In this study, it was investigated about optical simulation in high brightness and high uniformity direct-type backlight design for medical application. Direct-type backlight has been used high-brightness backlight such as Medical LCD application. The key parameter in designing direct-type backlight was consists of three geometrical dimension such as the distance of two lamps, the gap of lamp and reflection plate and the number of lamps. It has many of variations in optical design and it causes the different properties in backlight system. It shows the best values of above parameters; 26mm of the distance of two lamps, 4.5mm of the gap of lamp and reflection plate and 16 lamps. And we produced the specimen as above condition, and acquired good result in backlight such as the value of the brightness is 6423 nit in center of emission area and less than 5% in brightness uniformity. It shows the effective ways of designing backlight system using optical simulation method for medical LCD application.