Optical and Light-Based Interventions for Myopia Control: Orthokeratology, MiSightTM, and Red-light Therapy

Myopia is an escalating global public health issue. The earlier onset and increasing prevalence of high myopia heighten the lifetime risk of vision-threatening complications, making the control of childhood axial elongation a central objective of contemporary myopia management. This narrative review summarizes the mechanistic rationale, clinical efficacy, safety considerations, and practical implementation of three non-pharmacologic modalities: orthokeratology (Ortho-K), dual-focus/multifocal soft contact lenses (specifically MiSight 1 day), and repeated low-level red-light (RLRL) therapy. The review emphasizes evidence-based effect sizes and monitoring needs. Evidence from randomized trials, meta-analyses, guideline perspectives, and mechanism-oriented studies was synthesized, prioritizing axial length outcomes, with spherical equivalent refraction considered as a complementary endpoint where appropriate. Key randomized trials and meta-analyses indicate that Ortho-K reduces axial elongation compared to single-vision controls by approximately 0.19 mm at one year and 0.28 mm at two years. In contrast, MiSight 1 day demonstrates a sustained effect, showing roughly 0.32 mm less axial elongation over three years. While RLRL has exhibited large short-term effects in recent trials, the certainty of the evidence remains low, and long-term retinal safety and generalizability have yet to be fully established. Overall, Ortho-K and MiSight represent established optical options with consistent efficacy and defined safety profiles, whereas RLRL is a high-interest modality with promising signals but greater uncertainty regarding long-term retinal safety and durability. Clinicians should adopt a monitoring-forward approach centered on longitudinal axial length tracking, given the substantial inter-individual variability in progression rate and response.