Non-invasive low-level red-light therapy for axial length control in pediatric extreme myopia.

Extreme myopia presents a notable clinical challenge in management, with existing approaches having limitations. Repeated low-level red-light therapy (RLRL) has shown potential for myopia control. This multi-center prospective study included 59 children (101 eyes, aged 3-16.3 years) with extreme (SER ≤ -10D) or high myopia (-6D to -9.75D), who underwent twice-daily RLRL for 12 months 55 children (94 eyes) completed the follow-up. After treatment, significant improvements were observed: spherical equivalent error increased by 0.549D (95% confidence interval [CI]: 0.430 to 0.668, p < 0.001), axial length shortened by 0.056 mm (95% CI: -0.087 to -0.025, p = 0.001), best-corrected visual acuity improved by 0.110 LogMAR, and choroidal thickness increased by 34.84 μm, with no adverse events. Subgroup analysis found comparable efficacy between the extreme and high myopia groups. These results indicate RLRL is a safe, non-invasive option for managing extreme myopia in children, with meaningful clinical value.