What is repeated low-level red light (RLRL) therapy? Parents’ guide

• Repeated low-level red light therapy is a new treatment that has shown strong results for controlling myopia progression in children, while being safe and well-tolerated.
• It is easy to use and non-invasive, as treatment is performed at home in short, supervised sessions.
• After starting red light therapy, ongoing follow-up appointments with an eye care professional are important to ensure the treatment remains safe and effective.

Repeated low-level red light (RLRL) therapy is one of the latest treatments for myopia control in children.

When myopia (near-sightedness) develops and progresses, the eyeball grows too quickly and too long, compared to what is normal. The length of the eye affects how objects are seen and focused – longer eyes cause objects in the distance to appear blurry. RLRL therapy emits low-level red light to stimulate blood flow at the back of the eye to help regulate this excessive eye growth. 

The Eyerising Myopia Management Device is a home-use medical device that delivers RLRL therapy to slow the progression of myopia in children aged 3–16 years old. 

It has been registered as a TGA Class IIa medical device in Australia, has been CE marked for use in Europe and is also approved in other countries such as the UK (MHRA), New Zealand (MedSafe) and some Asian countries including China and Japan.

Outdoor time has long been recognized as a protective strategy against myopia, as increased outdoor time can reduce the risk of developing myopia.1,2 While the underlying trigger for this effect is still being explored, research has suggested that exposure to bright light could play a role.3

RLRL therapy harnesses red light to act as a time-effective alternative to spending more time outdoors. In China, red light therapy has been used for decades as an alternative treatment for amblyopia (lazy eye), but has since attracted significant interest as a new approach to controlling myopia progression.4

Using a specialized device, low-level red light from the visible spectrum (not ultraviolet or infrared light) is transmitted to the eye to increase blood flow at the back of the eye (retina and choroid). Better blood flow improves the oxygen supply and metabolism in the choroid and retina. 

These effects help the eye become less susceptible to uncontrolled growth, thereby controlling the progression or worsening of myopia. 

Aside from its innovative approach, RLRL therapy gained attention for its strong results in slowing myopia progression – at least comparable to other currently available treatments.

Three key studies have demonstrated great success in reducing the risk of myopia and the rate of progression in children. Two of the studies were a 1-year and 2-year clinical trial involving children with myopia aged 8–13 years and 7–12 years, respectively.5,6 The third study was conducted to assess whether RLRL therapy could reduce or delay myopia in children who were at a higher risk for developing myopia, but still had normal vision (called pre-myopia).7

The key findings from this research were that RLRL therapy:

• Reduced myopia progression (change in glasses power) by 66% over 1 year and 75% over 2 years5,6
• Slowed eye growth by 75% over 1 and 2 years5,6
• Reduced the risk of developing myopia, in children with normal vision, over 1 year by up to 54%7

RLRL can be used either on its own or in combination with other myopia control treatments, to potentially boost the effects of treatment.8 For example, it can be used together with specially designed glasses (e.g. MiYOSMART), soft contact lenses (e.g. MiSight 1 day), and orthokeratology lenses. 

However, RLRL should not be used with atropine eye drops as their combined effects have not yet been studied, and this combination is not recommended by manufacturers.

While treatment involves direct light exposure to the eye, lasers are commonly used to treat various eye conditions, such as retinal health problems due to diabetes (diabetic retinopathy). Compared to surgical lasers, the red light used in red light therapy is lower in intensity, so it is often referred to as ‘low-level’ laser.9 

The Eyerising International Myopia Management Device emits a wavelength of 650 ± 10 nm at a laser power of 0.29mW, and the device complies with the IEC 60825-1:2014 international standard for laser products safety. The series of studies on RLRL therapy in children with myopia reported no severe adverse events, vision loss, or damage to the eye, suggesting a strong safety profile. 

According to data from Eyerising International, around 70,000 to 80,000 children use the device every day in China. Among these users, only 5 side effect events have been recorded through the company’s reporting centre – a very low rate of about 0.0067%10 

The most common side effect is a temporary afterimage, where the child can still see the red light after a treatment session. This is similar to still seeing a camera flash in your vision after having a photograph taken, and usually fades within a few minutes. 

Your optometrist or eye doctor will conduct a baseline assessment including scans to record vision, prescription, eye length, and overall eye health. These provide a reference for future comparison.

RLRL therapy is performed at home using a prescribed device. During treatment, the child looks into the device’s viewing window while it emits low-level red light. Your child still needs to wear glasses or contact lenses for clear, corrected vision during the day.

Each session involves 3 minutes of treatment, completed twice a day, 5 days per week, with at least 4 hours between sessions. 

While the device can be used at any time during the day, on any day of the week, it is recommended to use the device from Monday to Friday to make it easier to form a habit. Using the device consistently and correctly helps achieve optimal treatment results.

The device is operated through a secure login and allows a maximum of 2 sessions per day and up to 10 sessions per week. It tracks each child’s use of the device – which can be monitored by parents and also accessed by the optometrist or eye doctor.

Regular follow-up appointments are important to ensure the therapy remains safe and effective. Children who have started RLRL therapy are recommended to have their vision and eye health monitored after 1, 3, and 6 months – and every 6 months thereafter.10 

Based on the current studies, a general guideline is a minimum period of 2 years of treatment.6

Because the goal of myopia management is to slow or stabilize myopia, some children may need to be treated for a longer time than others before they reach stability. These may depend on circumstances like the child’s age, current glasses prescription, and eye length (axial length). 

Your eye care professional will advise you whether your child needs ongoing treatment.

For the best safety and treatment outcomes, some individuals may be ideal candidates for RLRL, while others may require more caution or an alternative approach.

RLRL therapy may be ideal for:

• Children 7 to 16 years age, where the eyes are still developing
• Rapid myopia progression or eye growth (axial length growth)
• Poorly controlled myopia progression with other myopia control treatments
• Allergies or sensitivities to eye drops for myopia control (e.g. atropine) or contact lens solutions

RLRL therapy may not be suitable for people with:

• Pre-existing eye conditions – particularly retinal or macular conditions, glaucoma, or cataracts
• Colour vision defects
• Very young children who may not fully understand the usual after-effects of treatment

RLRL therapy has emerged as a new treatment for myopia control, alongside other treatments such as glasses, contact lenses, and eye drops. 

While there are numerous RLRL devices being marketed, particularly in China, only the Eyerising Myopia Management Device has over 40 clinical studies so far and a growing body of research supporting its use as a safe and effective treatment option for slowing myopia.

If you are considering RLRL therapy for your child, make sure to check with your child’s optometrist or eye doctor that it’s a device backed by evidence. The Eyerising Myopia Management Device is only available through eye care professionals (optometrists and ophthalmologists), and is currently accessible in parts of Europe, Asia, and Oceania.