Since its introduction in 1998, optical coherent elastography technology has significantly advanced in detecting and imaging of the biomechanical properties of soft tissues over the past two decades. This technology stands out owing to its high spatial resolution, sensitivity in measuring elastic moduli, and rapid imaging speed, making it one of the most promising optical elastography technologies for clinical application. At present, research groups worldwide are focusing on three main core elements of optical coherent elastography technology: developing safer and more effective excitation methods to generate the necessary vibration signals for elasticity evaluation, establishing new mechanical models to accurately quantify the biomechanical properties of tissues under complex boundary conditions, and developing new algorithms for the quantitative analysis of biomechanical properties. These efforts aim to accelerate the clinical application and transformation of this technology. This article reviews the fundamental theories and latest advancements in optical coherent elastography, explores noncontact approaches, establishes mechanical wave models for various biological tissues, and outlines future directions to facilitate its clinical application.