ABSTRACT The growing incidence of pediatric myopia worldwide has generated strong scientific interest in understanding factors leading to myopia development and progression. Although contact lenses (CLs) are prescribed primarily for refractive correction, there is burgeoning use of particular modalities for slowing progression of myopia following reported success in the literature. Standard soft and rigid CLs have been shown to have minimal or no effect for myopia control. Overall, orthokeratology and soft multifocal CLs have shown the most consistent performance for myopia control with the least side effects. However, their acceptance in both clinical and academic spheres is influenced by data limitations, required off-label usage, and a lack of clear understanding of their mechanisms for myopia control. Myopia development and progression seem to be multifactorial, with a complex interaction between genetics and environment influencing myopigenesis. The optical characteristics of the individual also play a role through variations in relative peripheral refraction, binocular vision function, and inherent higher-order aberrations that have been linked to different refractive states. Contact lenses provide the most viable opportunity to beneficially modify these factors through their close alignment with the eye and consistent wearing time. Contact lenses also have potential to provide a pharmacological delivery device and a possible feedback mechanism for modification of a visual environmental risk. An examination of current patents on myopia control provides a window to the future development of an ideal myopia-controlling CL, which would incorporate the broadest treatment of all currently understood myopigenic factors. This ideal lens must also satisfy safety and comfort aspects, along with overcoming practical issues around U.S. Food and Drug Administration approval, product supply, and availability to target populations. Translating the broad field of myopia research into clinical practice is a multidisciplinary challenge, but an analysis of the current literature provides a framework on how a future solution may take shape.