In this systematic review and meta-analysis of 28 randomized controlled trials (3,573 children), repeated low-level red-light (RLRL) therapy demonstrated duration-dependent slowing of myopia progression over 12 months, with improvements in spherical equivalent refraction, reduced axial elongation, and increased choroidal thickness compared with controls. Visual acuity outcomes favored treatment, while anterior segment parameters remained stable and adverse events were generally mild, though long-term retinal safety remains uncertain.