If red light therapy is the current leading approach in myopia management, then Orthokeratology (Ortho-k) was the previous gold standard. Both have received significant attention as key interventions for myopia control. What happens when these two leading approaches are combined?

This past May, the prestigious international ophthalmology journal Ophthalmology published significant research from Professor Mingguang He's team at the School of Optometry, The Hong Kong Polytechnic University—a multi-center randomized controlled trial investigating the combined effect of repeated low-level red-light therapy (RLRL) and Ortho-k on myopia control.

With red light therapy emerging as one of the most effective current methods for slowing myopia progression, and Ortho-k offering the advantage of clear vision without glasses or contact lenses during the day, could the combination provide a synergistic effect greater than the sum of its parts? Let's explore the findings.

Study Design:

Participant Selection: Children with Ortho-k-Resistant Myopia (Axial Length Progression > 0.5mm/year)

This 12-month, multi-center, randomized, parallel-group, single-masked clinical trial enrolled 48 children aged 8 to 13 years with cycloplegic spherical equivalent refractions ranging from -1.00 to -5.00 D at initial Ortho-k fitting and documented axial length (AL) progression of ≥ 0.50 mm per year despite one year of Ortho-k wear.

Importantly, this study specifically included children who had demonstrated inadequate response to Ortho-k monotherapy.

Intervention Groups: RLRL + Ortho-k vs. Ortho-k Alone

Participants were randomly assigned in a 2:1 ratio to either the combined repeated low-level red-light therapy (RLRL) and Ortho-k group or the Ortho-k-only group. The Ortho-k group wore lenses for at least 8 hours per night, while the RLRL + Ortho-k group received RLRL twice daily for 3 minutes in addition to Ortho-k wear.

Primary Outcome Measure: Change in axial length over 12 months.

 

Study Findings:

A total of 47 participants (97.9%) completed the study and were included in the final analysis.

At the 12-month follow-up, the mean change in axial length was -0.02 mm in the RLRL + Ortho-k group compared to 0.27 mm in the Ortho-k-only group, resulting in a statistically significant between-group difference of -0.29 mm (indicating greater axial length control in the combined therapy group).

Conclusions: The addition of RLRL to Ortho-k therapy resulted in a substantial improvement in myopia control, even in children who had previously exhibited poor response to Ortho-k monotherapy.

In essence: RLRL appears to mitigate the challenge of managing “difficult-to-control” myopia.

This study demonstrates that the combination of RLRL and Ortho-k not only effectively slows myopia progression but also provides satisfactory uncorrected visual acuity, reducing the need for daytime spectacle wear.

The efficacy of RLRL may stem from its potential to address the underlying mechanisms of myopia development. Analogous to removing a thorn from a foot, targeting the root cause is often the most effective approach to disease management.

The body of evidence supporting RLRL continues to grow. Recently, a second study on red light therapy from Beijing Tongren Hospital was published in the prestigious international medical journal JAMA Ophthalmology, authored by leading experts in the field, including Jie Ying (Director of Ophthalmology at Tongren Hospital), Zibing Jin (Vice President of Beijing Tongren Hospital), Dongli Ma, Lei Tian, Kai Cao, and Shiqiang Zhao.

This study found that daily application of 650nm low-intensity red light effectively slowed myopia progression and excessive axial length elongation without any observed safety concerns.    

Daily use of red light for one year resulted in a mean difference of 0.37 mm in axial length progression compared to the control group. · Among children without baseline myopia, the 1-year incidence of myopia was 7.1% in the red light group and 23.2% in the control group. · Regarding safety: Fundus examination and optical coherence tomography (OCT) analysis revealed no adverse events or retinal damage. No significant differences were observed between the groups in intraocular pressure, central corneal thickness, anterior chamber depth, and keratometry values (K1 and K2). 《Another Study on Red Light Therapy from Beijing Tongren Hospital Published in JAMA Ophthalmology》

 

Beyond the research conducted at Beijing Tongren Hospital, other ophthalmology centers across China are actively investigating red light therapy, each with specific areas of focus. Tianjin Medical University Eye Hospital has led a study on repeated low-intensity red light therapy in adults, with findings published in the international peer-reviewed journal Journal of Clinical Medicine. This study focused on myopic adults aged 18 to 35 and found that one month of red light therapy resulted in significant shortening of axial length, significant thickening of the choroid, and a significant increase in choroidal blood flow. These findings led to the conclusion that red light therapy can effectively slow and control myopia progression by increasing choroidal thickness and controlling axial length.

《Axial Length Shortening and Choroid Thickening in Myopic Adults Treated with Repeated Low-Level Red Light》