Grape is a major crop, covering 7.5 M ha worldwide, that is currently being confronted with three main challenges: intensive pesticide use that must be reduced, invasion by new pests/diseases, and climate change. The biological control of pests and vectors would help address these challenges. Here, we review the scientific literature on the biological control of grape moths by macroorganisms (excluding nematodes). Two components, biological control with an active human role, mainly using biocontrol agents through inundation or inoculation, and conservation biological control, are considered. The major points are the following. (1) Tortricid grape moths seriously damage grapes worldwide, causing yield losses and quality reduction. The more geographically widespread species, Lobesia botrana, continues to extend its range, invading South American and, more recently, North American vineyards. (2) Parasitoids and predators (including arthropods, birds, and bats) that can control grape pests are very diverse. (3) Different methods exist to assess pest control efficiency in the field but some of them remain to be developed. (4) Environmental factors, including host plants, landscape, grass or floral covers, and organic practices, affect the natural control of grape moths. (5) Pest resistance to parasitoids strongly depends on their immune system, which is controlled by the host plant. Future climate changes may modify this tritrophic interaction and thus affect biological control strategies. We conclude that biological control has a great deal of potential in viticulture and that addressing these key factors would improve the efficiency levels of biological control strategies. This would help growers and stakeholders to significantly reduce insecticide use in vineyards.