To compare the long-term efficacy between repeated low-level red light (RLRL) therapy and low-dose atropine (LDA) eye drops for myopia control.Treatment naïve myopic children receiving RLRL or LDA therapy were retrospectively included. The spherical equivalent (SE) and axial length (AL) were evaluated at baseline and 6-, 12-, and 24-month follow-up. The myopia progression and regression were compared between groups.In total, 122 myopic children were enrolled. The SE progression and AL elongation were significantly less in the RLRL than in the LDA group at 6 months (P = 0.002, SE; P = 0.004, AL), 12 months (P < 0.001) and 24 months (P < 0.001). For patients with RLRL, the SE progression was greater during the second than the first year (P = 0.05). The proportion of patients with SE regression in the RLRL group was greater than that in the LDA group at 12 months (P = 0.003), and the AL shortening proportion was significantly greater in the RLRL group than in the LDA group at 6 months (P = 0.001), 12 months (P = 0.001), and 24 months (P = 0.049). Eight adverse events were reported in the RLRL group without irreversible structural damage.The present research demonstrates that RLRL treatment is more effective than 0.01 % atropine in delaying myopia progression and observes a greater percentage of patients with SE regression and AL shortening in myopic children over two years.Copyright © 2025. Published by Elsevier B.V.