Abstract / Summary
Myopia progression increases the lifetime risk of vision-threatening complications, making effective control interventions a global priority. The reported efficacy of myopia-control spectacle lenses varies across studies and among individuals. This review examines the spectacle lens–eye interaction as an integrated opto-biological modulation system and aims to connect candidate biological growth signals to precision optical design, manufacturing, and evaluation. It synthesises evidence on the biological mechanisms underlying myopia progression and discusses their implications for myopia-suppression strategies. In parallel, current spectacle lens designs and their respective evaluation methodologies are systematically reviewed. Building on these synthesised insights, this article proposes an integrated framework that treats the lens and the visual system as a unified functional unit. The analysis suggests that focusing solely on peripheral myopic defocus overlooks critical wide-field aberrations and contrast-related cues. By introducing the opto-biological modulation perspective, this work presents a framework that links lens-design parameters to optical descriptors and candidate biological-response measures. To quantify this interaction, the potential use of a difference-of-Gaussians (DoG) filter is proposed as a proxy for retinal signal processing, enabling the computational assessment of how different lens designs modulate candidate growth-related cues. Overall, integrating biological pathways with optical design provides a more rigorous foundation for myopia control. The proposed system-level framework, supported by computational proxies, offers a structured roadmap for the future development of mechanism-informed, personalised interventions. Graphical Abstract