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Background To evaluate the efficacy and safety of repeated low-level red-light (RLRL) therapy for controlling myopia progression over 3 years in real-world settings.Methods This multicentre cohort study included participants currently undergoing RLRL treatment, identified from electronic medical databases in three hospitals (myopic children and adolescents aged 7–18 years, who were prescribed RLRL therapy from 1 June 2018 to 1 June 2023), using stratified random sampling based on RLRL treatment duration (≥0.5–1 year, ≥1–2 years, ≥2–3 years and ≥3 years), with approximately 90 participants in each group. All participants voluntarily received RLRL therapy twice a daily (3 min/session, ≥4-hour interval), 5–7 days/week.Results Among 362 participants, 90 were treated for ≥0.5–1 year (median 0.64 year), 91 for ≥1–2 years (median 1.40 years), 90 for ≥2–3 years (median 2.30 years) and 91 for ≥3 years (median 3.65 years). The satisfactory myopia control rate (defined as annual axial elongation ≤0.10 mm) was 72.53% (95% CI 62.17 to 81.37) over ≥3 years of RLRL treatment, with annual axial length change of 0.06 mm/year (95% CI 0.03 to 0.08). No subjective visual function damage was documented by best-corrected visual acuity, and no treatment duration-dependent changes in objective full-field electroretinogram were observed. A minimal, reversible optical coherence tomography change was noted in four eyes which did not impact visual function.Conclusions This real-world study demonstrates that RLRL therapy provides promising long-term efficacy and safety in myopia control over 3 years among Chinese myopic children and adolescents.Trial registration number NCT05871840.