Abstract / Summary
Background/Objectives: Repeated low-level red-light (RLRL) therapy has recently emerged as a promising treatment for childhood myopia. Choroidal thickening has been proposed as a key biological mechanism underlying its therapeutic efficacy; however, evidence regarding its effects on subfoveal choroidal thickness (SFCT), particularly in children with premyopia, remains limited. This systematic review and meta-analysis aimed to comprehensively evaluate the effects of RLRL therapy on SFCT in pediatric patients with myopia and premyopia. Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were systematically searched from database inception through 29 September 2026. Randomized controlled trials comparing RLRL therapy with controls in participants younger than 18 years were included. The primary outcome was the change in SFCT at 1, 3, 6, 9, and 12 months. Mean differences (MDs) with 95% confidence intervals (CIs) were pooled using random-effects models. Prespecified subgroup analyses were conducted according to refractive status. Results: Thirteen randomized controlled trials comprising 1974 children were included. In children with myopia, RLRL therapy was associated with significantly greater increases in SFCT than the control across all follow-up time points, with the greatest mean difference observed at 9 months (MD = 37.01 μm, 95% CI, 30.48–43.54). In children with premyopia, RLRL therapy also induced significant SFCT thickening from 1 to 9 months. Sensitivity analyses confirmed the robustness of the findings, and no evidence of significant publication bias was identified. Conclusions: These findings demonstrate consistent choroidal thickening following RLRL therapy in children with myopia and premyopia and support further investigation into the potential role of choroidal changes in myopia control.