Dr Nick Andrew, Glaucoma Surgeon
Minimally Invasive Glaucoma Surgery (MIGS)
Dr Nick Andrew is an eye surgeon with a special interest in glaucoma. He has been trained in state-of-the-art glaucoma management including minimally-invasive glaucoma surgery (MIGS) and glaucoma laser treatments. He has undertaken two specialist glaucoma fellowships including the GAASS fellowship in Toronto with Dr Ike Ahmed.
Glaucoma is an irreversible, potentially blinding disease that affects a large number of Australians. He believes that the goal of glaucoma management is not an intraocular pressure but your quality of life.
Dr Nick Andrew can help you with your glaucoma
Do you wish to reduce or eliminate eyedrops?
Are your eyes sore or red?
Is your eye pressure uncontrolled?
Is your glaucoma progressing?
Are you interested in micro-invasive glaucoma surgery (MIGS)?
Minimally Invasive Glaucoma Surgery (MIGS)
Minimally-invasive glaucoma surgery (MIGS) comprises highly targeted procedures with very specific mechanisms of action. The key to success is selecting the correct procedure for the correct patient, combined with meticulous surgical technique. Dr Andrew delivers individualised care tailored to the specific needs of each patient to achieve optimal patient outcomes.
Dr Andrew performs both traditional glaucoma surgeries as well as newer alternatives that can offer improved outcomes for some patients.
Dr Andrew is lead author of a landmark MIGS publication, titled “A Review of Aqueous Outflow Resistance and its Relevance to Micro-invasive Glaucoma Surgery” (Survey of Ophthalmology, Jan 2020). He is also principal author of the largest ever audit of Australian glaucoma practice patterns.
Dr Andrew performs the following glaucoma procedures:
Intermal micro-invasive glaucoma surgeries (MIGS):
- Hydrus glaucoma microshunt, the iStent and iStent inject, iTrack ab interno canaloplasty (ABiC- see Dr Andrew’s blog post), VISCO 360, OMNI 720, Kahook Dual Blade, goniotomy, gonioscopy-assisted transluminal trabeculotomy (GATT).
Glaucoma laser surgeries:
- Selective laser trabeculoplasty (SLT), endocyclo-photocoagulation (ECP), micropulsed cyclodiodelaser, cyclodiode laser.
Glaucoma filtering surgeries (‘blebs’):
- Trabeculectomy, glaucoma tube shunts (Baerveldt, Molteno, and Ahmed tubes), Xen gel stent, and PreserFlo microshunt(formally known as the InnFocus microshunt).
Overview of glaucoma
This video explains glaucoma and intraocular pressure (IOP).
Selective Laser Trabeculoplasty (SLT)
SLT is a non-invasive procedure performed in the clinic to lower intraocular pressure. Low dose pulses of light energy are used to stimulate the trabecular meshwork cells and enhance fluid drainage. SLT typically works for 12-36 months, has an excellent safety profile and can be repeated.
The hydrus microstent is a device that stents open the drainage channel of the eye, which is known as Schlemm’s Canal. It is 8mm long (approximately the size of an eyelash).
The iStent was the first micro-invasive glaucoma surgery (MIGS) device and is the smallest medical appliance in the world at just 360µm in size. It enhances fluid outflow into Schlemm’s Canal, which is the main drainage channel of the eye.
iTrack from Nova Eye
The iTrack is a flexible illuminated micro catheter that is just 220µm in width. It is used to cannulate Schlemm’s Canal and flush the drainage pathways of the eye. It is a versatile device that can also perform other micro-invasive glaucoma procedures such as Gonioscopy-Assisted Transluminal Trabeculotomy (GATT). Ellex is an Australian company and a world leader in advanced technology and innovation. Read more about iTrack in my blog.
Xen gel stent
The Xen gel stent is a soft micro-tube 6mm in length with a 45µm lumen. It is made from cross-linked gluteraldehyde (derived from collagen) that is well suited to the eye. It is used to create a new drainage system that shunts fluid under the tissues behind the upper eyelid. Dr Nick Andrew gave a presentation on surgical technique for the Xen gel stent at the 2019 Annual Congress of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO). This is the largest regional meeting for both glaucoma specialists and general ophthalmologists.
Learn more about the Xen gel stent with this information sheet by the Asia Pacific Glaucoma Society.
Trabeculectomy is a traditional glaucoma surgery used to treat glaucoma. During trabeculectomy surgery, the tissues of the eye are fashioned into a pressure-sensitive valve, which allows fluid to slowly drain from the eye. Although newer techniques have now emerged, trabeculectomy is still a common glaucoma surgery.
Glaucoma Drainage Tubes
Glaucoma tubes are a robust way of controlling eye pressure. They are made of silicone and drain fluid from the front of the eye, along a tube into a reservoir, from where it absorbed into the tissues behind the eye. Glaucoma drainage tubes are typically used in eyes that have risk factors for scarring and where other techniques are unlikely to be successful.
Learn more about glaucoma tube shunts from this information sheet provided by the International Glaucoma Association.
For all appointments and enquiries, please contact
Sight Specialists, Gold Coast.