Objective To analyze the clinical effect of vision shaping treatment (VST) orthokeratology combined with repeated low-level red-light (RLRL) therapy on rapidly progressive myopia in adolescents.Methods The clinical data of 75 adolescent patients (150 eyes) with rapidly progressive myopia admitted to Baoji People's Hospital from March 2020 to January 2022 were retrospectively analyzed. They were divided into the observation group (n = 38, with 76 eyes) and the control group (n = 37, with 74 eyes) based on different treatment methods. The control group received VST orthokeratology and the observation group received RLRL therapy in addition to VST orthokeratology. Uncorrected visual acuity, cylindrical power, spherical equivalent, ocular biometric parameters, corneal endothelial cell area and density, corneal epithelial staining, binocular accommodative facility and complications were compared between the two groups.Results The differences of uncorrected visual acuity, cylindrical power and spherical equivalent before and after treatment in the observation group were higher than those in the control group (P < 0.05). The differences of anterior chamber depth and central corneal thickness before and after treatment were not different between the two groups (P > 0.05). The difference of the axial length before and after treatment in the observation group was greater than that in the control group (P < 0.05). The corneal endothelial cell area and density in the observation group were higher than those in the control group both before and after treatment (P < 0.05). The overall rate of corneal staining in the observation group was lower than that of the control group (P < 0.05). The differences of positive relative accommodation, negative relative accommodation, amplitude of accommodation and accommodative facility before and after treatment in the observation group were higher than those in the control group (P < 0.05). There was no difference in the overall incidence of complications between the two groups (P > 0.05).Conclusion The combination of VST orthokeratology and RLRL therapy is effective in treating adolescents with rapidly progressive myopia. It can improve binocular accommodative facility, slow myopia progression, control axial elongation, enhance corneal function, and does not significantly increase the risk of complications.