Red Light Therapy and Ortho-K: Can Children Use Both?

Your child already wears Ortho-K lenses at night.

However, their prescription or axial length may still be changing.

You may then hear about repeated low-level red light therapy, also called RLRL therapy. This can lead to an important question:

Can children use red light therapy and Ortho-K together?

In selected cases, an optometrist may consider both treatments as part of a myopia management plan.

However, combination therapy does not suit every child. It also does not guarantee that myopia progression will stop.

Red light therapy and Ortho-K work in different ways. They also involve different routines, safety considerations and monitoring requirements.

Therefore, parents need a clear assessment before adding another treatment.

What Is Childhood Myopia?

Myopia is also called short-sightedness.

A child with myopia usually sees close objects clearly. However, distant objects appear blurry.

For example, the child may struggle to see:

• The classroom whiteboard
• Road signs
• A sports scoreboard
• A television across the room
• A teacher’s presentation screen
• People standing at a distance

Myopia often involves the eye growing too long from front to back. This is called axial elongation.

As the eye lengthens, light focuses in front of the retina rather than directly on it.

Standard glasses can correct the blur. However, standard single-vision glasses are not designed specifically to slow axial elongation.

Myopia management aims to slow the rate of change. It cannot guarantee that eye growth or prescription changes will stop.

Eye Philosophy explains the condition, warning signs and available management options on its myopia management information page.

What Is Red Light Therapy for Myopia?

Repeated low-level red light therapy uses a clinical device that delivers controlled red light to the eyes.

The treatment is often shortened to RLRL.

A child looks into the prescribed device for short sessions. The exact session length and schedule depend on the device and clinical plan.

Red light therapy does not work like ordinary room lighting. It also differs from red LED face masks, heat lamps and home wellness products.

Parents should never create a homemade treatment using:

• Red torches
• Laser pointers
• Decorative red lights
• Infrared lamps
• Beauty masks
• Phone applications
• Unapproved online devices

A myopia management device should only be used under professional guidance.

Eye Philosophy’s red light therapy service includes a clinical suitability assessment, baseline measurements, treatment guidance and ongoing progress reviews. The clinic notes that red light therapy does not replace glasses or contact lenses when a child still needs vision correction.

How May Red Light Therapy Affect Myopia Progression?

The exact biological mechanism remains under investigation.

Researchers have proposed that repeated low-level red light may affect the retina and choroid. The choroid is the layer of blood vessels beneath the retina.

Studies have observed changes in choroidal thickness and axial length during treatment. However, researchers are still examining what these changes mean over the long term.

A multicentre randomised trial published in Ophthalmology compared RLRL therapy plus single-vision glasses with single-vision glasses alone. The RLRL group showed less average prescription progression and axial elongation over 12 months.

However, one study cannot predict an individual child’s response. Many early RLRL studies also involved children in China. Therefore, practitioners should consider how well each study applies to the child being assessed.

External research: Effect of Repeated Low-Level Red-Light Therapy for Myopia Control in Children

What Is Ortho-K?

Orthokeratology, or Ortho-K, uses custom rigid gas-permeable contact lenses.

The child wears the lenses while sleeping. The lenses temporarily reshape the front surface of the eye, called the cornea.

The child removes them after waking.

A suitable wearer may then experience clearer daytime vision without standard glasses or daytime contact lenses.

The effect is temporary. Therefore, the child needs to continue wearing the lenses according to the prescribed schedule.

Ortho-K can serve two purposes:

1. It temporarily corrects the child’s blurry distance vision.
2. It may help slow myopia progression in suitable children.

However, Ortho-K remains a contact lens treatment. It requires careful cleaning, correct fitting and regular professional reviews.

Parents can review Eye Philosophy’s Orthokeratology service in Melbourne for more information about assessments, corneal mapping, lens fitting and follow-up care.

How Do Red Light Therapy and Ortho-K Differ?

Red light therapy and Ortho-K do not perform the same job.

Because the treatments work differently, an optometrist may consider using them together.

However, more treatment is not automatically better treatment.

Why Might an Optometrist Consider Both Treatments?

An optometrist may consider combination treatment when a child’s myopia appears to be progressing despite appropriate use of one management option.

For example, the practitioner may review:

• Continued axial elongation
• Ongoing prescription changes
• Young age at myopia onset
• A strong family history of high myopia
• A higher starting prescription
• Previous treatment response
• The child’s lifestyle
• Treatment adherence
• Eye health findings
• The family’s ability to manage two routines

Ortho-K may provide clearer daytime vision while also forming part of myopia management.

Red light therapy may add another myopia-management approach without placing a daytime lens on the eye.

Still, the practitioner must explain why the second treatment is being recommended.

Parents should not be told that adding red light therapy will definitely stop progression.

What Does Research Say About Combining Red Light Therapy and Ortho-K?

Research into combined RLRL and Ortho-K treatment is developing.

A 2024 clinical study compared children using Ortho-K alone with children using Ortho-K alongside repeated low-level red light therapy.

The authors concluded that the combination showed promise for improving control of axial elongation. However, the study does not prove that every child will achieve the same result.

In addition, parents should consider:

• The number of children studied
• Their ages and ethnic backgrounds
• Their starting prescriptions
• The treatment device used
• The length of follow-up
• How consistently treatment was used
• Whether the research was masked
• Potential commercial interests
• Whether the findings have been repeated independently

Longer and more diverse studies remain important.

External research: Myopia Control Effect of Repeated Low-Level Red-Light Therapy Combined With Orthokeratology

Does Combination Therapy Work Better Than Ortho-K Alone?

Current research suggests that combination treatment may reduce average axial elongation more than Ortho-K alone in some study groups.

However, “better on average” does not mean “better for every child.”

Some children may respond well to Ortho-K alone.

Others may:

• Continue to show eye growth
• Struggle with lens wear
• Miss treatment sessions
• Experience side effects
• Need another management approach
• Have a prescription or eye condition that affects suitability

A child should not receive two treatments simply because two sounds stronger than one.

The optometrist should identify a clear clinical reason for adding red light therapy.

Can Red Light Therapy Replace Ortho-K?

No. The treatments have different roles.

Red light therapy aims to help manage myopia progression. It does not normally provide the temporary corneal reshaping needed for clear daytime vision.

Therefore, a child using RLRL may still need:

• Standard prescription glasses
• Specialised myopia management glasses
• Soft contact lenses
• Ortho-K lenses
• Another suitable form of vision correction

Likewise, Ortho-K may provide clearer daytime vision. However, the child’s axial length may still need monitoring.

Parents should separate two goals:

1. Correcting blurry vision
2. Managing myopia progression

One treatment may address both goals. Another may mainly address one.

Can Red Light Therapy Replace Glasses?

Red light therapy is not a replacement for prescribed vision correction.

A child may still need glasses to see the classroom board, participate safely in sport or complete daily activities.

Do not stop the child’s glasses because treatment has started.

The optometrist should explain:

• Which correction the child should use
• When they should wear it
• Whether backup glasses are required
• How vision will be checked
• When the prescription should be reviewed

Clear vision remains important even while myopia progression is being managed.

Is Red Light Therapy Safe for Children?

Published trials have generally reported that RLRL was well tolerated during the study periods.

However, safety should not be described as absolute.

A 2024 randomised study evaluated retinal structure, retinal function and contrast sensitivity over 12 months. The researchers concluded that RLRL appeared safe within that period.

However, they also observed changes in some retinal structural measurements. The authors stated that these findings required further observation.

Therefore, longer-term monitoring remains important.

External research: Safety of Repeated Low-Level Red-Light Therapy for Children With Myopia

Possible temporary experiences may include:

• After-images
• Temporary light sensitivity
• Visual brightness after a session
• Mild discomfort
• Difficulty completing the session

The child should report any unusual visual experience.

Parents should contact the treating practitioner if symptoms continue or cause concern.

Are There Children Who May Not Suit Red Light Therapy?

Suitability depends on the device, the child’s eyes and the practitioner’s assessment.

An optometrist may need additional caution when a child has:

• A retinal condition
• Macular disease
• Significant light sensitivity
• A history of seizures triggered by light
• Reduced vision without a clear cause
• An eye condition affecting the visual pathway
• An active eye infection
• Difficulty following the device instructions
• An inability to keep both eyes correctly positioned
• A medical condition that requires further advice
• Medicines that increase light sensitivity

This is not a complete exclusion list.

Parents should provide the child’s full eye, medical and medication history before treatment begins.

The practitioner should also explain whether communication with the child’s GP, ophthalmologist or paediatric specialist is needed.

Are There Children Who May Not Suit Ortho-K?

Ortho-K may not suit a child with:

• An active eye infection
• Significant corneal disease
• Poor lens hygiene
• Certain corneal shapes
• Severe eye-surface problems
• Uncontrolled eye allergies
• Difficulty handling lenses
• An inability to attend reviews
• Strong resistance to lens insertion
• A family routine that cannot support safe overnight care

The child’s prescription also affects suitability.

An assessment does not guarantee that Ortho-K will provide complete daytime correction.

Some children may still need backup glasses for certain tasks.

What Are the Risks of Using Ortho-K?

Ortho-K involves overnight contact lens wear.

Possible complications include:

• Corneal infection
• Corneal inflammation
• Corneal staining
• Eye pain
• Redness
• Discharge
• Lens binding
• Fluctuating vision
• Glare
• Haloes
• Poor lens positioning
• Temporary visual changes

Careful hygiene can reduce avoidable risks. However, it cannot remove every risk.

The child should stop lens wear and contact the clinic promptly if they experience:

• Significant pain
• Increasing redness
• Strong light sensitivity
• Discharge
• A sudden reduction in vision
• A persistent gritty feeling
• A white mark on the cornea
• Difficulty opening the eye

Do not continue Ortho-K simply to preserve clear vision for school the next day.

Does Using Two Treatments Create More Risk?

Combination treatment creates a more complex care plan.

It may involve:

• More appointments
• More measurements
• Two treatment routines
• Additional costs
• More opportunities for missed treatment
• Separate safety checks
• Greater responsibility for the family

The risks of each treatment still need to be considered separately.

For example, adding RLRL does not remove the infection risk linked with Ortho-K.

Likewise, using Ortho-K does not remove the need to monitor possible visual effects from RLRL.

Parents should receive clear instructions for both treatments.

What Should Happen Before Combination Treatment Starts?

The child should receive a detailed assessment.

Depending on clinical need, this may include:

• Distance and near vision
• Cycloplegic or standard refraction
• Axial length measurement
• Corneal topography
• Corneal health assessment
• Retinal examination
• Optical coherence tomography
• Contrast sensitivity testing
• Pupil assessment
• Tear-film assessment
• Eye pressure measurement
• Family history review
• Medication review
• Previous prescription comparison

Not every child requires every test.

The practitioner should explain why each additional measurement is recommended.

A baseline is important because it gives the practitioner something to compare with future results.

Why Is Axial Length Monitoring Important?

Axial length measures the eye from front to back.

Because myopia often progresses as the eye lengthens, repeated measurements can help the optometrist monitor structural change.

The practitioner may compare:

• The baseline axial length
• Measurements after treatment begins
• The glasses prescription
• Corneal topography
• Treatment adherence
• The child’s age
• Expected growth patterns

However, axial length should not become a simple pass-or-fail score.

Small measurement differences can occur.

In addition, short-term axial shortening during RLRL treatment does not necessarily mean that the child’s underlying myopia has permanently reversed.

The optometrist should interpret the full pattern over time.

What Happens if the Eye Appears to Become Shorter?

Some RLRL studies have reported short-term axial shortening.

This finding can sound like myopia has been reversed.

However, parents should interpret it carefully.

Researchers are still examining how much of the measured change may relate to:

• Choroidal thickening
• Structural changes at the back of the eye
• Measurement timing
• Temporary treatment effects
• True changes in eye length

A shorter measurement does not automatically mean that the child has permanently lost their myopia.

The child may still need glasses or contact lenses.

What Is the Rebound Effect?

A rebound effect means that myopia progression may increase after a treatment stops.

Some RLRL research has observed increased progression after treatment withdrawal.

This does not mean that every child will experience rebound. However, it means treatment should not be stopped without a clinical plan.

The optometrist may consider:

• Why treatment is stopping
• The child’s current age
• Recent axial length changes
• Current prescription
• Whether another treatment will continue
• How frequently the child should be reviewed

Parents should not stop red light therapy because the prescription appears stable at one appointment.

Likewise, they should not extend treatment indefinitely without professional review.

How Often Is Red Light Therapy Used?

Treatment schedules depend on the prescribed device.

Some protocols use short sessions twice daily on several days each week.

However, parents should follow only the schedule provided for their child.

Do not:

• Add extra sessions
• Increase the light intensity
• Extend each session
• Repeat a missed session without advice
• Allow siblings to share the device
• Use the device without practitioner oversight
• Combine the device with another red light product

More exposure does not guarantee a better outcome.

Correct exposure and clinical monitoring matter more.

What Might a Combined Daily Routine Look Like?

The exact routine depends on the clinical plan.

A general example may look like this:

Morning

1. The child removes the Ortho-K lenses.
2. The lenses are cleaned and disinfected.
3. The parent checks both eyes for redness or discomfort.
4. The child completes a prescribed RLRL session if scheduled.
5. The parent records any symptoms.

During the Day

1. The child uses their prescribed backup correction when needed.
2. The child reports unusual blur or light sensitivity.
3. The parent encourages outdoor time and regular close-work breaks.

Evening

1. The child completes the second prescribed RLRL session if required.
2. The family leaves the required interval between sessions.
3. The child washes and dries their hands.
4. The child inserts the clean Ortho-K lenses.
5. A parent supervises the routine when appropriate.

This example does not replace the clinic’s instructions.

What if a Child Misses a Red Light Session?

Do not automatically double the next session.

Follow the device instructions and contact the treating clinic when necessary.

One missed session does not mean that the treatment has failed.

However, frequent missed sessions may reduce treatment consistency.

Parents should discuss practical barriers, such as:

• School mornings
• Sport schedules
• Shared parenting arrangements
• Travel
• Homework
• Device access
• The child’s willingness
• Forgetfulness

A treatment can only be useful when the family can follow it safely and consistently.

What if a Child Misses a Night of Ortho-K?

Daytime vision may become less clear after a missed night.

The effect varies between wearers.

The child should use backup glasses if needed.

Do not wear Ortho-K lenses for extra daytime hours to make up for a missed night.

Also, do not continue wearing a lens when the eye is painful, red or irritated.

Contact the clinic when visual changes are unexpected.

How Will the Optometrist Know Whether Combination Treatment Is Helping?

The practitioner should not rely on one result.

Instead, they may review:

• Changes in axial length
• Changes in prescription
• Unaided daytime vision
• Corneal topography
• Retinal health
• Treatment adherence
• Device session records
• Ortho-K lens condition
• Ortho-K lens fit
• Comfort
• Side effects
• The child’s daily visual needs

The optometrist may then recommend:

• Continuing both treatments
• Adjusting the Ortho-K lenses
• Reviewing the RLRL schedule
• Continuing only one option
• Changing to another treatment
• Seeking ophthalmology advice
• Increasing or reducing review frequency

The decision should reflect the child’s overall safety and clinical response.

When Might the Treatment Plan Need to Change?

The plan may need review when:

• Axial elongation continues
• The prescription changes quickly
• The child cannot follow the routine
• Side effects occur
• The Ortho-K lens fit changes
• Daytime vision becomes unstable
• The child develops an eye condition
• Family circumstances change
• Costs become difficult to manage
• The child no longer accepts the treatment
• New evidence affects clinical recommendations

Changing treatment does not always mean the first option failed.

Children grow. Their eyes, routines and preferences also change.

Questions Parents Should Ask

Before agreeing to combination treatment, ask:

• Why are you recommending both treatments?
• What has changed in my child’s prescription?
• Has the axial length continued to increase?
• Could we continue with one treatment first?
• What evidence supports the combination?
• How closely does the research match my child?
• What are the known risks?
• What remains uncertain?
• What symptoms should we report?
• Which baseline tests are required?
• How often will reviews occur?
• How will treatment response be measured?
• What happens if my child misses a session?
• What happens if we stop treatment?
• Could a rebound effect occur?
• Will my child still need glasses?
• What are the initial and ongoing costs?
• Is the device included in the Australian Register of Therapeutic Goods?
• Who should we contact if a problem occurs?

The practitioner should explain the answers in clear language.

Parents should also receive enough time to consider the treatment.

Red Light Therapy and Ortho-K in Williamstown and Doncaster

Eye Philosophy Optometrists offers myopia assessments, red light therapy guidance and Ortho-K consultations at two Melbourne clinics.

Williamstown Clinic

28 Douglas Parade
Williamstown VIC 3016
Phone: (03) 9397 5895

Doncaster Clinic

700 Doncaster Road
Doncaster VIC 3108
Phone: (03) 9042 0977

Eye Philosophy states that its red light therapy program may include a suitability assessment, baseline prescription and eye-length measurements, device guidance and ongoing progress monitoring. Service availability, treatment costs and clinic hours should be confirmed directly when booking.

Final Thoughts on Red Light Therapy and Ortho-K

Red light therapy and Ortho-K use different approaches to childhood myopia management.

Ortho-K temporarily reshapes the cornea. It may provide clearer daytime vision while also helping slow myopia progression.

Red light therapy uses controlled light exposure. It aims to influence the structural changes linked with myopia progression.

Emerging research suggests that combining the treatments may help some children more than Ortho-K alone.

However, important questions remain.

Longer-term safety, treatment withdrawal, rebound effects and results across diverse populations still require careful study.

Therefore, combination therapy should not become an automatic next step.

The optometrist should first assess why the child’s myopia is changing. They should then explain the evidence, possible risks, monitoring plan and realistic expectations.

Most importantly, no combination can guarantee that myopia or axial elongation will stop.

The next article explains red light therapy in more detail. These topics are connected because this article focuses on combining RLRL with Ortho-K, while the related article introduces the general purpose, process and evidence behind RLRL treatment.

Read our next blog about “Red Light Therapy for Childhood Myopia: A Modern Way to Slow Short-Sightedness” here: Read the related Eye Philosophy blog.

Book your appointment here: https://eyephilosophy.com.au/contact-us/