March 16, 2026
By Ashley Tucker, OD, FAAO, FSLS
Photo generated by Gemini
At this year’s SECO International meeting in Atlanta, I had the honor to serve as a panelist for a session titled “The Fascinating Intersection of Genetics, Color Vision, & Modern Myopia Management.” My role on the panel was to review the current landscape of contact lens–based myopia control, including both FDA-approved and off-label options commonly used in clinical practice.
Color Vision and Myopia
While preparing for the session, however, I found myself particularly captivated by another aspect of the discussion – the connection between color vision genetics and the development of myopia. It’s not often that discoveries rooted in basic visual neuroscience reshape how we think about refractive development, yet that is precisely what has emerged from the work of Dr. Jay Neitz.
Dr. Neitz has spent decades studying the genetics of human color vision, particularly the L- and M-cone opsin genes that enable cone photoreceptors to detect long- and middle-wavelength light. His research demonstrated that certain variations in these genes can produce subtle irregularities in the cone photoreceptor mosaic. In some cases, splicing defects reduce photopigment expression in subsets of cones, creating a less uniform cone mosaic across the retina.
What initially appeared to be a discovery limited to color vision deficiencies revealed broader implications. These altered mosaics introduce noise into retinal pathways responsible for detecting contrast. Intriguingly, individuals with these cone mosaic irregularities were also found to have higher rates of myopia. These observations helped lead to what Dr. Neitz and colleagues describe as the contrast theory of myopia.
The Contrast Theory of Myopia
The contrast theory proposes that contrast signaling may play a role in the retinal feedback system that regulates eye growth. In simplified terms, high levels of retinal contrast may signal continued eye elongation, whereas reduced contrast may signal the eye to slow axial growth. When viewed through this framework, the modern visual environment, filled with high-contrast digital text and prolonged near work, may deliver sustained high-contrast stimulation to the retina.
For clinicians involved in myopia management, the connection between color vision genetics, contrast processing and refractive development is fascinating. Many treatment strategies have traditionally focused on optical blur and defocus signals. Contrast theory suggests the retina may be responding to additional visual cues beyond blur alone, expanding our understanding of the biological signals that guide emmetropization.
Research in Action
This line of research ultimately helped inspire the development of Diffusion Optics Technology (DOT) by SightGlass Vision. These spectacle lenses incorporate thousands of microscopic light-scattering elements designed to gently reduce retinal image contrast while maintaining clear visual acuity. Rather than introducing peripheral defocus, the goal is to subtly modulate contrast reaching the retina, essentially recreating visual conditions the eye may interpret as a signal to slow growth.
Clinical studies evaluating this technology have demonstrated meaningful reductions in myopia progression and axial elongation in children. DOT spectacle lenses are already available in several international markets, including parts of Europe and Asia. In the United States, the technology is not yet commercially available, as ongoing clinical trials and regulatory review continue. The platform has also received FDA Breakthrough Device designation, reflecting growing interest in innovative approaches to slowing progressive pediatric myopia.
Looking Beyond the Exam Lane
My role on the SECO panel was to review the contact lens options currently available to clinicians, including the FDA-approved MiSight 1 day as well as multifocal soft contact lenses and orthokeratology approaches frequently used off-label to slow myopia progression. These remain powerful tools in our clinical arsenal.
What stood out most during the discussion was how these seemingly different strategies, from contrast-modulating spectacle lenses to optical defocus created by contact lenses, may ultimately influence overlapping retinal signaling pathways that regulate eye growth.
The story behind contrast theory is a reminder that some of the most important advances in myopia management often begin far outside the exam lane. Research that started with questions about how we perceive color has now helped inspire an entirely new optical approach to slowing myopia progression. As clinicians, it challenges us to stay curious not only about the tools we use today, but also about the basic science that may shape the treatments of tomorrow. Because the next breakthrough in myopia management may not come from another lens design alone, but from a deeper understanding of how the retina interprets the visual world around us.
