<![CDATA[Diabetic retinopathy is a leading cause of preventable blindness in working-age populations, with vascular endothelial growth factor (VEGF) playing a central role in its progression. This critical narrative review aims to synthesize comparative evidence on the efficacy and durability of anti-VEGF agents and to formulate a contextual clinical decision-making framework for developing countries, particularly Indonesia. A literature search through PubMed/MEDLINE, Google Scholar, and ClinicalTrials.gov identified 143 articles; after stepwise screening with qualitative appraisal based on study design, sample size, and clinical relevance, 40 articles were included. Findings show that aflibercept demonstrated meaningful superiority in patients with poor baseline visual acuity of 20/50 or worse (approximately 2.7 ETDRS letters compared to bevacizumab, PROTOCOL T), while all three major agents yielded comparable outcomes at better baseline vision. Faricimab offered clinical durability up to 16 weeks in 53% of patients (YOSEMITE/RHINE). Approximately 30 to 40% of patients exhibit inadequate response, classifiable as primary non-response or secondary loss of response, each carrying distinct therapeutic implications. Optimal agent selection requires stratification by baseline visual acuity, durability profile, and cost-effectiveness considerations within Indonesia's National Health Insurance (JKN) system. Prospective research in the Indonesian population remains an urgent priority.]]>
