Although smart contact lenses have demonstrated great potential in theranostics, there remain critical challenges and opportunities in their commercial development. In this Perspective, the current status and capability of smart theranostic contact lenses are highlighted, focusing on their application as sensing systems for detecting biomarkers such as glucose, intraocular pressure (IOP), and inflammatory cytokines, and as drug delivery systems (DDS) for precise and controlled therapy. Additionally, key challenges associated with clinical development and commercialization of smart theranostic contact lenses are discussed, to optimize diagnostic and therapeutic interventions. Considering the rapid evolution of the field, we finally also discuss the need for systematic studies on safety, efficacy, and mass-production, and we spark new ideas for advancing smart theranostic contact lenses into versatile platforms for personalized medicine.