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Purpose To compare the treatment efficacy between repeated low-level red light (RLRL) therapy and 0.01% atropine eye drops for myopia control. Methods A single-masked, single-center, randomized controlled trial was conducted on children 7 to 15 years old with cycloplegic spherical equivalent refraction (SER) ≤ −1.00 diopter (D) and astigmatism ≤ 2.50 D. Participants were randomly assigned to the RLRL group or low-dose atropine (LDA, 0.01% atropine eye drops) group and were followed up at 1, 3, 6, and 12 months. RLRL treatment was provided by a desktop light therapy device that emits 650-nm red light. The primary outcome was the change in axial length (AL), and the secondary outcome was the change in SER. Results Among 62 eligible children equally randomized to each group (31 in the RLRL group, 31 in the LDA group), 60 children were qualified for analysis. The mean 1-year change in AL was 0.08 mm (95% confidence interval [CI], 0.03–0.14) in the RLRL group and 0.33 mm (95% CI, 0.27–0.38) in the LDA group, with a mean difference (MD) of −0.24 mm (95% CI, −0.32 to −0.17; P < 0.001). The 1-year change in SER was −0.03 D (95% CI, −0.01 to −0.08) in the RLRL group and −0.60 D (95% CI, −0.7 to −0.48) in the LDA group (MD = 0.57 D; 95% CI, 0.40–0.73; P < 0.001). The progression of AL < 0.1 mm was 53.2% and 9.7% ( P < 0.001) in the RLRL and LDA groups, respectively. For AL ≥ 0.36 mm, progression was 9.7% and 50.0% ( P < 0.001) in the RLRL and LDA groups, respectively. Conclusions In this study, RLRL was more effective for controlling AL and myopia progression over 12 months of use compared with 0.01% atropine eye drops. Translational Relevance RLRL therapy significantly slows axial elongation and myopia progression compared with 0.01% atropine; thus, it is an effective alternative treatment for myopia control in children.

Introduction: Axial length (AL) elongation in myopia is considered irreversible. We aimed to systemically report unexpected AL shortening observed in a randomized clinical trial (RCT) after repeated low-level red-light (RLRL) therapy.Methods: This is a post hoc analysis of a multicenter, single-masked RCT. Two hundred sixtyfour myopic children aged 8-13 years allocated to RLRL treatment (intervention group) or a single vision spectacle (SVS, control group) were included. AL was measured using an IOL-master 500 at baseline, 1-, 3-, 6-, and 12-month followup visits. AL shortening was defined as AL reduction from baseline to follow-up visits at three cutoffs: [ 0.05 mm, [ 0.10 mm, and [ 0.20 mm. Frequency of AL shortening at different cutoffs was calculated. Analysis was done with intent to treat (ITT). Results: At 12-months follow up, frequency of AL shortening [ 0.05 mm was 26/119 (21.85%)