Global insights on repeated low-level red light therapy: interview series

Professor Ohno-Matsui is a professor of ophthalmology in Tokyo and chief of the Advanced Clinical Centre for High Myopia. She first encountered RLRL when she heard founder Professor Mingguang He’s presentation on the first Eyerising study in 2021, and has since launched two trials at Tokyo Medical and Dental University looking into the effects of RLRL in highly myopic children and adults. 

In her interview, she explores the 6-month results of the highly myopic children trial. These patients had extremely high myopia at baseline, with a mean spherical equivalence refraction of -9.65D and axial length of 27mm. Shortening of this axial length by 0.05mm was seen from as early as 1 month in over 50% of patients to 60% of patients at 6 months, with 43% showing even greater axial length shortening of 0.1mm at 6 months. Improvement in spherical equivalent refraction was also seen in 60% of patients. Professor Ohno-Matsui explains this is particularly promising as conventional myopia treatments have shown to be less effective in these highly myopic populations. She also discusses her ongoing adult trial which has completed recruitment, investigating whether RLRL can induce choroidal thickening in highly myopic adults and prevent choroidal atrophy. 

She also addresses her theory on a case report published of a retinal light injury in an RLRL patient that this patient had preclinical Stargardt syndrome as a cause of secondary myopia, and therefore may not have been appropriate for RLRL in the first place. She cites the patient’s high fundus autofluorescence and dark choroid on OCT characteristic of Stargardt syndrome as reasons for her suspicion. 

Dr Karl Schulmeister is a laser safety consultant from Seibersdorf Laboratories, an accredited laser safety test house, in Austria. He was consulted by Eyerising International to review their device according to the IEC 60825:1-2014 standards and provide his expert opinion on the device’s safety profile.

In his interview, he explains the basis of the IEC 60825:1-2014 standard and the testing results of the Eyerising Myopia Management Device, classifying as a Class 3R laser with a power measurement of 1.03mW for a 7mm pupil as per the standard. However, he then explains how despite this Class 3R status, there is negligible risk of retinal injury when using the device as intended. He compares the Eyerising device to known thermal and photochemical hazard thresholds, and cites an experiment of human volunteers looking at a laser of 5 times the power and duration of exposure of the Eyerising device, which demonstrated no retinal damage. Finally, he discusses how although the measurements were completed for a 7mm pupil as per the standard, it is likely in reality that pupils will constrict in response to the bright light of the Eyerising device, with the emission reaching Class 1 levels where the pupil is less than 4.3mm.

Dr. Nellie Deen is an optometrist and General Manager of City Clinics at the Australian College of Optometry (ACO). She first encountered RLRL through a chance meeting with founder Professor Mingguang He in 2021. They then collaborated to set up a randomized controlled trial on the efficacy of RLRL in multi-ethnic children in Australia, mirroring the protocols from the landmark Chinese trial by Jiang et al. 

In her interview, she delves into the three-month and six-month interim analysis of the ongoing ACO study, both of which have shown less myopic progression, mean axial shortening and stabilisation of myopia in children using the device. Of note, these were even better results than the results seen in the Chinese trial.

She also discusses user feedback with RLRL, with most children reporting the device is easy-to-use and maintaining good treatment compliance, and offers some tips on how to optimise treatment compliance for young children. 

Professor Grzybowski is a professor of ophthalmology in Poland with over 20 years of experience in myopia control. After reading the first few studies of RLRL in 2022, he reached out to Eyerising International and collaborated on the European Advisory Board and the European real-world study, both of which he is leading. 

In his interview, he explains the key advantage of compliance monitoring with RLRL to accurately determine patient adherence and correlate this with treatment effect. He also goes through some of the use cases he considers for RLRL treatment, which include the very young, children who are averse to contact lenses or atropine, the highly myopic or as combination therapy.  

He then expands on the European real-world study presently underway, aiming to establish the efficacy of RLRL in Caucasian European children and recruiting 10 children in 7 European countries for a total of 70 children. This is a single-arm prospective study investigating whether the incidence of full myopic control, which they have defined as <0.1mm, is greater than 30% after 12 months of RLRL. This study has begun recruitment in several countries, and is aiming to present interim results next year. 

Professor Mingguang He is Chair Professor of Ophthalmology at Hong Kong Polytechnic University, and the founder and Chief Medical Officer of Eyerising International, where he developed the Eyerising RLRL device. 

In his interview, he outlines the research pipeline of RLRL from its conceptualisation to now, highlighting several pivotal studies that demonstrate RLRL’s efficacy in different scenarios such as in high myopia, pre-myopia, and adjunct therapy with orthokeratology. He also expands on some of the exciting future research in China on RLRL, and offers his opinion on the aforementioned case report of a reversible retinal light injury associated with RLRL.

Furthermore, he provides his recommendations to clinicians considering RLRL on how to identify and monitor their first patient. In particular, he recommends clinicians try RLRL on their difficult-to-treat patients, as RLRL has shown stronger efficacy in higher degrees of myopia or for non-responders.