Can Ocular Optical Biomarkers Predict Response to Contact-Lens Myopia Control? A Critical Review of Current Evidence

Background: Contact-lens interventions can slow, but do not arrest, axial elongation in children, and individual response varies substantially. The review examined whether early optical measurements of the lens–eye system can provide clinically useful prediction of later axial growth. Methods: A critical narrative review of PubMed-indexed literature was updated through October 2026. Evidence from dual-focus, centre-distance multifocal and extended-depth-of-focus soft contact lenses and orthokeratology was appraised according to temporal ordering, repeatability, independent prediction, external validation and potential clinical utility. Spectacle-based myopia-control designs were outside the primary scope. Results: Relative peripheral refraction (RPR), pupil-weighted retinal image-quality metrics and selected higher-order aberration (HOA) measures are the principal optical candidates. In soft-lens wear, early wide-field RPR change has shown moderate discrimination of later axial growth. In orthokeratology, the most developed HOA evidence concerns total HOA root-mean-square (RMS), primary spherical aberration and coma; change in total anterior corneal HOA RMS has shown the strongest single-study discrimination. Accommodation, lens centration, pupil size and wear time are better treated as modifiers of optical exposure than as ocular optical biomarkers. Positive findings remain largely small, single-centre, post hoc or design-specific, and no candidate has undergone adequate independent external validation. Conclusions: Current evidence supports candidate-predictive signals rather than clinically validated biomarkers. No optical measure has demonstrated sufficient incremental value beyond established clinical factors or shown that biomarker-guided management improves outcomes. Modality-specific or multivariable optical signatures remain more plausible than a universal scalar marker.