Non-Pharmacological and Non-Optical Interventions for Myopia Prevention and Control in Children: A Systematic Review...

Myopia is projected to affect 50% of the global population by 2050. Its progression increases the risk of severe ocular pathologies, making it imperative to validate safe and effective non-pharmacological prevention interventions.

To evaluate the clinical efficacy of low-level red-light therapy (RLRL) and nutritional supplementation in preventing and controlling myopia progression in children and adolescents.

This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO (CRD420261301596). Randomized clinical trials in pediatric populations (aged 0-18 years) were included. The primary quantitative outcome measures for myopia were axial length (AL) and spherical equivalent (SE). Risk of bias (RoB 2) and heterogeneity (I²) were assessed.

18 articles were included (n = 2438). RLRL demonstrated a significant reduction in axial elongation (mean difference (MD): -0.26 mm; 95% CI: -0.34 to -0.18) and a protective effect on refractive progression (MD: +0.60 D; 95% CI: 0.42 to 0.78), although with high heterogeneity (I² > 97%). Nutritional supplementation exhibited a modest, non-significant effect on axial length (-0.22 mm; 95% CI: -0.44 to 0.00), acting primarily as functional support.

RLRL slows ocular elongation and myopia progression. Recent studies provide reassuring evidence regarding its long-term safety when recommended treatment protocols are followed. However, the high heterogeneity among studies, the need for standardized treatment discontinuation strategies, and the limited long-term evidence in geographically and ethnically diverse pediatric populations warrant further investigation. Current evidence is insufficient to demonstrate a consistent clinically meaningful effect of nutritional supplementation on axial elongation.