Photobiomodulation therapy for children’s eye and vision conditions

Photobiomodulation therapy for children’s eye and vision conditions | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Photobiomodulation therapy for children’s eye and vision conditions Annegret Dahlmann-Noor, Alicia Alicia Fothergill, Charles Hennings, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7903395/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background: Photobiomodulation (PBM) is a non-invasive, light-based technology that stimulates cellular mechanisms, with therapeutic effect on a variety of medical conditions. Wavelengths of light are absorbed by intracellular photoreceptors, resulting in the activation of signalling pathways that culminate in biological changes within the cell. PBM treatment has been reported for a range of eye/vision conditions, mostly in adults. Objectives: We carried out a scoping review of the published literature and collated reported uses of PBM for eye/vision/lid/orbital conditions in children and young people. Eligibility criteria: We developed a comprehensive Ovid Medline, Ovid Embase and Cochrane Library search strategy. We included primary research articles written in English reporting an age range from 0-18 years. Ocular, vision, lid, or orbital conditions treated with PBMT, low light therapy, or intense pulsed light therapy (400–1100 nm spectral range). Case reports, meta-analyses, systematic reviews, and studies using photodynamic therapy, cross-linking, or optogenetics were excluded. Sources of evidence: We used Covidence Systematic Review Software for de-duplication and screening of titles and abstracts, using a pre-specified screening tool. Charting methods: We developed and used a data extraction tool in Covidence. Two reviewers independently extracted data and discussed and resolved disagreements. Results: Of 5,081 identified studies, 47 were included. The majority focused on myopia control, reporting reductions in axial elongation, some noted rebound effects upon cessation. Amblyopia, retinopathy of prematurity, meibomian gland dysfunction, chalazion, concussion, and visual fatigue were also investigated. Most studies were randomized controlled trials, with China as the predominant investigating region. PBMT demonstrated potential benefits across various conditions with a favourable safety profile. Discussion: PBMT may have a role in the management of childhood eye conditions, particularly myopia and blepharitis. It appears generally safe, with transient adverse effects such as mild photophobia and dry eye. Conclusions: Further research is needed to optimize protocols and assess sustained efficacy and safety for widespread clinical adoption. Health sciences/Health care/Paediatrics Health sciences/Diseases/Eye diseases/Vision disorders Figures Figure 1 Figure 2 Figure 3 Introduction Background Photobiomodulation (PBM) therapy is a form of light therapy that utilizes non-ionizing forms of light sources, including lasers, LEDs, and broadband light, in the visible and infrared spectrum[ 1 ] [ 2 ] PBM therapy, formerly known as low-level light therapy (LLLT), or, before the use of LED, as Low-level-laser therapy, generally uses light with red and near-infrared wavelengths (600–1000nm) to modulate a wide range of biological processes, such as neural stimulation, downregulation of inflammation and promotion of wound healing and tissue regeneration [ 1 ]. The Medical Subject Headings (MeSH) descriptor defines LLLT as “Treatment using irradiation with light of low power intensity so that the effects are a response to the light and not due to heat. A variety of light sources, especially low-power lasers are used”[ 3 ] [ 4 ], highlighting its non-thermal mechanism of action and contrasting it with the use of laser for photo-ablation or -coagulation. PBM is listed as alternative entry term [ 3 ]. In PBM, light targets endogenous chromophores to trigger photophysical and photochemical events [ 1 ] [ 2 ]. Targeted chromophores include cytochrome c oxidase and photoactive porphyrins. In mitochondria, long-wavelength light induces increased ATP production, modulation of reactive oxygen species and induction of transcription factors [ 2 ]. Depending on cell type, this then activates cell proliferation and/or migration (fibroblasts), modulation of cytokines, growth factors and inflammatory mediators (immune cells), and increased tissue oxygenation [ 2 ]. FIGURE 1: Summarised photophysical and photochemical events from photobiomodulation and various light wavelengths In eye and vision conditions, PBM may be best known for its use in age-related macular degeneration [ 5 ] and blepharitis [ 6 ]. Less well known may be its use in acute traumatic brain injury [ 7 ]. In children’s eye conditions, low-level laser treatment has been reported to slow progression of myopia [ 8 ]. Rationale There is currently a gap of knowledge about using PBM in eye/vision conditions in children and young people which might be amenable to PMB therapy, such as blepharokeratoconjunctivitis (BKC), atopic lid dermatitis and keratoconjunctivitis (AKC), abusive head trauma (AHT), and potentially others. Objectives This scoping review aims to collate available information on indications for and use of PBM in children and young people with eye, vision and lid/orbital conditions. We will formulate and execute a comprehensive search of relevant databases, extracting information on PBM to treat relevant conditions in the appropriate age range, and detailing treatment protocols and reported outcomes. Methods Protocol and registration We followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols/Extension for Scoping reviews (PRISMA-ScR) [ 9 ]. The protocol was registered on the Open Science Framework [ 10 ]. Eligibility criteria Participants We r eported studies that included children and young people from birth to 18 years of age, male and female, any ethnic and socioeconomic group, with eye, vision, adnexal or orbital conditions. Concept We included papers reporting therapeutic use of light of specified wavelength in a spectral range of 400–1100 nm, pulsed, continuous, single or multi-wavelength. We reported outcomes relevant to the target conditions as specified in the publication. Context We included peer-reviewed journal articles published until the last day of the search, written in English. Types of studies We included primary research articles with any study design other than single-case report and secondary data analyses. Exclusion criteria We excluded articles in other languages that did not include an English translation within the publication, animal and cell/tissue studies. We also excluded meta-analyses, systematic and scoping reviews, commentaries, editorials and grey literature. We excluded forms of low dose light that require exogenous chromophores or engineered light-activated chemical switches, such as photodynamic therapy, corneal cross-linking and optogenetics. Setting We included studies where PBM was conducted and administered in any setting, including hospitals, clinical trials units, community clinics and at participants’ homes. Information sources A search strategist (DB) carried out searches on Ovid Medline (1946-), Ovid Embase (1947-) and Cochrane Library. Search We used Medical Subject Headings (MeSH) and free text terms with all relevant synonyms to develop the search strategies. We also used Boolean operators “OR”, “AND” to combine search lines and apply age limits to retrieved studies on children up to age of 18 years. Selection of sources of evidence The search strategist (DB) exported the results to Covidence Systematic Review Software (Veritas Health Innovation, Melbourne, Australia) for de-duplication and screening. To ensure consistency among reviewers during title and abstract screening, we developed an abstract screening tool. For piloting, two reviewers, CH and AF independently screened the same selection of 20 titles and abstracts from the search, discussed the results and amended the abstract screening tool. CH and AF then screened all titles and abstracts, discussed and resolved disagreements within Covidence, with reviewer A-DN as mediator when required. We included publications for full-text review where the abstract review indicated “unsure”. Two reviewers, CH and AF, then independently scrutinised the full texts for inclusion using a custom-designed inclusion/exclusion criteria list within Covidence. We discussed and resolved disagreements, with A-DN as mediator. Data charting process We developed a data extraction tool within Covidence. Two reviewers independently extracted data, then discussed to resolved disagreements. Data items We extracted publication-identifying information (first author and author contact details, year, title, country), study aims, design, start/end date, funding sources, conflicts of interest, target population, inclusion/exclusion criteria, recruitment methods, number of participants and duration of study participation, population demographics (mean age, gender, diagnosis), intervention(s), parameters studied, technology used, summary statistics of intervention parameters outcomes at baseline and follow-up timepoints. Critical appraisal of individual sources of evidence (if applicable) In line with guidance for scoping reviews [ 9 ], we did not carry out a critical appraisal of individual sources. Synthesis of results We tabulated the characteristics of included studies (number, geographic distribution, populations, study designs). We then analysed the content and summarised the findings of included studies according to interventions (if any) and outcomes. We did not carry out a quality assessment of included studies, because the objective of this scoping review is to provide a map and overview of the research conducted to date. Results Selection of sources of evidence A total of 45 studies met the inclusion criteria and were included in the final synthesis from a total of 5025 following literature search. Figure 2: Prisma Scoping Review Flow diagram. Geographical and Temporal Distribution The majority of studies (34/45) were conducted in China, with smaller contributions from the USA (n = 2), Australia (n = 3) and individual studies from Italy, Japan, Germany, Taiwan and Turkey. Studies were published or conducted between 2012 and 2024, with increasing output in recent years. Six studies were conducted in 2021, and five in each of 2022 and 2023. Figure 3: Map showing the geographic distribution of photobiomodulation studies. Photobiomodulation Devices Used PBM was delivered using a range of commercially available and custom-built devices. The most commonly reported device was the Eyerising® red-light therapy system developed by Suzhou Xuanjia Optoelectronics Technology, which appeared under several naming variations across studies. This device was used most for myopia studies. Other devices used across other conditions included: Experimental head-mounted and desktop PBM units Devices from manufacturers such as Londa Optics, Lutronic, and Quantum Devices Many studies lacked sufficient technical detail to confirm equivalence between models. Two out of three amblyopia studies used laser acupuncture equipment with acupuncture sites focussed on the auricular nodes. Summary of Intervention Protocols Wavelength: Most studies used 650 ± 10 nm red light. Other wavelengths included 633 nm, 635 nm, and a few using broader or dual-spectrum bands. One study explored the use of violet light of 360-400nm for myopia control treatment. Type of Light: Delivery was predominantly continuous wave (n = 39), with fewer studies using pulsed light or intense pulsed light. The use of pulsed light was limited to studies exploring amblyopia and lid margin disease treatments. Exposure Duration: The most common exposure time was 3 minutes per session (n = 28), delivered as single or multiple daily sessions. 44 studies directed the light towards the visual system via the eye, however one study explored PBM for concussion used transcranial light delivery. Frequency: PBM was typically administered twice daily, spaced ≥ 4 hours apart, over 5–7 days per week. Some studies used once-daily or once-weekly applications or. Outcomes and Evidence Synthesis To facilitate meaningful synthesis, outcomes were grouped according to the primary eye/vision condition under investigation. We categorised studies by condition, such as myopia, amblyopia, retinopathy of prematurity (ROP), lid margin disease. This categorisation allowed for condition-specific analysis of intervention protocols, outcome measures, and reported effects. Myopia Thirty-three studies reported outcomes related to myopia control. The most frequently assessed primary outcome was axial length, typically measured using optical biometry. This was reported in various formats, including absolute change in axial length (in millimetres) from baseline, and as proportion of participants demonstrating initial axial shortening, such as reductions exceeding 0.05 mm [ 11 – 44 ]. Secondary outcomes commonly included spherical equivalent refraction (SER), choroidal thickness (measured via OCT), and clinical measures such as visual acuity, treatment compliance, and adverse events. Across included studies, most reported a reduction in axial elongation in the eyes of children treated with PBM compared to controls. Several studies also described a proportion of participants experiencing initial absolute axial shortening, particularly among those with high adherence to the treatment protocol. SER outcomes often indicated slower myopic progression in the intervention groups, although the statistical significance of these findings varied. Mechanistic outcomes—such as increased choroidal thickness or changes in retinal perfusion—were less consistently reported, but generally supported a response to PBM [ 11 – 44 ]. Importantly, the safety profile of PBM appeared favourable, with most adverse events described as mild and transient, including symptoms such as flash, glare and temporary afterimages. Detailed outcome data—including device specifications, statistical results (means, standard deviations, confidence intervals, and p-values), and reported direction of effect—are summarised in Supplementary Table 1. Amblyopia Three studies explored the role of PBM in the management of amblyopia, each reporting distinct primary outcomes. These included change in best-corrected visual acuity (BCVA) and/or refractive error in ametropic amblyopia. Improvements were observed across all studies in the PBM intervention groups, while control groups generally showed little or no change [ 45 – 47 ]. Secondary outcomes reported in the other two studies included amplitude of accommodation and multifocal visual evoked potentials (M-VEP). One study demonstrated an increase in M-VEP amplitudes (mean increase of 1207 nV, p < 0.001)[ 45 – 47 ]. Overall, outcomes were classified under efficacy, with no reports of adverse events or safety concerns in this subgroup. Lid Margin Disease Five studies investigated the application of PBM, predominantly using intense pulsed light (IPL), for the treatment of lid margin disease, particularly meibomian gland dysfunction (MGD) and chalazion. Across these studies, both subjective symptom improvement and objective ocular surface changes were reported [ 39 , 48 – 51 ]. PBM was delivered using a variety of IPL systems, including the SOLARI IPL system (Lutronic Corporation, Korea), E > Eye (ESwin, Paris, France), and the Eye-light® treatment mask. Devices typically emitted pulsed, polychromatic light with wavelengths ranging from 500 to 1200 nm, often filtered through 570–580 nm cut-off filters. Reported energy densities ranged from 8 to 13 J/cm². Treatment regimens varied. Most protocols involved multiple IPL sessions (ranging from 1 to 10), spaced every 2–4 weeks. Exposures consisted of 4–5 light pulses per eye, delivered along the lower eyelid, with session durations ranging from brief targeted flashes to 15-minute mask-based treatments. Several studies incorporated concurrent interventions. These included topical antibiotics or steroid-antibiotic drops, warm compresses, eyelid hygiene, and meibomian gland expression (MGX). For instance, one study explicitly combined tobramycin eye drops with IPL [ 48 ], while another used LLLT alongside antibiotics [ 50 ]. These adjunctive treatments may have influenced outcomes and should be considered when interpreting efficacy. Outcomes and Efficacy The most assessed primary outcomes were: Corneal fluorescein staining (CFS) Ocular Surface Disease Index (OSDI) Reduction in chalazion size Adverse event incidence Across studies, PBM was associated with significant improvements. One study reported a reduction in OSDI score from 29.7 ± 4.6 at baseline to 12.4 ± 1.8 at 10 weeks [ 51 ]. In cases of chalazion, resolution was observed in 22.7% of treated lesions, compared with 6.8% in the control group receiving hot compresses[ 51 ]. Another study found that 46% of chalazia resolved after a single IPL session [ 50 ]. One study focused on safety, reporting an adverse event rate of 3.2% (74/2,282 patients), with most events categorised as mild or moderate. Secondary outcomes included: Tear break-up time (TBUT) – which improved from 5.6 ± 3.8 seconds to 8.4 ± 4.4 seconds post-treatment Compression of the eyelid (COTE) scores Comparative analysis of IPL vs conventional therapies (e.g. warm compresses), where IPL was often more effective Other conditions: retinopathy of prematurity and concussion. Two studies investigated the effect of using 670nm light applied to neonates to improve outcomes for retinopathy of prematurity. Their main outcome measures were severity of retinopathy of prematurity and survival rate [ 52 ]. One study applied transcranial photobiomodulation vs placebo for the treatment of concussion. Main outcome measures were post-concussion symptom scale score, immediate post-concussion assessment, and cognitive testing composite scores. They found no significant difference in outcomes compared to placebo after either 3 or 6 weeks of treatment [ 53 ]. Discussion This scoping review demonstrates that a broad spectrum of studies have explored PBM in eye and vision conditions in children and young people (CYP). The majority of studies were randomised control trials which evaluated PBM to reduce myopia progression. In this indication, PBM had a large effect size in terms of reduction in axial elongation, demonstrated in multiple studies. IPL appears to be a promising therapeutic modality for lid margin disease in CYP. Studies observed an improvement in ocular surface health, meibomian gland function, and symptom scores. However, the heterogeneity in treatment protocols, lack of masking, and use of concurrent therapies limit the ability to isolate the effects of PBM in these studies. Further high-quality trials with standardised protocols and comparator arms are warranted. Whilst use of PBM for childhood myopia and blepharitis appears effective, it is not in common clinical use in amblyopia, retinopathy of prematurity and concussion. These disease modalities typically had studies published over 5 years ago and did not contain RCT evidence to conclude treatment affect. In the case of ROP RCT were of safety and feasibility. This scoping review adhered to JBI (2020) [ 57 ] and PRISMA-Scr [58] guidance., applying a systematic review framework, but without quality/bias grading of the evidence reviewed. This review can therefore not make recommendations for clinical practice, but it highlights areas for further research. The inclusion of a wide range of type of studies, from case series to randomised controlled trials, precludes a meta-analysis of findings. Some included studies warrant caution in interpretation. For example, one study included several individual case reports, but no summary statistics [ 47 ]. While BCVA improvements were described individually for each participant, no refractions were recorded beyond baseline, and no orthoptic assessments or stereoacuity measurements were reported. This limits the interpretability and strength of the evidence, rendering the study of very weak methodological quality relative to the others. It should be noted as well that in the lid margin studies two retrospective case series reviews used concurrent topical antibiotics and steroids confounding any treatment effect. [ 49 , 50 ] Similarly, our scoping review only provides information on the breadth, not the depth of published research on PBM in childhood eye/vision conditions. However, as the intention of this work is to present the broad spectrum of potential applications, a scoping review methodology is appropriate. Exclusion of any publications written in languages other than English is another limitation. Our filtering searches may have missed PBM reports in other languages, and our findings may only be applicable to those settings where included studies were conducted. Exclusion of single-case studies and current protocols may be another limitation, as we could not include single-case reports in rare conditions, such as Sticklers Syndrome [ 27 ]. The predominance of studies conducted in East Asia may limit the applicability of our findings in other settings; further research is needed to demonstrate validity in other populations. Lastly, our scoping review we did not include publications about adverse events reported in single cases or in regulatory approvals for PBM devices, such as a recent case report of retinal damage with partial recovery after use of a red-laser device for myopia control, bench testing of similar devices, and regulatory changes [ 54 ] [ 55 ] [ 56 ] [ 57 ]. Wider inclusion criteria may be appropriate for PBM reviews, as adverse events may only be detected in post-marketing studies and reports. Conclusion PBM may be useful in paediatric populations in the treatment of blepharitis and chalazion, and in myopia prevention and control. Knowledge gaps persist in optimum wavelengths, dosages and administration regimes, which should be the topic of further research, ideally in the form of randomised controlled trials. Declarations FUNDING This study does not receive specific funding. A-DN is supported by the NIHR Moorfields Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Conflicts of interest: A Dahlmann-Noor has received honoraria for contributing to educational events and advisory boards from Santen, Novartis, Bayer, CooperVision, Zeiss, Thea, Essilor and Hoya. She served as principal or co-ordinating investigator for the NEVAKAR CHAMP, CHAMP-UK, OCUMENSION, MYOPIA-X and MODERATO clinical trials. 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Additional Declarations There is conflict of interest Supplementary Files SupplementaryTable1.xlsx Supplementary Data: Summary of Included Studies and Extracted Parameters Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: revise 02 Mar, 2026 Review # 3 received at journal 01 Mar, 2026 Reviewer # 3 agreed at journal 11 Feb, 2026 Reviewer # 2 agreed at journal 03 Dec, 2025 Reviewer # 1 agreed at journal 16 Nov, 2025 Reviewers invited by journal 31 Oct, 2025 Editor assigned by journal 29 Oct, 2025 Submission checks completed at journal 22 Oct, 2025 First submitted to journal 20 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7903395","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":537878319,"identity":"135f0ab3-3a89-434d-83b4-7b06ea0265a6","order_by":0,"name":"Annegret Dahlmann-Noor","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0002-7402-4350","institution":"NIHR Moorfields BRC","correspondingAuthor":true,"prefix":"","firstName":"Annegret","middleName":"","lastName":"Dahlmann-Noor","suffix":""},{"id":537878320,"identity":"58d74f03-b61f-43fa-8cde-53848c4ab6e2","order_by":1,"name":"Alicia Alicia Fothergill","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Alicia","middleName":"Alicia","lastName":"Fothergill","suffix":""},{"id":537878321,"identity":"1e4ddd0d-b236-42b5-b84b-8f302bfa8ab8","order_by":2,"name":"Charles Hennings","email":"","orcid":"https://orcid.org/0009-0000-9261-2386","institution":"NIHR Moorfields BRC","correspondingAuthor":false,"prefix":"","firstName":"Charles","middleName":"","lastName":"Hennings","suffix":""},{"id":537878322,"identity":"a7a17271-3020-4b94-b861-28306378be94","order_by":3,"name":"Desta Bokre","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Desta","middleName":"","lastName":"Bokre","suffix":""}],"badges":[],"createdAt":"2025-10-20 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1","display":"","copyAsset":false,"role":"figure","size":837101,"visible":true,"origin":"","legend":"\u003cp\u003eSummarised photophysical and photochemical events from photobiomodulation and various light wavelengths\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7903395/v1/fcd1486f11a7647ed4267680.png"},{"id":95666550,"identity":"a7bb7546-af33-4692-aa90-ea15fa83a6eb","added_by":"auto","created_at":"2025-11-11 16:53:10","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":244963,"visible":true,"origin":"","legend":"\u003cp\u003ePrisma Scoping Review Flow diagram.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7903395/v1/7088bc790c7841118d73969b.png"},{"id":95666547,"identity":"8b485d8d-3b80-48ad-8800-a72bcf6d2809","added_by":"auto","created_at":"2025-11-11 16:53:10","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":148327,"visible":true,"origin":"","legend":"\u003cp\u003eMap showing the geographic distribution of photobiomodulation studies.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-7903395/v1/8a5298a2373bea163df0839a.png"},{"id":95818693,"identity":"ae01f025-9a3b-40c2-a08d-bdfd024126d3","added_by":"auto","created_at":"2025-11-13 10:29:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1553221,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7903395/v1/8e99d376-d883-4c98-8e51-75305cce0cd5.pdf"},{"id":95666543,"identity":"853d01cb-6d19-4bcf-8f01-f365f6f95819","added_by":"auto","created_at":"2025-11-11 16:53:10","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":79761,"visible":true,"origin":"","legend":"Supplementary Data: Summary of Included Studies and Extracted Parameters","description":"","filename":"SupplementaryTable1.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7903395/v1/d10c0e53a445121669609019.xlsx"}],"financialInterests":"There is conflict of interest","formattedTitle":"Photobiomodulation therapy for children’s eye and vision conditions","fulltext":[{"header":"Introduction","content":"\u003ch2\u003eBackground\u003c/h2\u003e\n\u003cp\u003ePhotobiomodulation (PBM) therapy is a form of light therapy that utilizes non-ionizing forms of light sources, including lasers, LEDs, and broadband light, in the visible and infrared spectrum[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] PBM therapy, formerly known as low-level light therapy (LLLT), or, before the use of LED, as Low-level-laser therapy, generally uses light with red and near-infrared wavelengths (600\u0026ndash;1000nm) to modulate a wide range of biological processes, such as neural stimulation, downregulation of inflammation and promotion of wound healing and tissue regeneration [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The Medical Subject Headings (MeSH) descriptor defines LLLT as \u0026ldquo;Treatment using irradiation with light of low power intensity so that the effects are a response to the light and not due to heat. A variety of light sources, especially low-power lasers are used\u0026rdquo;[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], highlighting its non-thermal mechanism of action and contrasting it with the use of laser for photo-ablation or -coagulation. PBM is listed as alternative entry term [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn PBM, light targets endogenous chromophores to trigger photophysical and photochemical events [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Targeted chromophores include cytochrome c oxidase and photoactive porphyrins. In mitochondria, long-wavelength light induces increased ATP production, modulation of reactive oxygen species and induction of transcription factors [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Depending on cell type, this then activates cell proliferation and/or migration (fibroblasts), modulation of cytokines, growth factors and inflammatory mediators (immune cells), and increased tissue oxygenation [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFIGURE 1: Summarised photophysical and photochemical events from photobiomodulation and various light wavelengths\u003c/p\u003e\u003cp\u003eIn eye and vision conditions, PBM may be best known for its use in age-related macular degeneration [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] and blepharitis [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Less well known may be its use in acute traumatic brain injury [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In children\u0026rsquo;s eye conditions, low-level laser treatment has been reported to slow progression of myopia [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eRationale\u003c/strong\u003e\u003cp\u003eThere is currently a gap of knowledge about using PBM in eye/vision conditions in children and young people which might be amenable to PMB therapy, such as blepharokeratoconjunctivitis (BKC), atopic lid dermatitis and keratoconjunctivitis (AKC), abusive head trauma (AHT), and potentially others.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e\u003cp\u003eThis scoping review aims to collate available information on indications for and use of PBM in children and young people with eye, vision and lid/orbital conditions. We will formulate and execute a comprehensive search of relevant databases, extracting information on PBM to treat relevant conditions in the appropriate age range, and detailing treatment protocols and reported outcomes.\u003c/p\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eProtocol and registration\u003c/h2\u003e\u003cp\u003eWe followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols/Extension for Scoping reviews (PRISMA-ScR) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The protocol was registered on the Open Science Framework [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEligibility criteria\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003cp\u003eWe \u003cb\u003er\u003c/b\u003eeported studies that included children and young people from birth to 18 years of age, male and female, any ethnic and socioeconomic group, with eye, vision, adnexal or orbital conditions.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConcept\u003c/strong\u003e\u003cp\u003eWe included papers reporting therapeutic use of light of specified wavelength in a spectral range of 400\u0026ndash;1100 nm, pulsed, continuous, single or multi-wavelength. We reported outcomes relevant to the target conditions as specified in the publication.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eContext\u003c/strong\u003e\u003cp\u003eWe included peer-reviewed journal articles published until the last day of the search, written in English.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTypes of studies\u003c/strong\u003e\u003cp\u003eWe included primary research articles with any study design other than single-case report and secondary data analyses.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eExclusion criteria\u003c/strong\u003e\u003cp\u003eWe excluded articles in other languages that did not include an English translation within the publication, animal and cell/tissue studies. We also excluded meta-analyses, systematic and scoping reviews, commentaries, editorials and grey literature. We excluded forms of low dose light that require exogenous chromophores or engineered light-activated chemical switches, such as photodynamic therapy, corneal cross-linking and optogenetics.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSetting\u003c/strong\u003e\u003cp\u003e We included studies where PBM was conducted and administered in any setting, including hospitals, clinical trials units, community clinics and at participants\u0026rsquo; homes.\u003c/p\u003e\u003c/p\u003e\n\u003ch3\u003eInformation sources\u003c/h3\u003e\n\u003cp\u003eA search strategist (DB) carried out searches on Ovid Medline (1946-), Ovid Embase (1947-) and Cochrane Library.\u003c/p\u003e\n\u003ch3\u003eSearch\u003c/h3\u003e\n\u003cp\u003eWe used Medical Subject Headings (MeSH) and free text terms with all relevant synonyms to develop the search strategies. We also used Boolean operators \u0026ldquo;OR\u0026rdquo;, \u0026ldquo;AND\u0026rdquo; to combine search lines and apply age limits to retrieved studies on children up to age of 18 years.\u003c/p\u003e\n\u003ch3\u003eSelection of sources of evidence\u003c/h3\u003e\n\u003cp\u003eThe search strategist (DB) exported the results to Covidence Systematic Review Software (Veritas Health Innovation, Melbourne, Australia) for de-duplication and screening. To ensure consistency among reviewers during title and abstract screening, we developed an abstract screening tool. For piloting, two reviewers, CH and AF independently screened the same selection of 20 titles and abstracts from the search, discussed the results and amended the abstract screening tool. CH and AF then screened all titles and abstracts, discussed and resolved disagreements within Covidence, with reviewer A-DN as mediator when required. We included publications for full-text review where the abstract review indicated \u0026ldquo;unsure\u0026rdquo;.\u003c/p\u003e\u003cp\u003eTwo reviewers, CH and AF, then independently scrutinised the full texts for inclusion using a custom-designed inclusion/exclusion criteria list within Covidence. We discussed and resolved disagreements, with A-DN as mediator.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData charting process\u003c/h2\u003e\u003cp\u003eWe developed a data extraction tool within Covidence. Two reviewers independently extracted data, then discussed to resolved disagreements.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData items\u003c/h3\u003e\n\u003cp\u003e We extracted publication-identifying information (first author and author contact details, year, title, country), study aims, design, start/end date, funding sources, conflicts of interest, target population, inclusion/exclusion criteria, recruitment methods, number of participants and duration of study participation, population demographics (mean age, gender, diagnosis), intervention(s), parameters studied, technology used, summary statistics of intervention parameters outcomes at baseline and follow-up timepoints.\u003c/p\u003e\n\u003ch3\u003eCritical appraisal of individual sources of evidence (if applicable)\u003c/h3\u003e\n\u003cp\u003eIn line with guidance for scoping reviews [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], we did not carry out a critical appraisal of individual sources.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eSynthesis of results\u003c/h2\u003e\u003cp\u003eWe tabulated the characteristics of included studies (number, geographic distribution, populations, study designs). We then analysed the content and summarised the findings of included studies according to interventions (if any) and outcomes. We did not carry out a quality assessment of included studies, because the objective of this scoping review is to provide a map and overview of the research conducted to date.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eSelection of sources of evidence\u003c/h2\u003e\u003cp\u003eA total of 45 studies met the inclusion criteria and were included in the final synthesis from a total of 5025 following literature search.\u003c/p\u003e\u003cp\u003eFigure 2: Prisma Scoping Review Flow diagram.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eGeographical and Temporal Distribution\u003c/h2\u003e\u003cp\u003eThe majority of studies (34/45) were conducted in China, with smaller contributions from the USA (n\u0026thinsp;=\u0026thinsp;2), Australia (n\u0026thinsp;=\u0026thinsp;3) and individual studies from Italy, Japan, Germany, Taiwan and Turkey.\u003c/p\u003e\u003cp\u003eStudies were published or conducted between 2012 and 2024, with increasing output in recent years. Six studies were conducted in 2021, and five in each of 2022 and 2023.\u003c/p\u003e\u003cp\u003eFigure 3: Map showing the geographic distribution of photobiomodulation studies.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003ePhotobiomodulation Devices Used\u003c/h2\u003e\u003cp\u003ePBM was delivered using a range of commercially available and custom-built devices. The most commonly reported device was the Eyerising\u0026reg; red-light therapy system developed by Suzhou Xuanjia Optoelectronics Technology, which appeared under several naming variations across studies. This device was used most for myopia studies. Other devices used across other conditions included:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eExperimental head-mounted and desktop PBM units\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eDevices from manufacturers such as Londa Optics, Lutronic, and Quantum Devices\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eMany studies lacked sufficient technical detail to confirm equivalence between models.\u003c/p\u003e\u003cp\u003eTwo out of three amblyopia studies used laser acupuncture equipment with acupuncture sites focussed on the auricular nodes.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eSummary of Intervention Protocols\u003c/h2\u003e\u003cp\u003eWavelength: Most studies used 650\u0026thinsp;\u0026plusmn;\u0026thinsp;10 nm red light. Other wavelengths included 633 nm, 635 nm, and a few using broader or dual-spectrum bands. One study explored the use of violet light of 360-400nm for myopia control treatment.\u003c/p\u003e\u003cp\u003eType of Light: Delivery was predominantly continuous wave (n\u0026thinsp;=\u0026thinsp;39), with fewer studies using pulsed light or intense pulsed light. The use of pulsed light was limited to studies exploring amblyopia and lid margin disease treatments.\u003c/p\u003e\u003cp\u003eExposure Duration: The most common exposure time was 3 minutes per session (n\u0026thinsp;=\u0026thinsp;28), delivered as single or multiple daily sessions. 44 studies directed the light towards the visual system via the eye, however one study explored PBM for concussion used transcranial light delivery.\u003c/p\u003e\u003cp\u003eFrequency: PBM was typically administered twice daily, spaced\u0026thinsp;\u0026ge;\u0026thinsp;4 hours apart, over 5\u0026ndash;7 days per week. Some studies used once-daily or once-weekly applications or.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eOutcomes and Evidence Synthesis\u003c/h2\u003e\u003cp\u003eTo facilitate meaningful synthesis, outcomes were grouped according to the primary eye/vision condition under investigation. We categorised studies by condition, such as myopia, amblyopia, retinopathy of prematurity (ROP), lid margin disease. This categorisation allowed for condition-specific analysis of intervention protocols, outcome measures, and reported effects.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eMyopia\u003c/h2\u003e\u003cp\u003eThirty-three studies reported outcomes related to myopia control. The most frequently assessed primary outcome was axial length, typically measured using optical biometry. This was reported in various formats, including absolute change in axial length (in millimetres) from baseline, and as proportion of participants demonstrating initial axial shortening, such as reductions exceeding 0.05 mm [\u003cspan additionalcitationids=\"CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29 CR30 CR31 CR32 CR33 CR34 CR35 CR36 CR37 CR38 CR39 CR40 CR41 CR42 CR43\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSecondary outcomes commonly included spherical equivalent refraction (SER), choroidal thickness (measured via OCT), and clinical measures such as visual acuity, treatment compliance, and adverse events.\u003c/p\u003e\u003cp\u003eAcross included studies, most reported a reduction in axial elongation in the eyes of children treated with PBM compared to controls. Several studies also described a proportion of participants experiencing initial absolute axial shortening, particularly among those with high adherence to the treatment protocol. SER outcomes often indicated slower myopic progression in the intervention groups, although the statistical significance of these findings varied. Mechanistic outcomes\u0026mdash;such as increased choroidal thickness or changes in retinal perfusion\u0026mdash;were less consistently reported, but generally supported a response to PBM [\u003cspan additionalcitationids=\"CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29 CR30 CR31 CR32 CR33 CR34 CR35 CR36 CR37 CR38 CR39 CR40 CR41 CR42 CR43\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eImportantly, the safety profile of PBM appeared favourable, with most adverse events described as mild and transient, including symptoms such as flash, glare and temporary afterimages.\u003c/p\u003e\u003cp\u003eDetailed outcome data\u0026mdash;including device specifications, statistical results (means, standard deviations, confidence intervals, and p-values), and reported direction of effect\u0026mdash;are summarised in Supplementary Table\u0026nbsp;1.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eAmblyopia\u003c/h2\u003e\u003cp\u003eThree studies explored the role of PBM in the management of amblyopia, each reporting distinct primary outcomes. These included change in best-corrected visual acuity (BCVA) and/or refractive error in ametropic amblyopia. Improvements were observed across all studies in the PBM intervention groups, while control groups generally showed little or no change [\u003cspan additionalcitationids=\"CR46\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSecondary outcomes reported in the other two studies included amplitude of accommodation and multifocal visual evoked potentials (M-VEP). One study demonstrated an increase in M-VEP amplitudes (mean increase of 1207 nV, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001)[\u003cspan additionalcitationids=\"CR46\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOverall, outcomes were classified under efficacy, with no reports of adverse events or safety concerns in this subgroup.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eLid Margin Disease\u003c/h2\u003e\u003cp\u003eFive studies investigated the application of PBM, predominantly using intense pulsed light (IPL), for the treatment of lid margin disease, particularly meibomian gland dysfunction (MGD) and chalazion. Across these studies, both subjective symptom improvement and objective ocular surface changes were reported [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan additionalcitationids=\"CR49 CR50\" citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePBM was delivered using a variety of IPL systems, including the SOLARI IPL system (Lutronic Corporation, Korea), E\u0026thinsp;\u0026gt;\u0026thinsp;Eye (ESwin, Paris, France), and the Eye-light\u0026reg; treatment mask. Devices typically emitted pulsed, polychromatic light with wavelengths ranging from 500 to 1200 nm, often filtered through 570\u0026ndash;580 nm cut-off filters. Reported energy densities ranged from 8 to 13 J/cm\u0026sup2;.\u003c/p\u003e\u003cp\u003eTreatment regimens varied. Most protocols involved multiple IPL sessions (ranging from 1 to 10), spaced every 2\u0026ndash;4 weeks. Exposures consisted of 4\u0026ndash;5 light pulses per eye, delivered along the lower eyelid, with session durations ranging from brief targeted flashes to 15-minute mask-based treatments.\u003c/p\u003e\u003cp\u003eSeveral studies incorporated concurrent interventions. These included topical antibiotics or steroid-antibiotic drops, warm compresses, eyelid hygiene, and meibomian gland expression (MGX). For instance, one study explicitly combined tobramycin eye drops with IPL [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], while another used LLLT alongside antibiotics [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. These adjunctive treatments may have influenced outcomes and should be considered when interpreting efficacy.\u003c/p\u003e\u003cp\u003eOutcomes and Efficacy\u003c/p\u003e\u003cp\u003eThe most assessed primary outcomes were:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eCorneal fluorescein staining (CFS)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eOcular Surface Disease Index (OSDI)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eReduction in chalazion size\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAdverse event incidence\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eAcross studies, PBM was associated with significant improvements. One study reported a reduction in OSDI score from 29.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6 at baseline to 12.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 at 10 weeks [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. In cases of chalazion, resolution was observed in 22.7% of treated lesions, compared with 6.8% in the control group receiving hot compresses[\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Another study found that 46% of chalazia resolved after a single IPL session [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOne study focused on safety, reporting an adverse event rate of 3.2% (74/2,282 patients), with most events categorised as mild or moderate.\u003c/p\u003e\u003cp\u003eSecondary outcomes included:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eTear break-up time (TBUT) \u0026ndash; which improved from 5.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8 seconds to 8.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4 seconds post-treatment\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eCompression of the eyelid (COTE) scores\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eComparative analysis of IPL vs conventional therapies (e.g. warm compresses), where IPL was often more effective\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eOther conditions: retinopathy of prematurity and concussion.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTwo studies investigated the effect of using 670nm light applied to neonates to improve outcomes for retinopathy of prematurity. Their main outcome measures were severity of retinopathy of prematurity and survival rate [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. One study applied transcranial photobiomodulation vs placebo for the treatment of concussion. Main outcome measures were post-concussion symptom scale score, immediate post-concussion assessment, and cognitive testing composite scores. They found no significant difference in outcomes compared to placebo after either 3 or 6 weeks of treatment [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e This scoping review demonstrates that a broad spectrum of studies have explored PBM in eye and vision conditions in children and young people (CYP). The majority of studies were randomised control trials which evaluated PBM to reduce myopia progression. In this indication, PBM had a large effect size in terms of reduction in axial elongation, demonstrated in multiple studies.\u003c/p\u003e\u003cp\u003eIPL appears to be a promising therapeutic modality for lid margin disease in CYP. Studies observed an improvement in ocular surface health, meibomian gland function, and symptom scores. However, the heterogeneity in treatment protocols, lack of masking, and use of concurrent therapies limit the ability to isolate the effects of PBM in these studies. Further high-quality trials with standardised protocols and comparator arms are warranted.\u003c/p\u003e\u003cp\u003eWhilst use of PBM for childhood myopia and blepharitis appears effective, it is not in common clinical use in amblyopia, retinopathy of prematurity and concussion. These disease modalities typically had studies published over 5 years ago and did not contain RCT evidence to conclude treatment affect. In the case of ROP RCT were of safety and feasibility.\u003c/p\u003e\u003cp\u003eThis scoping review adhered to JBI (2020) [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e] and PRISMA-Scr [58] guidance., applying a systematic review framework, but without quality/bias grading of the evidence reviewed. This review can therefore not make recommendations for clinical practice, but it highlights areas for further research. The inclusion of a wide range of type of studies, from case series to randomised controlled trials, precludes a meta-analysis of findings.\u003c/p\u003e\u003cp\u003eSome included studies warrant caution in interpretation. For example, one study included several individual case reports, but no summary statistics [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. While BCVA improvements were described individually for each participant, no refractions were recorded beyond baseline, and no orthoptic assessments or stereoacuity measurements were reported. This limits the interpretability and strength of the evidence, rendering the study of very weak methodological quality relative to the others. It should be noted as well that in the lid margin studies two retrospective case series reviews used concurrent topical antibiotics and steroids confounding any treatment effect. [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eSimilarly, our scoping review only provides information on the breadth, not the depth of published research on PBM in childhood eye/vision conditions. However, as the intention of this work is to present the broad spectrum of potential applications, a scoping review methodology is appropriate.\u003c/p\u003e\u003cp\u003e Exclusion of any publications written in languages other than English is another limitation. Our filtering searches may have missed PBM reports in other languages, and our findings may only be applicable to those settings where included studies were conducted. Exclusion of single-case studies and current protocols may be another limitation, as we could not include single-case reports in rare conditions, such as Sticklers Syndrome [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe predominance of studies conducted in East Asia may limit the applicability of our findings in other settings; further research is needed to demonstrate validity in other populations.\u003c/p\u003e\u003cp\u003eLastly, our scoping review we did not include publications about adverse events reported in single cases or in regulatory approvals for PBM devices, such as a recent case report of retinal damage with partial recovery after use of a red-laser device for myopia control, bench testing of similar devices, and regulatory changes [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e] [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e] [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e] [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. Wider inclusion criteria may be appropriate for PBM reviews, as adverse events may only be detected in post-marketing studies and reports.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePBM may be useful in paediatric populations in the treatment of blepharitis and chalazion, and in myopia prevention and control. Knowledge gaps persist in optimum wavelengths, dosages and administration regimes, which should be the topic of further research, ideally in the form of randomised controlled trials.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFUNDING\u003c/h2\u003e\u003cp\u003eThis study does not receive specific funding. A-DN is supported by the NIHR Moorfields Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.\u003c/p\u003e\u003cp\u003e Conflicts of interest: A Dahlmann-Noor has received honoraria for contributing to educational events and advisory boards from Santen, Novartis, Bayer, CooperVision, Zeiss, Thea, Essilor and Hoya. She served as principal or co-ordinating investigator for the NEVAKAR CHAMP, CHAMP-UK, OCUMENSION, MYOPIA-X and MODERATO clinical trials. She is the PI on two studies investigating the effect of red light on adult and children\u0026rsquo;s eyes, and she is a director of Myolight Ltd.\u003c/p\u003e\u003cp\u003eThe other authors have no interest to declare.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTsai, S.R. and M.R. Hamblin, \u003cem\u003eBiological effects and medical applications of infrared radiation\u003c/em\u003e. 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Translational Vision Science and Technology, 2022. 11(10) (no pagination).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChiCtr, \u003cem\u003eThe safety of repeated low-intensity red light therapy for the treatment of myopia in children.\u003c/em\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://trialsearch.who.int/Trial2.aspx?TrialID=ChiCTR2300075398\u003c/span\u003e\u003cspan address=\"https://trialsearch.who.int/Trial2.aspx?TrialID=ChiCTR2300075398\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e, 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDeen, N., et al., \u003cem\u003eThree-Month Interim Analyses of Repeated Low-Level Red-Light Therapy in Myopia Control in Schoolchildren: A Multi-Ethnic Randomized Controlled Trial.\u003c/em\u003e medRxiv., 2024. 18.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDong, J., et al., \u003cem\u003eMyopia Control Effect of Repeated Low-Level Red-Light Therapy in Chinese Children: A Randomized, Double-Blind, Controlled Clinical Trial\u003c/em\u003e. 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Ophthalmology, 2024. 131(11): p. 1304\u0026ndash;1313.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXiong, R., et al., \u003cem\u003eSustained and rebound effect of repeated low-level red-light therapy on myopia control: a 2-year post-trial follow-up study\u003c/em\u003e. Clinical \u0026amp; experimental ophthalmology, 2022. 50(9): p. 1013\u0026ndash;1024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXiong, R., et al., \u003cem\u003eLongitudinal Changes and Predictive Value of Choroidal Thickness for Myopia Control after Repeated Low-Level Red-Light Therapy\u003c/em\u003e. Ophthalmology, 2023. 130(3): p. 286\u0026ndash;296.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXiong, Y., et al., \u003cem\u003eEffectiveness of low-level red light for controlling progression of Myopia in children and adolescents\u003c/em\u003e. Photodiagnosis Photodyn Ther, 2024. 49: p. 104267.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXu, Y., et al., \u003cem\u003eRepeated Low-Level Red Light Therapy for Myopia Control in High Myopia Children and Adolescents: A Randomized Clinical Trial\u003c/em\u003e. Ophthalmology, 2024. 131(11): p. 1314\u0026ndash;1323.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXuan, M., et al., \u003cem\u003eLongitudinal Changes in Choroidal Structure Following Repeated Low-Level Red-Light Therapy for Myopia Control: Secondary Analysis of a Randomized Controlled Trial\u003c/em\u003e. Asia Pac J Ophthalmol (Phila), 2023. 12(4): p. 377\u0026ndash;383.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYang, W., et al., \u003cem\u003eImmediate Effect in the Retina and Choroid after 650 nm Low-Level Red Light Therapy in Children\u003c/em\u003e. Ophthalmic Research, 2023. 66(1): p. 312\u0026ndash;318.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYu, M., et al., \u003cem\u003eAxial Length Shortening after Combined Repeated Low-Level Red-Light Therapy in Poor Responders of Orthokeratology in Myopic Children\u003c/em\u003e. Journal of Ophthalmology, 2024. 2024(no pagination).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhai, Z., et al., \u003cem\u003eSafety and Feasibility of Low Fluence Intense Pulsed Light for Treating Pediatric Patients with Moderate-to-Severe Blepharitis\u003c/em\u003e. Journal of Clinical Medicine, 2022. 11(11) (no pagination).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang, H., et al., \u003cem\u003eEfficacy of repeated low-level red-light therapy in the prevention and control of myopia in children\u003c/em\u003e. Photodiagnosis Photodyn Ther, 2024. 47: p. 104216.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhou, L., et al., \u003cem\u003ePhotobiomodulation therapy retarded axial length growth in children with myopia: evidence from a 12-month randomized controlled trial evidence\u003c/em\u003e. Sci, 2023. 13(1): p. 3321.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhou, L., et al., \u003cem\u003eLow-intensity, long-wavelength red light slows the progression of myopia in children: an Eastern China-based cohort\u003c/em\u003e. Ophthalmic \u0026amp; physiological optics, 2022. 42(2): p. 335\u0026ndash;344.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhou, W., et al., \u003cem\u003eEfficacy of Different Powers of Low-Level Red Light in Children for Myopia Control\u003c/em\u003e. Ophthalmology, 2024. 131(1): p. 48\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhu, M., et al., \u003cem\u003eSafety of repeated low-level red-light therapy for children with myopia\u003c/em\u003e. Photodiagnosis Photodyn Ther, 2024. 47: p. 104198.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIvandic, B.T. and T. Ivandic, \u003cem\u003eLow-level laser therapy improves visual acuity in adolescent and adult patients with amblyopia\u003c/em\u003e. Photomed Laser Surg, 2012. 30(3): p. 167\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLin, C.H., et al., \u003cem\u003eEffect of low-level laser irradiation on accommodation and visual fatigue\u003c/em\u003e. Clinical Ophthalmology, 2021. 15: p. 3431\u0026ndash;3439.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVanzini, M. and M. Gallamini, \u003cem\u003eAmblyopia: Can Laser Acupuncture be an Option?\u003c/em\u003e Journal acupunct, 2016. 9(5): p. 267\u0026ndash;274.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJiang, J., et al., \u003cem\u003eTherapeutic effect of intense pulsed light on different types of chalazion in children\u003c/em\u003e. Sci, 2024. 14(1): p. 3645.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eQiao, C., et al., \u003cem\u003eAdverse Events of Intense Pulsed Light Combined With Meibomian Gland Expression Versus Meibomian Gland Expression in the Treatment of Meibomian Gland Dysfunction\u003c/em\u003e. Lasers Surg Med, 2021. 53(5): p. 664\u0026ndash;670.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStonecipher, K. and R. Potvin, \u003cem\u003eLow level light therapy for the treatment of recalcitrant chalazia: A sample case summary\u003c/em\u003e. Clinical Ophthalmology, 2019. 13: p. 1727\u0026ndash;1733.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTotuk, O.M.G., et al., \u003cem\u003eEfficacy of intense pulsed light treatment for moderate to severe acute blepharitis or blepharoconjunctivitis: A retrospective case series\u003c/em\u003e. Turkish Journal of Ophthalmology, 2021. 51(2): p. 89\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKent, A.L., et al., \u003cem\u003eA pilot randomised clinical trial of 670 nm red light for reducing retinopathy of prematurity\u003c/em\u003e. Pediatr Res, 2020. 87(1): p. 131\u0026ndash;136.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTaylor, A.M., et al., A Randomized, \u003cem\u003eDouble-Blind, Placebo-Controlled Clinical Trial Evaluating Transcranial Photobiomodulation as Treatment for Concussion\u003c/em\u003e. Med Sci Sports Exerc, 2024. 56(5): p. 822\u0026ndash;827.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTroilo, D., et al., \u003cem\u003eIMI - Report on Experimental Models of Emmetropization and Myopia\u003c/em\u003e. Invest Ophthalmol Vis Sci, 2019. 60(3): p. M31-M88.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu, H., et al., \u003cem\u003eRetinal Damage After Repeated Low-level Red-Light Laser Exposure\u003c/em\u003e. JAMA Ophthalmol, 2023. 141(7): p. 693\u0026ndash;695.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang, Y.X., N. Wang, and T.Y. Wong, \u003cem\u003eRed Light Therapy for Myopia-Current Regulatory Changes in China\u003c/em\u003e. JAMA Ophthalmol, 2025. 143(3): p. 197\u0026ndash;198.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiao, X., et al., \u003cem\u003eCone Density Changes After Repeated Low-Level Red Light Treatment in Children With Myopia\u003c/em\u003e. JAMA Ophthalmol, 2025. 143(6): p. 480\u0026ndash;488.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"eye","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"eye","sideBox":"Learn more about [Eye](http://www.nature.com/eye/)","snPcode":"41433","submissionUrl":"https://mts-eye.nature.com/cgi-bin/main.plex","title":"Eye","twitterHandle":"@eye_journal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7903395/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7903395/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003ePhotobiomodulation (PBM) is a non-invasive, light-based technology that stimulates cellular mechanisms, with therapeutic effect on a variety of medical conditions. Wavelengths of light are absorbed by intracellular photoreceptors, resulting in the activation of signalling pathways that culminate in biological changes within the cell. PBM treatment has been reported for a range of eye/vision conditions, mostly in adults.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003e We carried out a scoping review of the published literature and collated reported uses of PBM for eye/vision/lid/orbital conditions in children and young people.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEligibility criteria:\u003c/strong\u003e We developed a comprehensive Ovid Medline, Ovid Embase and Cochrane Library search strategy. We included primary research articles written in English reporting an age range from 0-18 years. Ocular, vision, lid, or orbital conditions treated with PBMT, low light therapy, or intense pulsed light therapy (400–1100 nm spectral range). Case reports, meta-analyses, systematic reviews, and studies using photodynamic therapy, cross-linking, or optogenetics were excluded.\u003cbr\u003e\n \u003cstrong\u003eSources of evidence: \u003c/strong\u003eWe used Covidence Systematic Review Software for de-duplication and screening of titles and abstracts, using a pre-specified screening tool. Charting methods: We developed and used a data extraction tool in Covidence. Two reviewers independently extracted data and discussed and resolved disagreements.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Of 5,081 identified studies, 47 were included. The majority focused on myopia control, reporting reductions in axial elongation, some noted rebound effects upon cessation. Amblyopia, retinopathy of prematurity, meibomian gland dysfunction, chalazion, concussion, and visual fatigue were also investigated. Most studies were randomized controlled trials, with China as the predominant investigating region. PBMT demonstrated potential benefits across various conditions with a favourable safety profile.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion:\u003c/strong\u003e PBMT may have a role in the management of childhood eye conditions, particularly myopia and blepharitis. It appears generally safe, with transient adverse effects such as mild photophobia and dry eye.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eFurther research is needed to optimize protocols and assess sustained efficacy and safety for widespread clinical adoption.\u003c/p\u003e","manuscriptTitle":"Photobiomodulation therapy for children’s eye and vision conditions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-11 16:53:05","doi":"10.21203/rs.3.rs-7903395/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"revise","date":"2026-03-02T08:17:43+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"This content is not available.","date":"2026-03-01T10:51:56+00:00","index":3,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2026-02-11T17:45:43+00:00","index":3,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-12-03T09:09:14+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-11-16T08:47:58+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2025-10-31T06:52:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-29T13:39:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-22T14:38:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"Eye","date":"2025-10-20T07:57:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"eye","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"eye","sideBox":"Learn more about [Eye](http://www.nature.com/eye/)","snPcode":"41433","submissionUrl":"https://mts-eye.nature.com/cgi-bin/main.plex","title":"Eye","twitterHandle":"@eye_journal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"35be13d6-baa0-48f7-934b-49f4ce32c23d","owner":[],"postedDate":"November 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":57205060,"name":"Health sciences/Health care/Paediatrics"},{"id":57205061,"name":"Health sciences/Diseases/Eye diseases/Vision disorders"}],"tags":[],"updatedAt":"2026-05-07T10:20:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-11 16:53:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7903395","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7903395","identity":"rs-7903395","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}