methods A systematic literature search of three databases was conducted. Interventions were grouped into four categories: environmental/behavioral (outdoor time, near work), pharmacological (e.g., atropine), optical interventions (spectacles and contact lenses), and novel approaches such as red-light (RLRL) therapies. Review articles and original articles on randomized controlled trials (RCT) were selected. Results From the initial 3224 retrieved records, 18 reviews and 41 original articles reporting results from RCTs were included. While there is more evidence supporting the efficacy of low-dose atropine and certain myopia-controlling contact lenses in slowing myopia progression, the evidence about the efficacy of the newer interventions, such as spectacle lenses (e.g., defocus incorporated multiple segments and highly aspheric lenslets) is more limited. Behavioral interventions, i.e., increased outdoor time, seem effective for preventing the onset of myopia if implemented successfully in schools and homes. While environmental interventions and spectacles are regarded as generally safe, pharmacological interventions, contact lenses, and RLRL may be associated with adverse effects. All interventions, except for behavioral change, are tied to moderate to high expenditures. Conclusion Our review suggests that myopia control interventions are recommended and prescribed on the basis of accessibility and clinical practice patterns, which vary widely around the world. Clinical trials indicate short- to medium-term efficacy in reducing myopia progression for various interventions, but none have demonstrated long-term effectiveness in preventing high myopia and potential complications in adulthood. There is an unmet need for a unified consensus for strategies that balance risk and effectiveness for these methods for personalized myopia management. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-024-00951-w.

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Section: Resultsmentioning

confidence: 99%

Myopia Control: Are We Ready for an Evidence Based Approach?

Eppenberger,

Grzybowski,

Schmetterer

et al. 2024

Ophthalmol Ther

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“…Red light therapy is a new approach to control myopia progression in patients with moderate myopia 20 . Although the mechanism of action is not fully understood, this device emits a red light (650 nm) that seems to improve scleral hypoxia and thus prevent myopia progression 20,60 . RCTs evaluating myopia control with this treatment are limited.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, it can be also considered as a viable option for combination therapy with any of the optical treatments to enhance the efficacy of myopia control 19 . Recently, new light therapy devices, such as low‐level light therapy (LLLT) seem to achieve promising results for myopia control 20 . Therefore, the long‐term efficacy, as well as the possible rebound effects of these treatments, are an important area of study.…”

Section: Introductionmentioning

confidence: 99%

“…Rebound effect is defined as the greater myopic progression that occurs after cessation of myopia control treatment, with the participant ultimately reaching the same level of myopia observed in a child of the same age and with similar environmental factors who did not receive any myopia control treatment 21 . Although several studies have evaluated the efficacy and safety of different myopia control treatments, 11–16,18,20 there is no systematic review analysing the changes in axial length (AL) and spherical equivalent refraction (SER) after the cessation of myopia control treatments.…”

Section: Introductionmentioning

confidence: 99%

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Assessing the rebound phenomenon in different myopia control treatments: A systematic review

Sánchez‐Tena,

Ballesteros‐Sánchez,

Martinez‐Perez

et al. 2024

Ophthalmic Physiologic Optic

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PurposeTo review the rebound effect after cessation of different myopia control treatments.MethodsA systematic review that included full‐length randomised controlled studies (RCTs), as well as post‐hoc analyses of RCTs reporting new findings on myopia control treatments rebound effect in two databases, PubMed and Web of Science, was performed according to the PRISMA statement. The search period was between 15 June 2023 and 30 June 2023. The Cochrane risk of bias tool was used to analyse the quality of the selected studies.ResultsA total of 11 studies were included in this systematic review. Unifying the rebound effects of all myopia control treatments, the mean rebound effect for axial length (AL) and spherical equivalent refraction (SER) were 0.10 ± 0.07 mm [−0.02 to 0.22] and −0.27 ± 0.2 D [−0.71 to −0.03] after 10.2 ± 7.4 months of washout, respectively. In addition, spectacles with highly aspherical lenslets or defocus incorporated multiple segments technology, soft multifocal contact lenses and orthokeratology showed lower rebound effects compared with atropine and low‐level light therapy, with a mean rebound effect for AL and SER of 0.04 ± 0.04 mm [0 to 0.08] and −0.13 ± 0.07 D [−0.05 to −0.2], respectively.ConclusionsIt appears that the different treatments for myopia control produce a rebound effect after their cessation. Specifically, optical treatments seem to produce less rebound effect than pharmacological or light therapies. However, more studies are required to confirm these results.

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“…In these reports, red light was delivered directly into the eyes twice a day through an enclosed device and a prominent anti‐myopia effect was observed 10–17 . A recent meta‐analysis showed that RLRL therapy effectively promoted hyperopia, shortened axial length and thickened the choroid 18 . Very little, however, is known about the parameters related to these effects and the underlying mechanisms.…”

Section: Introductionmentioning

confidence: 99%

The effects of intensity, spectral purity and duty cycle on red light‐induced hyperopia in tree shrews

Gawne

Samal

She

2023

Ophthalmic Physiologic Optic

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IntroductionThere have recently been several clinical studies suggesting that brief periods of exposure to red light (repeated low‐level red light, ‘RLRL’) may produce a dramatic anti‐myopia effect, calling for further investigations into its therapeutic parameters. Unfortunately, many experimental species used in refractive studies develop myopia in response to this wavelength. Tree shrews are the only animal model other than rhesus monkeys that consistently exhibit hyperopic responses to ambient red light. Here, tree shrews were used to study the influence of the spectral purity, duty cycle and intensity of red light on its anti‐myopic effect.MethodsJuvenile tree shrews (Tupaia belangeri) were raised from 24 to 35 days after eye opening under ambient lighting that was: standard white colony fluorescent light; pure narrow band red light of either 600, 50–100 or 5 lux; red light that was diluted with 10% white light (by lux) or 50% white and 2 s of pure red light that alternated with 2 s of pure white light (50% duty cycle). Refractive measures were taken with a NIDEK ARK‐700 autorefractor and axial dimensions with a LenStar LS‐900 Axial Biometer.ResultsThe pro‐hyperopia effect of ambient red light was greatly reduced by even small amounts of concurrent white light ‘contamination’, but remained robust if 2‐s periods of pure white light alternated with 2 s of red. Finally, the hyperopic effect of red light was maintained at reduced luminance levels in the 50–100 lux range and only failed at 5 lux.ConclusionsThese results have implications for understanding the mechanisms by which ambient red light affects refractive development, and possibly also for clinical therapies using RLRL. Nevertheless, it remains to be determined if the mechanism of the current clinical RLRL therapy is the same as that operating on tree shrews in ambient red light.

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Efficacy of Repeated Low-Level Red-Light Therapy for Slowing the Progression of Childhood Myopia: A Systematic Review and Meta-analysis

Cited by 32 publications

References 43 publications

Myopia Control: Are We Ready for an Evidence Based Approach?

Myopia Control: Are We Ready for an Evidence Based Approach?

Assessing the rebound phenomenon in different myopia control treatments: A systematic review

The effects of intensity, spectral purity and duty cycle on red light‐induced hyperopia in tree shrews

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