Daniel Agarwal

My first gift from a patient. Fight the good fight, because even if you don’t win, your patients will know they didn’t have to fight alone. We are the collective lighthouse guiding patients during the blinding tempest of disease. #ophthalmology #attending

Disc edema can be a non-specific sign of severe intraocular inflammation, it often points toward specific systemic or posterior segment involvements. Here is how you should categorize the possible causes: 1. Severe Secondary Inflammation (spill-over effect) In cases of intense anterior segment inflammation, inflammatory mediators can migrate posteriorly through the vitreous, causing reactive disc swelling. HLA-B27 Related Uveitis: Specifically, when the inflammation is fibrinoid or very severe. Posner-Schlossman Syndrome: While usually presenting with high IOP and mild AC reaction, severe episodes can rarely show disc changes due to the pressure spike or inflammatory surge. 2. Systemic Granulomatous Diseases These are the classic differentials when you see multi-focal inflammation or disc involvement. Sarcoidosis: A major masquerader. It can cause anterior granulomatous uveitis and direct infiltration of the ONH (optic nerve granuloma) or reactive papilledema. Tuberculosis (TB): Often presents as a chronic granulomatous uveitis; disc edema can occur due to associated papillitis or raised intracranial pressure from CNS involvement. Syphilis: It can cause any form of uveitis and is a frequent cause of concurrent syphilitic optic neuritis. 3. Infectious Etiologies Vogt-Koyanagi-Harada (VKH) Syndrome: (Early Stage). While primarily a panuveitis, the presenting sign is often bilateral disc edema with exudative RDs and AC reaction. Cat-Scratch Disease (Bartonella): Classically causes neuroretinitis (disc edema + macular star), but can present with significant AC cellular reaction. Herpetic Uveitis (HSV/VZV): Usually unilateral with high IOP; disc edema may occur if there is an associated viral optic neuritis. Lyme Disease: Can present with anterior uveitis and direct optic nerve inflammation. 4. Specific Syndromes & Masquerades TINU Syndrome (Tubulointerstitial Nephritis and Uveitis): A common cause in younger patients/children. It presents as a bilateral anterior uveitis, and optic disc edema is a recognized and frequent clinical finding in these patients. Behçet’s Disease: Though typically a non-granulomatous panuveitis with shifting hypopyon, it causes occlusive vasculitis that can lead to disc edema. Lymphoma/Leukemia: Always keep masquerades in the back of your mind if the uveitis is recalcitrant to steroids and the disc looks infiltrated rather than just edematous. Pro-tip for the Resident: Always distinguish between papillitis (decreased vision, RAPD, color vision loss) and passive disc oedema (vision often preserved initially). This helps localize whether the nerve is inflamed or just swollen from the surrounding environment. #MedTwitter #ophthalmology #neetpg Image @uiowa

A new imaging option for optic disc drusen could help quantify disease progression. Read: ow.ly/W9aJ50YxT6U #AAO #Ophthalmology #neuroophthalmology

caution against routinely using the untreated fellow eye as a control in trials or natural-history analyses. The low r² values (<26% explanation of variability ) show that a lot of the growth-rate differences between eyes are driven by factors other than simple biological symmetry.

Posterior staphyloma in a high myope. Note epiretinal membrane and very thin choroid.

ASSOCIATION BETWEEN ANTIBIOTIC PROPHYLAXIS AND ENDOPHTHALMITIS AFTER INTRAVITREAL INJECTION: A Systematic Review and Meta-Analysis Liu, Xiao MS; et. al. Retina 46(4):p 566-574, April 2026. | DOI: 10.1097/IAE.0000000000004687 ow.ly/QnZQ50YC3jP #retina #EyeHealth

Have you tried oral fluorescein angiography? Researchers say this new method may eliminate many issues with the IV approach. 🔗 Learn more: retina-specialist.com/article/optimi… #retina #retinaspecialist #ophthalmology #ophthalmologist #eyecare #eyedoctor

Safa Rahmani, MD, provided advice on the transition to practice. Some skills are more important than you think, such as communication, complication management, surgical judgement, and practice politics. @dukeeyecenter @YoungMDConnect @DukeMedSchool #retina #DukefAVS2026

Eleonora Lad, MD, PhD, provided a review of complement inhibition for GA, including the possible vision preservation and potential adverse events. @dukeeyecenter @YoungMDConnect @DukeMedSchool #retina #DukefAVS2026

Big data helped Mathew MacCumber, MD, PhD, better understand PVR risk factors; patients with an RD with PVR in one eye who experienced an RD in the second eye have a 3.5 higher risk of PVR in the fellow eye. @dukeeyecenter @YoungMDConnect @DukeMedSchool #retina #DukefAVS2026

Prithu Mettu, MD, kicked off the morning lectures with best practices in treating wet AMD. Most clinicians adhere to a treat-and-extend approach, he said, but new therapies are shifting practice patterns. @dukeeyecenter @YoungMDConnect @DukeMedSchool #retina #DukefAVS2026

Miguel A. Materin, MD, discussed intraocular lumps and bumps. If it’s not melanoma, what is it? This is a retinal astrocytic hamartoma. @dukeeyecenter @YoungMDConnect @DukeMedSchool #retina #DukefAVS2026

Arpita S. Maniar, MD, used cases to demonstrate the benefit of using PDT to treat various ocular tumors. @dukeeyecenter @YoungMDConnect @DukeMedSchool #retina #DukefAVS2026

At a recent #Retinaws meeting in Amman, Dr. Khalid Al Sabti shared a video of his approach to a case of a giant retinal tear with the use of subretinal perfluorocarbon liquid. Watch this and more videos from the meeting on Eyetube: ow.ly/38H950YvQJx

Central serous retinopathy in female who is 5 months pregnant.

Study shows that worse baseline vision, greater retinal thickness, & delayed corticosteroid therapy were associated with refractory #VogtKoyanagiHarada disease, whereas bacillary layer detachment was not. These findings support the importance of early intensive management, particularly in patients with severe initial findings. ow.ly/qVxZ50YlU1K #ophthalmology

Proliferative vitreoretinopathy goes through five distinct phases in its development cycle: 1) Ischemic 2) Inflammatory 3) Retinal apoptotic 4) Cell migratory and proliferation 5) Scar contraction Learn more: retina-specialist.com/article/inflam… #retina #retinaspecialist #ophthalmology

We have two seminars this week! Our second is presented by Assoc. Prof Brian Hafler from @YaleOph on Thursday 5th March at 1pm, hosted by Dr Madhvi Menon of @UoM_DIIIRM. As ever, details on poster - all welcome! 🧠

Can photobiomodulation regulate dry AMD? Here, Tiago Rassi, Daniel Berinstein, & Michael Colucciello, examine the evidence behind PBM following FDA authorization of the Valeda system and debate whether the benefits reflect true treatment effects. ow.ly/BTzC50Yp5nQ

OCT-Based Evaluation of Vitreous Haze in the First-Line Antimetabolites as Steroid-Sparing Treatment (FAST) Uveitis Trial. Learn more: ophthalmologyscience.org/article/S2666-… @EdmundTsuiMD #ophthalmology #uveitis #aao