This study synthesizes various research initiatives conducted within the coral reef systems of the Greater Suva Urban Area (GSUA), Fiji, with the aim of providing a comprehensive understanding of the state of knowledge at these urban reef systems. The literature suggests that climate change, pollution, ocean creep and resource exploitation, have been changing coral growth, zonation, and community structure, substantially changing the reefs since the 1960s. However, a detailed synthesis of temporal changes on coral reef drivers and ecological responses for the GSUA is still missing. This review addresses these gaps by analyzing trends in both current ecological and anthropogenic drivers and proposing a framework for future research. Key recommendations include the need for systematic studies across all reef systems, mapping ecological and human-driven factors, and developing a strategic, sustainable monitoring framework. Such actions are aimed at enhancing research capacity and mitigating the persistent impacts of urban development and climate change on the reefs. These insights contribute to a nuanced understanding of the delicate balance between urbanization and coral reef health, crucial for fostering sustainable marine ecosystems in the GSUA, with potential application to other reefs in the Pacific Ocean and beyond.