Biomarker-Guided Management in Vitreoretinal Diseases: Integrating Imaging, Pharmacotherapy, and Surgical Decision-Making-A Narrative Review.

PURPOSE: To synthesize current evidence on imaging biomarkers in vitreoretinal diseases and to review the potential for a biomarker-guided framework integrating imaging, pharmacotherapy, and surgical decision-making in contemporary clinical practice. METHODS: This narrative review integrates published evidence and clinical insights on optical coherence tomography (OCT) and OCT angiography (OCTA)-derived biomarkers, focusing on their role in predicting disease behavior, therapeutic response, and surgical indications. RESULTS: Key imaging biomarkers-including disorganization of the retinal inner layers (DRIL), hyperreflective foci (HRF), intraretinal and subretinal fluid patterns, and vascular perfusion changes-demonstrate significant value in stratifying disease phenotype and guiding management. Biomarker-based approaches enable differentiation between angiogenic and inflammatory patterns, supporting individualized therapeutic strategies. These include optimized use of anti-vascular endothelial growth factor therapy, corticosteroid-based treatments, and newer long-acting agents. In addition, imaging biomarkers play a central role in identifying surgical candidates and determining timing of intervention, particularly in tractional maculopathies and refractory disease. CONCLUSION: A biomarker-guided approach provides a clinically actionable framework for personalized vitreoretinal care. The integration of multimodal imaging with pharmacologic and surgical decision-making represents a critical step toward precision medicine, with the potential to improve outcomes and reduce treatment burden.