Exosomes, small extracellular vesicles containing various cellular components such as DNA, RNA, proteins, and metabolites, play a crucial role in regulating biological responses and cell-to-cell communication. They are being explored as potential therapies for retinal vascular diseases due to their ability to deliver substances to target cells. Recent research highlights the significance of noncoding RNAs (ncRNAs) in the regulation of retinal vascular diseases, including microRNAs (miRNAs), circular RNAs (circRNAs), and long noncoding RNAs (lncRNAs). These ncRNAs can influence retinal vascular formation, inflammation, and cell death. Exosomal ncRNAs have shown promise in managing conditions such as glaucoma, dry eye syndrome, retinal ischemia, diabetic retinopathy, and age-related macular degeneration. By engineering exosomes to control their content and surface proteins, researchers aim to enhance their therapeutic effects. This review discusses the latest advancements in using exosomal ncRNAs as biomarkers and therapeutic targets for retinal vascular diseases, emphasizing their potential in early diagnosis and treatment.Exosomes, small extracellular vesicles containing various cellular components such as DNA, RNA, proteins, and metabolites, play a crucial role in regulating biological responses and cell-to-cell communication. They are being explored as potential therapies for retinal vascular diseases due to their ability to deliver substances to target cells. Recent research highlights the significance of noncoding RNAs (ncRNAs) in the regulation of retinal vascular diseases, including microRNAs (miRNAs), circular RNAs (circRNAs), and long noncoding RNAs (lncRNAs). These ncRNAs can influence retinal vascular formation, inflammation, and cell death. Exosomal ncRNAs have shown promise in managing conditions such as glaucoma, dry eye syndrome, retinal ischemia, diabetic retinopathy, and age-related macular degeneration. By engineering exosomes to control their content and surface proteins, researchers aim to enhance their therapeutic effects. This review discusses the latest advancements in using exosomal ncRNAs as biomarkers and therapeutic targets for retinal vascular diseases, emphasizing their potential in early diagnosis and treatment.