The effects of leaf dorsoventrality and its interaction with environmentally induced changes in the leaf spectral response are still poorly understood, particularly for isobilateral leaves. We investigated the spectral performance of 24 genotypes of field-grown durum wheat at two locations under both rainfed and irrigated conditions. Flag leaf reflectance spectra in the VIS-NIR-SWIR (visible–near-infrared–short-wave infrared) regions were recorded in the adaxial and abaxial leaf sides and at the canopy level, while traits providing information on water status and grain yield were evaluated. Moreover, leaf anatomical parameters were measured in a subset of five genotypes. The spectral traits studied were more affected by the leaf side than by the water regime. Leaf dorsoventral differences suggested higher accessory pigment content in the abaxial leaf side, while water regime differences were related to increased chlorophyll, nitrogen, and water contents in the leaves in the irrigated treatment. These variations were associated with anatomical changes. Additionally, leaf dorsoventral differences were less in the rainfed treatment, suggesting the existence of leaf-side-specific responses at the anatomical and biochemical level. Finally, the accuracy in yield prediction was enhanced when abaxial leaf spectra were employed. We concluded that the importance of dorsoventrality in spectral traits is paramount, even in isobilateral leaves.