Metasurfaces, renowned for their remarkable capabilities in manipulating electromagnetic fields, have been extensively investigated in the realms of optoelectronics and wireless devices. In the domain of biomedical sensing, the utilization of metasurfaces in optical biosensors has garnered escalating interest over the past three years. While conventional optical biosensors boast advantages such as label-free, real-time monitoring, high sensitivity, and rapid response, the integration of metasurfaces further enhances their wavefront manipulation, selectivity for multifunctional sensing, and the potential for device miniaturization to meet increasingly complex application requirements. Despite the promising advancements in this nascent field, there is currently a lack of a comprehensive review addressing the existing research achievements and future perspectives. This article aims to fill this gap by providing an exhaustive review and serving as a valuable reference for researchers embarking on the exploration of metasurface biomedical sensors. The review commences by elucidating the fundamental sensing principles, design processes, and key figures of merit. Subsequently, it delineates several prevalent applications, encompassing the diagnostic and monitoring of blood glucose, viruses, cancers, and drugs. The fabrication processes and techniques are also meticulously explored, offering insights into the intricate methodologies. The article concludes by outlining several promising areas for further exploration, accompanied by a critical analysis of structure fabrication methods with an eye toward future commercialization prospects.