Antibody and Related Biologic Therapeutics in Ocular Diseases: Molecular Targets, Clinical Applications, and Next-Generation Delivery Strategies

Antibody-based therapeutics have transformed the management of several vision-threatening ocular diseases by enabling targeted modulation of pathological angiogenesis, inflammation, and disease-associated molecular pathways. However, their clinical effectiveness remains constrained by anatomical and physiological barriers that limit ocular tissue penetration, therapeutic durability, and treatment accessibility. This review provides a comprehensive overview of antibody and related biologic therapeutics across six major ocular disease domains: age-related macular degeneration (AMD), diabetic retinopathy (DR) and diabetic macular edema (DME), retinal vein occlusion (RVO), uveitis, glaucoma, and thyroid eye disease (TED). We first discuss the molecular mechanisms underlying their therapeutic actions, including inhibition of angiogenic signaling, modulation of inflammatory and immune pathways, complement inhibition, and regulation of apoptosis and fibrosis. We then summarize the clinical applications of established and emerging biologic therapies, highlighting their molecular targets, therapeutic outcomes, and limitations. Particular emphasis is placed on advances in antibody engineering and ocular drug delivery, including bispecific antibodies, Fc engineering, antibody–drug conjugates, sustained-release systems, and targeted delivery platforms. Despite substantial progress, repeated administration, variable therapeutic responses, and limited treatment durability remain important challenges. Integrating next-generation biologic platforms with innovative ocular delivery technologies may support more effective, durable, and individualized therapeutic strategies for ocular diseases.