Comparison of repeated low-level red-light therapy with single-vision spectacles, DIMS lenses, and orthokeratology for myopia control in children: a one-year retrospective cohort study

Background To evaluate the 1-year efficacy of repeated low-level red-light (RLRL) therapy for myopia control in children and compare it with single-vision spectacles (SVS), defocus incorporated multiple segments (DIMS) spectacles, and orthokeratology (OK) in a real-world setting. Methods This retrospective study included 527 children (6–12 years) with mild to moderate myopia who received SVS (n = 139), DIMS (n = 121), RLRL (n = 122), or OK (n = 145) for at least one year. Changes in axial length (ΔAL) and spherical equivalent refraction (ΔSER) were assessed. Analysis of covariance (ANCOVA) adjusted for baseline values, with Bonferroni-corrected pairwise comparisons. Results Baseline AL differed significantly among groups (p < 0.001) and was adjusted for in analyses. RLRL resulted in the smallest adjusted ΔAL (0.10 mm, 95% CI 0.046–0.144) versus SVS (0.38 mm), DIMS (0.32 mm), and OK (0.25 mm) (all p < 0.001). For ΔSER (OK excluded), RLRL also showed least progression (–0.17 D, 95% CI − 0.263 to − 0.072) compared with SVS (–0.85 D) and DIMS (–0.57 D) (both p < 0.001). Subgroup analyses revealed consistent benefits across age, gender, and baseline myopia, with RLRL efficacy comparable to DIMS and OK in males and those with moderate myopia. No severe adverse events were reported. Conclusions RLRL therapy demonstrated superior 1-year efficacy in controlling myopia progression compared to SVS, DIMS, and OK, particularly in females and younger children. While short-term safety was reassuring, long-term retinal health monitoring remains warranted.