Q4 2025 Glaukos Corp Earnings Call

February 17, 2026

Speaker #2: All lines have been placed on mute to prevent any background noise. After the speakers' remarks, there will be a question-and-answer session. If you would like to ask a question during that time, simply press star, then the number 1 on your telephone keypad.

Speaker #2: I would now like to turn the call over to Chris Lewis, Vice President of Investor Relations and Corporate Affairs. Chris, please go ahead. Thank you, and good afternoon.

Chris Lewis: Thank you, and good afternoon. Joining me today are Glaukos Chairman and CEO, Tom Burns, President and COO, Joe Gilliam, and CFO, Alex Thurman. Similar to prior quarters, the company has posted a document on its investor relations website under the Financials and Filings, Quarterly Results section titled Quarterly Summary. This document is designed to be read by investors before the regularly scheduled quarterly conference call. To ensure ample time and opportunity to address everyone's questions, we request that you limit yourself to one question and one follow-up. If you still have additional questions, you may get back into the queue. Please note that all statements other than statements of historical facts made on this call that address activities, events, or developments we expect, believe, or anticipate will or may occur in the future are forward-looking statements.

Speaker #2: Joining me today are Glaukos Chairman and CEO, Tom Burns; President and COO, Joe Gilliam; and CFO, Alex Thurman. Similar to prior quarters, the company has posted a document on its investor relations website under the Financials and Filings Quarterly Results section titled 'Quarterly Summary.' This document is designed to be read by investors before the regularly scheduled quarterly conference call.

Speaker #2: To ensure ample time and opportunity to address everyone's questions, we request that you limit yourself to one question and one follow-up. If you still have additional questions, you may get back into the queue.

Speaker #2: Please note that all statements, other than statements of historical facts made on this call that address activities, events, or developments we expect, believe, or anticipate will or may occur in the future, are forward-looking statements.

Speaker #2: These include statements about our plans, objectives, strategies, and prospects regarding, among other things, our sales, products, pipeline technologies, and clinical trials; U.S. and international commercialization; market development efforts; product approvals; the efficacy of our current and future products; competitive market position; regulatory strategies; reimbursement for our products; financial condition; and results of operations.

Chris Lewis: These include statements about our plans, objectives, strategies, and prospects regarding, among other things, our sales, products, pipeline technologies, and clinical trials, US and international commercialization, market development efforts, product approvals, the efficacy of our current and future products, competitive market position, regulatory strategies, and reimbursement for our products, financial condition, and results of operations, as well as the expected impact of general macroeconomic conditions, including foreign currency fluctuations on our business and operations. These statements are based on current expectations about future events affecting us and are subject to risks, uncertainties, and factors relating to our operations and business environment, all of which are difficult to predict and many of which are beyond our control. Therefore, they may cause our actual results to differ materially from those expressed or implied by forward-looking statements.

Speaker #2: As well as the expected impact of general macroeconomic conditions, including foreign currency fluctuations, on our business and operations. These statements are based on current expectations about future events affecting us and are subject to risks, uncertainties, and factors relating to our operations and business environment.

Speaker #2: All of which are difficult to predict, and many of which are beyond our control. Therefore, they may cause our actual results to differ materially from those expressed or implied by forward-looking statements.

Speaker #2: Please review today's press release and our recent SEC filings for more information about these risk factors. You'll find these documents in the investor section of our website at www.glaucos.com.

Chris Lewis: Please review today's press release and our recent SEC filings for more information about these risk factors. You'll find these documents in the investor section of our website at www.glaukos.com. Finally, please note that during today's call, we will also discuss certain non-GAAP financial measures, including results on an adjusted basis. We believe these financial measures can facilitate a more complete analysis and greater transparency into Glaukos's ongoing results of operations, particularly when comparing underlying results from period to period. Please refer to the tables in our earnings press release available in the investor relations section of our website for a reconciliation of these measures to their most directly comparable GAAP financial measure. With that, I will turn the call over to Glaukos Chairman and CEO Tom Burns.

Speaker #2: Finally, please note that during today's call, we will also discuss certain non-GAAP financial measures, including results on an adjusted basis. We believe these financial measures can facilitate a more complete analysis and greater transparency into Glaukos's ongoing results of operations.

Speaker #2: Particularly when comparing underlying results from period to period. Please refer to the tables and our earnings press release, available in the investor relations section of our website, for a reconciliation of these measures to their most directly comparable GAAP financial measure.

Speaker #2: With that, I will turn the call over to Glaukos Chairman and CEO, Thomas Burns.

Speaker #3: Okay, thanks, Chris. Good afternoon, and thank you all for joining us. Today, Glaukos reported record fourth-quarter consolidated net sales of $143.1 million, consistent with our pre-announcement last month and up 36% on a reported basis and 34% on a constant currency basis.

Tom Burns: Okay, thanks, Chris. Good afternoon, and thank you all for joining us. Today, Glaukos reported record Q4 consolidated net sales of $143.1 million, consistent with our pre-announcement last month, and up 36% on a reported basis and 34% on a constant currency basis versus the year ago quarter. For the full year of 2025, consolidated record net sales of $507.4 million, grew 32% versus 2024. We are also reaffirming our full year 2026 net sales guidance range of $600 to 620 million, which implies continued strong year-over-year growth of more than 20% at the midpoint.

Speaker #3: Versus the year-ago quarter. For the full year 2025, consolidated record net sales of $507.4 million grew 32% versus 2024. We are also reaffirming our full year 2026 net sales guidance range of $600 to $620 million, which implies continued strong year-over-year growth of more than 20% at the midpoint.

Speaker #3: Our record fourth-quarter and full-year results reflect a highly successful year of global execution across our key commercial and development initiatives, and underscore the dedication of our global teams, the strength of our differentiated technology platforms, and our evolution into a more diversified ophthalmic leader.

Tom Burns: Our record fourth quarter and full year results reflect a highly successful year of global execution across our key commercial and development initiatives, and underscore the dedication of our global teams, the strength of our differentiated technology platforms, and our evolution into a more diversified ophthalmic leader. From a corporate perspective, 2025 was a milestone year. In addition to surpassing half a billion dollars in annual sales, we celebrated our 10th anniversary of our 2015 IPO, surpassed 1,000 employees worldwide, and broke ground on a new facility in Huntsville, Alabama. As we enter into 2026, we are well-positioned to sustain our strong growth momentum, led by 2 transformational growth drivers, including the continued advancement of the interventional glaucoma treatment paradigm with iDose TR, along with the launch of Epioxa, opening up a new paradigm in interventional keratoconus and rare diseases.

Speaker #3: From a corporate perspective, 2025 was a milestone year. In addition to surpassing half a billion dollars in annual sales, we celebrated the 10th anniversary of our 2015 IPO, surpassed 1,000 employees worldwide, and broke ground on a new facility in Huntsville, Alabama.

Speaker #3: As we enter into 2026, we are well positioned to sustain our strong growth momentum, led by two transformational growth drivers: the continued advancement of the interventional glaucoma treatment paradigm with i-DOSE-TR, along with the launch of EpiOxa, opening up a new paradigm in interventional keratoconus and rare diseases.

Speaker #3: These two highly differentiated and durable market opportunities underpin our confidence to deliver a best-in-class growth profile extending well into the next decade, as we continue to invest in and advance a robust, industry-leading pipeline.

Tom Burns: These two highly differentiated and durable market opportunities underpin our confidence to deliver a best-in-class growth profile extending well into the next decade, as we continue to invest in and advance a robust, industry-leading pipeline while remaining disciplined in capital allocation, focusing on ROI-driven investments and cash flow. Our record fourth quarter results are a testament to the progress we continue to make in advancing our mission to transform vision therapies for the benefits of patients worldwide. Within our US glaucoma franchise, we delivered record fourth quarter net sales of $86.4 million on strong year-over-year growth of 53%, driven by growing contributions from iDose TR, which generated sales of approximately $45 million in the fourth quarter.

Speaker #3: While remaining disciplined in capital allocation, focusing on ROI-driven investments and cash.

Speaker #1: Our record fourth quarter results are a testament to the progress we continue to make in advancing our mission to transform vision therapies for the benefit of patients worldwide.

Speaker #1: Within our US , glaucoma franchise , we delivered record fourth quarter net sales of 86.4 million on strong year over year growth of 53% , driven by growing contributions from Idose TR , which generated sales of approximately 45 million in the fourth quarter .

Speaker #1: Iris TR tr positive clinical outcomes continued to generate momentum , with sales of approximately 136,000,000 in 2025 , reflecting strong physician adoption . Reaffirming the compelling patient impact of this game changing therapy Operationally , our teams continue to execute well on all of our plans , focused on growing trained surgeons and accounts , increasing utilization , broadening market access , expanding the clinical evidence and accelerating targeted marketing investments We believe TR remains early in its overall adoption curve , with significant value yet to be unlocked .

Tom Burns: iDose TR's positive clinical outcomes continue to generate momentum, with sales of approximately $136 million in 2025, reflecting strong physician adoption, reaffirming the compelling patient impact of this game-changing therapy. Operationally, our teams continued to execute well on our plans, focused on growing trained surgeons and accounts, increasing utilization, broadening market access, expanding the clinical evidence, and accelerating targeted marketing investments. We believe iDose TR remains early in its overall adoption curve, with significant value yet to be unlocked as we expand market access and build on the progress in 2026 and beyond. Last month, we were pleased to announce that the US FDA approved our NDA labeling supplement, allowing for unlimited re-administration of iDose TR in patients who maintain a healthy cornea.

Speaker #1: As we expand market access and build on the progress in 2026 and beyond Last month , we were pleased to announce that the US , FDA approved our NDA labeling supplement , allowing for unlimited readministration of Idose TR in patients who maintain a healthy cornea .

Speaker #1: We welcome this important labeling enhancement and believe it should help expand access for patients who may benefit from a repeat treatment and provide physicians with greater flexibility in managing their glaucoma patients over time.

Tom Burns: We welcome this important labeling enhancement and believe it should help expand access for patients who may benefit from a repeat treatment and provide physicians with greater flexibility in managing their glaucoma patients over time. With iDose TR as the foundation, our goal to advance and improve glaucoma treatment by driving earlier intervention continues to gain steam as we educate surgeons and thought leaders globally to organically drive this broader evolution in the standard of care for the benefits of patients. While we remain in the early stages of these interventional glaucoma efforts, we are encouraged with the increasing levels of clinical interest for this paradigm-changing evolution. Moving on. Our international glaucoma franchise delivered net sales of $32.8 million on year-over-year growth of 18% on a reported basis and 13% on a constant currency basis.

Speaker #1: With Idose , TR is the foundation our goal to advance and improve glaucoma treatment by driving earlier intervention continues to gain steam as we educate surgeons and thought leaders globally to organically drive this broader evolution in the standard of care for the benefits of patients While we remain in the early stages of these interventional glaucoma efforts , we are encouraged with the increasing levels of clinical interest for this paradigm changing evolution Moving on , our international glaucoma franchise delivered net sales of 32.8 million on year over year growth of 18% on a reported basis and 13% on a constant currency basis .

Speaker #1: This strong growth was once again broad-based, as we continued to scale our international infrastructure and execute our plans to drive MIGS forward as the standard of care in each region and major market in the world.

Tom Burns: This strong growth was once again broad-based as we continued to scale our international infrastructure and execute our plans to drive MIGS forward as the standard of care in each region and major market in the world. As previously discussed, we continue to expect new competitive product trialing headwinds in some of our major international markets as we progress through 2026, partially offset by growing contributions from iStent infinite following its EU MDR certification and associated European commercial launch late last year. And finally, our corneal health franchise delivered net sales of $24 million on year-over-year growth of 12%, including for T-Rex and net sales of $21.4 million.

Speaker #1: As previously discussed, we continue to expect new competitive product trialing headwinds in some of our major international markets as we progress through 2026.

Speaker #1: Partially offset by growing contributions from Infinite Following its EU , MDR certification and associated European commercial launch late last year . And finally , our corneal health franchise delivered net sales of 24 million on year over year growth of 12% , including for Trexan net sales of 21.4 million .

Speaker #1: As you note , during the fourth quarter , we were delighted to announce the FDA approval of Epyaxa , a novel , groundbreaking advancement in corneal cross-linking for the treatment of keratoconus , a rare sight threatening disease that is currently far too often undiagnosed and untreated Interest from the physician community , following approval , has been very encouraging and reinforces our view that with Epyaxa , we are ushering in a new standard of care for keratoconus patients and practitioners .

Tom Burns: As you know, during the fourth quarter, we were delighted to announce the FDA approval of Epioxa, a novel groundbreaking advancement in corneal cross-linking for the treatment of keratoconus, a rare sight-threatening disease that is currently far too often undiagnosed and untreated. Interest from the physician community following approval has been very encouraging and reinforces our view that with Epioxa, we are ushering in a new standard of care for keratoconus patients and practitioners, with the first and only FDA-approved topical drug therapy that does not require removal of the corneal epithelium, the outermost layer of the front of the eye. As a reminder, Epioxa utilizes a proprietary combination of an oxygen-enriched novel therapeutic that is bioactivated by UV light in an incision-free procedure.

Speaker #1: With the first and only FDA-approved topical drug therapy that does not require removal of the corneal epithelium, the outermost layer of the front of the eye.

Speaker #1: As a reminder , Epyaxa utilizes a proprietary combination of an oxygen enriched , novel therapeutic that is bioactivated by UV light . In an incision free procedure It is the result of more than a decade of research focused on slowing or halting the progression of keratoconus , while significantly improving patient comfort and minimizing recovery time .

Tom Burns: It is the result of more than a decade of research focused on slowing or halting the progression of keratoconus, while significantly improving patient comfort and minimizing recovery time to provide a new way forward for patients afflicted with this sight-threatening rare disease. As we've discussed, the FDA approval of Epioxa has allowed us to reset and redefine our go-to-market approach to better address this sight-threatening disease and truly expand patient care and access. Immediately following approval, our cross-functional teams commenced execution of our detailed, methodical, initial commercial launch plans ahead of Epioxa drug availability expected later this quarter. Importantly, with this launch, we plan to substantially increase our investments in patient awareness, education, and access while addressing the long-standing challenges of under-diagnosis and under-treatment that have affected this rare disease community.

Speaker #1: To provide a new way forward for patients afflicted with this sight threatening , rare disease As we've discussed , the FDA approval of EPI , has allowed us to reset and redefine our go to market approach to better address this sight threatening disease and truly expand patient care and access Immediately following approval .

Speaker #1: Our cross-functional teams commenced execution of our detailed , methodical initial commercial launch plans ahead of epilepsy drug availability , expected later this quarter Importantly , with this launch , we plan to substantially increase our investments in patient awareness , education and access while addressing the long standing challenges of Underdiagnosis and Undertreatment that have affected this rare disease .

Speaker #1: Community . Our efforts are designed to support patients and families at every stage , from awareness and diagnosis , through ongoing treatment , making the entire journey as seamless , efficient and patient friendly as possible .

Tom Burns: Our efforts are designed to support patients and families at every stage, from awareness and diagnosis through ongoing treatment, making the entire journey as seamless, efficient, and patient-friendly as possible over time. As with all pharmaceutical launches, initial patient access will be gated by our site of care network deployment and typical payer adoption headwinds and hurdles, but we're investing in the infrastructure, teams, and processes necessary to get Epioxa to as many patients as possible in 2026 and beyond. We've been encouraged by the progress we've made in short order following approval. First, I'm proud to report we are ahead of schedule in establishing our Epioxa sites of care network. Our early wave one efforts are yielding results, with acquired O2N systems already actively deployed at locations covering nearly 50% of the US population....

Speaker #1: Over time, as with all pharmaceutical launches, initial patient access will be gated by our site of care network deployment and typical payer adoption headwinds and hurdles, but we're investing in the infrastructure, teams, and processes necessary to get to as many patients as possible as soon as possible.

Speaker #1: In 2026 and beyond . We've been encouraged by the progress we've made . In short order , following approval . First , I'm proud to report we are ahead of schedule in establishing our sites of care network .

Speaker #1: Our early wave one efforts are yielding results, with acquired O2N systems already actively deployed at locations covering nearly 50% of the U.S. population, and a broader pipeline of systems moving through the approval processes that would expand our treatment center reach closer to 90%.

Tom Burns: and a broader pipeline of systems moving through the approval processes that would expand our treatment center reach closer to 90%. Looking ahead, we will continue evolving this network to bring treatment access closer to patients as reimbursement and drug acquisition pathways become further established and streamlined. Next, on the market access front, we have completed our initial payer communications and updated key payer databases with the details associated with the Epioxa, Epioxa launch. Our payer team is already actively engaged today with insurers, representing approximately 50% of commercially covered lives in the United States, including 4 of the top 5 commercial payers. As a result, we have seen several early positive coverage determinations spanning across the Medicaid and commercial payer landscape. We successfully submitted for the permanent J-code and expect it to become effective in July 2026, based on the CMS cycle for J-codes.

Speaker #1: Looking ahead , we will continue evolving , evolving this network to bring treatment access closer to patients as reimbursement and drug acquisition pathways become further established in streamlined Next on the market access front , we have completed our initial payer communications and updated key payer databases with the details associated with the launch .

Speaker #1: Our payer team is already actively engaged today with insurers representing approximately 50% of commercially covered lives in the United States, including four of the top five commercial payers.

Speaker #1: As a result , we have seen several early positive coverage determinations spanning across the Medicaid and commercial payer landscape . We successfully submitted for the permanent J code and expect it to become effective in July of 2026 , based on the CMS cycle .

Speaker #1: For J codes, until then, we anticipate it will be commercially available under a new technology miscellaneous J code, and anticipate measured adoption over this initial period until the permanent J code is in place.

Tom Burns: Until then, we anticipate Epioxa will be commercially available under a new technology miscellaneous J-code and anticipate measured adoption over this initial period until the permanent J-code is in place. In addition, we've also rolled out various new patient services and support programs led by our patient access liaison teams, designed to streamline care coordination, demystify the insurance approval process, and advance coverage decisions where possible. Our teams are also deploying new marketing and DTC campaigns designed to significantly enhance awareness, education, and detection, driven by increased engagement with the optometric community, the development of a handheld KC screening device, and expanded advocacy partnerships alongside new patient education efforts to identify and reach patients earlier. Finally, as we've discussed with the launch of Epioxa, a critical focus of ours is to improve patient access to the sight-saving keratoconus treatment.

Speaker #1: In addition , we've also rolled out various new patient services and support programs led by our Patient Access Liaison Teams , designed to streamline care coordination , demystify the insurance approval process , and advance covered decisions where possible .

Speaker #1: The teams are also deploying new marketing and DTC campaigns designed to significantly enhance awareness, education, and detection, driven by increased engagement with the optometric community.

Speaker #1: The development of a handheld Casey screening device and expanded advocacy partnerships alongside new patient education efforts to identify and reach patients . Earlier Finally , as we've discussed with the launch of Epyaxa , a critical focus of ours is to improve patient access to the site , saving care treatment .

Speaker #1: On that front, we have successfully deployed a new financial copay assistance program for eligible patients and operationalized the comprehensive specialty pharma option available for our customers at launch.

Tom Burns: On that front, we have successfully deployed a new financial co-pay assistance program for eligible patients and operationalized a comprehensive specialty pharma option available for our customers at launch. As you can see, we are very excited by the significant potential Epioxa offers to patients living with keratoconus, and believe it will deliver exceptional value to patients, providers, and the healthcare system. This enthusiasm was on full display during our recent national sales meeting, where anticipation for Epioxa's availability later this quarter was palpable. We're proud to lead the way once again in forging a new path to drive expanded patient access and enhance treatment standards. Beyond Epioxa, we continue to advance a broad and differentiated clinical pipeline across our five novel therapeutic platforms with several notable milestones.

Speaker #1: As you can see , we are very excited by the significant potential for OXA offers to patients living with keratoconus and believe it will deliver an exceptional value to patients , providers and healthcare system This enthusiasm was on full display during our recent national sales meeting , where anticipation for availability later this quarter was palpable We're proud to lead the way once again in forging a new path to drive expanded patient access and enhanced treatment standards beyond Epyaxa , we continue to advance a broad and differentiated clinical pipeline across our five novel therapeutic platforms , with several notable milestones within our Estén surgical glaucoma platform .

Tom Burns: Within our iStent surgical glaucoma prep platform, we completed patient enrollment in a PMA pivotal trial for iStent infinite in mild to moderate glaucoma patients during Q4 and continue to advance a 510(k) pivotal study for the Preserflo MicroShunt. Within our iDose platform, patient enrollment is well underway in the Phase 2B/3 clinical program for iDose TREX, our next generation iDose therapy, with initial results of our Phase 2A clinical trial demonstrating substantial IOP reductions of 8.6 to 10.8 mmHg through 3 months. In addition, we recently commenced a Phase 3B study for iDose Trio and continue to advance several Phase 4 studies.

Speaker #1: We completed patient enrollment in a PMA pivotal trial for iStent infinite in mild to moderate glaucoma patients during the fourth quarter and continue to advance a five-pivotal study for the Pressure Flow MicroShunt within our iDose platform. Patient enrollment is well underway in the Phase 2b3 clinical program for iDose TR-ex.

Speaker #1: Our next-generation iDose therapy, with initial results of our phase two clinical trial, demonstrates substantial IOP reductions of 8.6 to 10.8 millimeters of mercury through three months.

Speaker #1: In addition, we very recently commenced a Phase 3b study for iDose TR and continue to advance several Phase 4 studies within our iLink platform.

Tom Burns: Within our iLink platform, we plan to bring a KC treatment screening tool to market later this year and initiate a Phase 3 program for our 3rd gen iLink therapy next year. Within our iLucion platform, we commenced a Phase 2 study for iLucion demodex blepharitis in Q4. Finally, within our retinal platform, we recently completed enrollment in a first-in-human clinical development program for GLK-401, our intravitreal multikinase inhibitor retinal program in patients with wet AMD. Despite being a relatively young company, Glaukos has invested over $1 billion in R&D since inception to develop a robust pipeline focused on chronic and rare ophthalmic diseases. Our continued investment in R&D remains best in class, underscoring our commitment to going first and advancing the standard of care for ophthalmic patients worldwide into the future.

Speaker #1: We plan to bring a KC screening tool to market later this year and initiate a Phase 3 program for our third-gen iLink therapy next year.

Speaker #1: Within our Elution platform , we commenced a phase two study for elution Demodex Blepharitis . In the fourth quarter and finally , within our retinal platform , we recently completed enrollment in a first in human clinical development program for Glk 401 .

Speaker #1: Our intravitreal multikinase inhibitor retinal program and patients with wet AMD. Despite being a relatively young company, Glaukos has invested over $1 billion in R&D since inception to develop a robust pipeline focused on chronic and rare ophthalmic diseases.

Speaker #1: Our continued investment in R&D remains best in class, underscoring our commitment to going first and advancing the standard of care for ophthalmic patients worldwide into the future.

Speaker #1: In conclusion, at Glaukos, we're in the business of pioneering entirely new marketplaces within ophthalmology. Innovation is at the core of everything we do as we advance our mission to transform vision therapies.

Tom Burns: In conclusion, at Glaukos, we're in the business of pioneering entirely new marketplaces within ophthalmology. Innovation is at the core of everything we do as we advance our mission to transform vision therapies that can meaningfully advance the standard of care and improve outcomes for patients suffering from sight-threatening chronic eye diseases. Our mantra, our mantra of "We'll go first" embodies our commitment and determination to take chances, push the limits of science, and disrupt the legacy of treatment paradigms in glaucoma, rare disease, and retinal diseases through our pursuit of game-changing innovation. Our record fourth quarter and full year 2025 highlights the strength of our strategy and execution as we continue evolving into a diversified ophthalmic leader with multiple transformational growth drivers in iDose TR and Epioxa... and advance our mission to transform vision therapies for the benefit of patients worldwide.

Speaker #1: That can meaningfully advance the standard of care and improve outcomes for patients suffering from sight threatening chronic eye diseases . Our mantra , our mantra of will go first embodies our commitment and determination to take chances Push the limits of science , and disrupt the legacy of treatment paradigms in glaucoma , rare disease , and retinal diseases .

Speaker #1: Through our pursuit of game changing innovation . Our record fourth quarter and full year 2025 highlights the strength of our strategy and execution as we continue evolving into a diversified ophthalmic leader with multiple transformational growth drivers in Idose , TR and EPI , OXA and advance our mission to transform vision therapies for the benefit of patients worldwide .

Speaker #1: So with that, I'll open the call for questions. Operator.

Tom Burns: So with that, I'll open the call for questions. Operator?

Speaker #2: At this time, if you would like to ask a question, press star, then the number one on your telephone keypad.

Operator: At this time, if you would like to ask a question, press star, then the number one on your telephone keypad. To withdraw your question, simply press star one again. We will pause for just a moment to compile the Q&A roster. Your first question comes from the line of Tom Steven with Stifel. Please go ahead.

Speaker #2: To withdraw your question, simply press star one. Again, we will pause for just a moment to compile the Q&A roster. Your first question comes from the line of Tom Steven with Stiefel.

Speaker #2: Please go ahead .

Speaker #3: Great . Hey guys , thanks for taking the questions . First one on Foxa . Tom , you mentioned early positive coverage determinations from commercials and Medicaid .

Tom Stephan: Great. Hey, guys. Thanks for taking the questions. First one on Epioxa. Tom, you mentioned early positive coverage determinations from commercials and Medicaid, I believe you said. Can you elaborate on kind of the key highlights here a bit? And then just broadly, to what extent has there been any payer pushback on pricing of Epioxa and, or, the Fotrexa discontinuation?

Speaker #3: I believe you said , can you elaborate on kind of the key highlights here a bit ? And then just broadly to what extent has there been any payer pushback on pricing of EPI , OXA and or the Photrexa discontinuation ?

Speaker #4: Hey , Tom , it's Joe . I'll start off there . If Tom wants to add comments , he certainly can . So from a payer standpoint , it's important to remember that really you start to get a lot more of the coverage policies in place .

Joe Gilliam: Hey, Tom, it's Joe. I'll start off there. If Tom wants to add comments, he certainly can. So from a payer standpoint, it's important to remember that, you know, really you start to get a lot more of the coverage policies in place once you've got drug and channel, and you're actually adjudicating the claims. In the early days, it's all about the clinical education associated with the product, making sure those payers understand, you know, what Epioxa is, what it means for patients, and how that's differentiated from Fotrexa, that they've obviously known for several years now.

Speaker #4: Once you've got drug and channel and you're actually adjudicating the claims . In the early days , it's all about the clinical education associated with the product , making sure those payers understand what it is , what it means for patients and how that's differentiated from photrexa that they've obviously known for for several years now .

Speaker #4: So when he says that there's a positive development in terms of those early policies , it's really because it's even a bit surprising in the context of a normal drug launch here in this case , in pre drug and channel , you're getting positive outcomes with a handful of Medicaid societies as well as with one of the larger blue plans out there .

Joe Gilliam: So when he says that there's a positive development in terms of those early policies, it's really because it's even a bit surprising in the context of a normal drug launch here, in this case, in pre-drug and channel, you're getting positive outcomes with a handful of Medicaid societies, as well as with one of the larger blue plans out there. And so, you know, all of the conversations so far have been much more clinical in nature. We've not heard any formal or informal pushback from payers on the pricing dynamics associated with Epioxa.

Speaker #4: And so , you know , all of the conversations so far have been much more clinical in nature . We've not heard any formal or informal pushback from payers on the pricing dynamics associated with with EPI .

Speaker #4: And so we continue to move forward and and look forward to , obviously , to getting the drug officially launched , if you will , and engaging , you know , on a on a claim by claim basis with these payers and ultimately getting it to a place where many more have the positive coverage determinations that we expect

Joe Gilliam: And so we continue to move forward and look forward, obviously, to getting the drug officially launched, if you will, and engaging, you know, on a claim-by-claim basis with these payers, and ultimately getting it to a place where many more have the positive coverage determinations that we expect.

Speaker #3: Got it . That's great . And then my second question on Idose Joe , maybe to stick with you , can you talk a bit about kind of the key factors that drove the sequential deceleration in revenue in four ?

Tom Stephan: Got it. That's great. Then my second question on iDose. Joe, maybe just stick with you. Can you talk a bit about kind of the key factors that drove the sequential deceleration in revenue in Q4, now that there's been some time to digest? And, and maybe more importantly, you know, what's your level of confidence in continued sequential growth here in the first quarter? Maybe you can speak about how to think about, I guess, iDose growth directionally in Q1, as well as throughout 2026. Thanks.

Speaker #3: Now that there's been some time to digest, and maybe more importantly, what's your level of confidence in continued sequential growth here in the first quarter?

Speaker #3: Maybe you can speak about how to think about, I guess, iDose growth directionally in one quarter, as well as throughout '26.

Speaker #3: Thanks

Speaker #4: Yeah , sure . Tom , I think from a idose perspective in the fourth quarter and we talked a little bit about this at a recent conference .

Joe Gilliam: Yeah, sure, Tom. I think from an iDose perspective in Q4, and we talked a little bit about this at a recent conference, you know, we did see a couple of factors up. So we did continue to grow sequentially and grow nicely. I think it was, you know, north of 10% sequentially. But underlying that were a couple of dynamics worth calling out. The first is that in Q4, and this is a, you know, learning a little bit for us in the context of iDose, the mix shifts a little bit towards Medicare Advantage. There's a lot more volume done in Q4, typically within ophthalmology.

Speaker #4: You know , we did see a couple of factors . Obviously , we did continue to grow sequentially and grow nicely . I think it was north of 10% sequentially .

Speaker #4: But underlying that were a couple dynamics worth calling out . The first is that in the fourth quarter , and this is , you know , learning a little bit for us in the context of idose , the mix shifts a little bit towards Medicare Advantage .

Speaker #4: There's a lot more volume done in the fourth quarter . Typically within ophthalmology . But because a lot of those benefits and I'll call it the patient out-of-pocket dynamics and the related , you tend to see a little bit more on the Medicare Advantage side relative to the fee for service patient population .

Joe Gilliam: But because a lot of those benefits, and I'll call it the patient out-of-pocket dynamics and related, you tend to see a little bit more on the Medicare Advantage side relative to the fee-for-service patient population. And the second was just some specific things to glaucoma and I'll call it our rep incentive, that in looking back, we saw probably a little bit of pull into Q3 and a little bit of pull out into Q4, but on the margin, I think also impacted that. As you think about translating that moving forward, I think what I would say is, we do expect continued progress sequentially into Q1 with iDose, despite it being a seasonally low quarter from procedure volumes.

Speaker #4: And the second was just some specific things to Glaukos Corp. And I'll call it our rep incentives, that in looking back, we saw probably a little bit of pull into Q3 and a little bit of pull out into Q4.

Speaker #4: But on the margin , I think also also impacted that . As you think about translating that moving forward , I think what I would say is we do expect continued progress sequentially into the first quarter with Idose , despite it being a seasonally low quarter from procedure volumes .

Speaker #4: And as for the overall year, which we can talk more about throughout this call, we expect there to be continued sequential improvement each quarter throughout the 2026 time period.

Joe Gilliam: And as the overall year, which we can talk more about throughout here, a matter, we expect there to be continued sequential improvement each quarter throughout the 2026 time period.

Speaker #3: Great . Thanks , Joe

Tom Stephan: Great. Thanks, Joe.

Speaker #2: Your next question comes from the line of Adam Mader with Piper Sandler. Please go ahead.

Operator: Your next question comes from the line of Adam Mader with Piper Sandler. Please go ahead.

Speaker #5: Hi . Good afternoon . Thank you for taking the questions . And congrats on all the progress . Maybe picking up Joe a little bit where we just left off .

Adam Mader: Hi, good afternoon. Thank you for taking the questions, and congrats on all the progress. Maybe picking up, Joe, a little bit where we just left off, wanted to ask about top-line guidance for FY 2026, the $600 to $620 million. And really just hoping you can kind of pull apart some of the different components, whether it's iDose contribution, how you're thinking about the US stent business, and corneal health with Epioxa. You know, any quantitative color would be fantastic, but even just, you know, broad qualitative strokes, you know, such as, "We expect this business to grow or not grow," would be really helpful. And then I had a follow-up. Thanks.

Adam Maeder: Hi, good afternoon. Thank you for taking the questions, and congrats on all the progress. Maybe picking up, Joe, a little bit where we just left off, wanted to ask about top-line guidance for FY 2026, the $600 to $620 million. And really just hoping you can kind of pull apart some of the different components, whether it's iDose contribution, how you're thinking about the US stent business, and corneal health with Epioxa. You know, any quantitative color would be fantastic, but even just, you know, broad qualitative strokes, you know, such as, "We expect this business to grow or not grow," would be really helpful. And then I had a follow-up. Thanks.

Speaker #5: I wanted to ask about top line guidance for FY 26 . The 600 to 620 million , and really just hoping you can kind of pull apart some of the different components , whether it's Idose contribution , how you're thinking about us , stent business and corneal health with OXA , you know , any quantitative color would be fantastic .

Speaker #5: But even just , you know , broad qualitative strokes , you know , such as we expect this business to grow or not grow , would be really helpful .

Speaker #5: And then I had a follow-up. Thanks.

Speaker #4: Yeah . Happy to do that . Adam . And maybe I'll start off and obviously if you follow up questions or others , we can we can dive a little bit deeper .

Joe Gilliam: Yeah, happy to do that, Adam, and maybe I'll start off, and obviously, if you have follow-up questions or others, we can dive a little bit deeper. But if you think about the guidance that we've set and kind of affirmed here today, which is normally a time when we set it for the first time, as many of you know. There's no question 2026 is another pivotal year for us as our efforts, as you heard Tom say, to transform the standard of care in intermittent glaucoma with iDose and iStent infinite are kind of now finally joined by what I'll call a complete reset and expansion of our investment, the launch of Epioxa.

Speaker #4: But as you think about the guidance that we that we've set and kind of affirmed here today , which is normally the time when we set it for the first time , as many of you know , there's no question 2026 is another pivotal year for us as our , you know , our efforts .

Speaker #4: As you heard Tom say, to transform the standard of care in interventional glaucoma with iDose and iNFINITE are kind of now finally joined by what I'll call a complete reset and expansion of our investment in the launch of EPI, OXA.

Speaker #4: And so we were pleased to be able to establish , you know , an initial guidance range of 600 , 620 million , which , you know , at the midpoint represents more than $100 million of growth in this year .

Joe Gilliam: And so we were pleased to be able to establish, you know, an initial guidance range of $600 to 620 million, which, you know, at the midpoint, represents more than $100 million of growth in this year. If you think about it by franchise, I think this is probably the easiest way to start. On the international glaucoma side, we expect high single-digit growth internationally for the year, as competitive launch headwinds really play themselves out in several of the key markets, as we've talked about for a couple of quarters now. And they're somewhat offset by iStent and iStent infinite launches, and the broader interventional glaucoma and market access initiatives that we have going on worldwide.

Speaker #4: As you think about it, by franchise, I think this is probably the easiest way to start on the international glaucoma side. We expect high single-digit growth internationally for the year, as competitive launch headwinds really play themselves out in several key markets.

Speaker #4: As we've talked about for a couple of quarters now. And they're somewhat offset by NICE and iStent infinite launches and the broader interventional glaucoma and market access initiatives that we have going on worldwide.

Speaker #4: I think at the early part of the year, that'll be a little bit higher than that. And then as some of the currency tailwinds wear off, we would certainly expect that to come in a little bit on the back half of the year.

Joe Gilliam: I think in the early part of the year, that'll be a little bit higher than that. And then as some of the currency tailwinds wear off, we would certainly expect that to come in a little bit on the back half of the year. On the US glaucoma side, we expect embedded in the guidance is growth in the 30% range year-over-year, driven entirely by iDose TR. I think as we've said in prior calls, I think it's safe to start off this 2026, assuming that the non-iDose business is flat on a year-over-year basis. And so the entirety of that growth I'm talking about is really being driven by iDose. And that leaves corneal health.

Speaker #4: On the U.S. glaucoma side, we expect, embedded in the guidance, is growth in the 30% range year over year, driven entirely by iDose TR.

Speaker #4: I think as we've said in prior calls , I think it's safe to start off this 2026 , assuming that the non idose business is flat on a year over year basis .

Speaker #4: And so the entirety of that growth I'm talking about is really being driven by by Idose . And that leaves corneal health . And while there are a fair number of I'll call it moving parts associated with the launch of epi OXA in the transition from Photrexa , I think we can confidently say we we continue to expect that the franchise will grow modestly year over year , but with a fair amount of volatility , particularly in Q2 .

Joe Gilliam: And while there are a fair number of, I'll call it moving parts associated with the launch of Epioxa and the transition from Fotrexa, I think we can confidently say we continue to expect that the franchise will grow modestly year over year, but with a fair amount of volatility, particularly in Q2 and as we enter into Q3, as Epioxa becomes available and that permanent J-code is established, you'll see the warehousing effect that we've been thinking about and the sort of delay as those patients are working their way through the approval process and ultimately getting approval and treatment, as we kind of make our way through Q3 and certainly into Q4, where we think that the strongest results will be for that business.

Speaker #4: And as we enter into Q3, as EPI becomes available and that permanent J code is established, you'll see the warehousing effect that we've been thinking about, and the sort of delay as those patients are working their way through the approval process and ultimately getting approval and treatment as we kind of make our way through Q3 and certainly into Q4, where we think that the strongest results will be for that business.

Adam Mader: That's really helpful, Joe. Appreciate all the color. And maybe just for the follow-up, I guess, another modeling question, and just wanted to ask for a little bit more color on, you know, cadence quarterly, realizing you just gave a little bit there. But, you know, for Q1, I have the street modeling, I think $132, $133 million of revenue, which is down sequentially quarter-over-quarter. Just curious if you have any reaction to that figure. And, you know, obviously, Epioxa transition versus Fotrexa, you know, is a little bit, I think, tough to pin down. So any more color you can kind of give us on how you're thinking about sequencing would be appreciated. Thank you.

Adam Maeder: That's really helpful, Joe. Appreciate all the color. And maybe just for the follow-up, I guess, another modeling question, and just wanted to ask for a little bit more color on, you know, cadence quarterly, realizing you just gave a little bit there. But, you know, for Q1, I have the street modeling, I think $132, $133 million of revenue, which is down sequentially quarter-over-quarter. Just curious if you have any reaction to that figure. And, you know, obviously, Epioxa transition versus Fotrexa, you know, is a little bit, I think, tough to pin down. So any more color you can kind of give us on how you're thinking about sequencing would be appreciated. Thank you.

Speaker #5: That's really helpful . Joe , appreciate all the color . And maybe just for the follow up , I guess another modeling question and just wanted to ask for a little bit more color on , you know , cadence quarterly , realizing you just gave a little bit there , but , you know , for Q1 , I have the street modeling , I think 132 133 million of revenue , which is down sequentially quarter over quarter .

Speaker #5: Just curious if you have any reaction to that figure . And , you know , obviously epi oxa transition versus photrexa , you know , is is a little bit , I think , tough to pin down .

Speaker #5: So any more color you can kind of give us on how you're thinking about sequencing would be appreciated. Thank you.

Speaker #4: Yeah . Adam . It obviously is a bit tricky on the cornea side , but I'll zoom out for a second . I think from for 2026 , we'll probably deviate a little bit from those historical norms that you've been around the story for a while .

Joe Gilliam: Yeah, Adam, it obviously is a bit tricky on the cornea side, but I'll zoom out for a second. I think for 2026, we'll probably deviate a little bit from those historical norms that you've been around the story for a while. You know that ophthalmic procedures tend to see seasonality of, you know, call it 22, 23% in the first quarter and 24, 25% in Q2 and Q3, and then 28% ± in Q4. When you look at what's driving it, for us, it's really based on the two primary factors you might expect. With the iDose launch, as I mentioned earlier in the call, we continue to expect sequential growth quarterly throughout 2026.

Speaker #4: You know that ophthalmic procedures tend to see seasonality of call it 22 , 23% in the first quarter , and 24 , 25% in Q2 and Q3 , and then 28% plus or minus in Q4 .

Speaker #4: When you look at what's driving it for us, it's really based on the two primary factors you might expect with the iDose launch.

Speaker #4: As I mentioned earlier in the call , we continue to expect sequential growth quarterly throughout 2026 . That will lead , obviously , to incrementally a more back half weighted , you know , Idose contribution and US glaucoma number .

Joe Gilliam: That will lead, obviously, to incrementally a more back-half weighted, you know, iDose contribution in the US glaucoma number. And then from a corneal health perspective, I alluded to it in your first question, but we expect to see modest growth in Q1 as folks continue to do Fotrexa procedures in advance of Epioxa being available. I think we'll see a fairly material dip in Q2 as we really are in the heart, I'll call it, of the transition from Fotrexa to Epioxa, and those patients are being entered in for the approvals and prior authorizations, but perhaps not treated at the clip that we'll start to see with the J-code and, you know, as we make our way through Q3.

Speaker #4: And then from a corneal health perspective , I alluded to it in your in your first question . But we expect to see modest growth in the first quarter as folks continue to do foot procedures and advance of of of OXA being available .

Speaker #4: I think we'll see a fairly material dip in Q2, as we really are in the heart—I'll call it—the transition from Botox to EP.

Speaker #4: And those patients are being entered in for the approvals and prior authorizations . But perhaps not treated . The clip that we'll start to see with the J-code and , you know , as we make our way through Q3 , I think Q3 will probably be a bit more of a flattish year over year quarter as the J code comes online and you see some of the , the , the , the patients moving out of the funnel and into treatment towards the latter part of that quarter .

Joe Gilliam: I think Q3 will probably be a bit more of a flattish year-over-year quarter, as the J-code comes online and you see some of the patients moving out of the funnel and into treatment towards the latter part of that quarter. And then obviously, implied in that is a pretty strong exit in the fourth quarter as the J-code comes online and we start to see hopefully a little bit more normalized treatment patterns as we're exiting the year and heading into next. And if you think about that, just the first quarter and the way you said, I think the US glaucoma business will probably be, you know, somewhat flat to Q4, as the non-iDose seasonality, you know, headwinds are offset by iDose itself expansion.

Speaker #4: And then, obviously, implied in that is a pretty strong exit in the fourth quarter as a J code comes online, and we start to see, hopefully, a little bit more normalized treatment patterns as we're exiting the year and heading into next.

Speaker #4: And if you take if you think about that just in the first quarter and the way you said , I think the US glaucoma business will probably be , you know , somewhat flat to Q4 as the non seasonality , you know , headwinds are offset by Eidos itself expansion .

Joe Gilliam: Cornea, as I mentioned earlier, will probably be modest growth on a year-over-year basis. And international glaucoma, we'll see. It's more normalized, so I think we'll see the same high single digit to maybe low double-digit growth on a year-over-year basis.

Speaker #4: Cornea , as I mentioned earlier , will probably be modest growth on a year over year basis . In interventional interventional international glaucoma will see its more normalized .

Speaker #4: So I think we'll see the same high single digit to low double digit growth on a year over year basis .

Speaker #5: That's perfect. You gave a lot of great color. I'll leave it there. Thank you.

Adam Mader: That's perfect. You gave a lot of great color. I'll leave it there. Thank you.

Adam Maeder: That's perfect. You gave a lot of great color. I'll leave it there. Thank you.

Speaker #2: Your next question comes from the line of Ryan Zimmerman with BTIG. Please go ahead.

Operator: Your next question comes from the line of Brian Zimmerman with BTIG. Please go ahead.

Speaker #6: Hey , guys . Thanks for taking the questions . I'm going to try and do a little lightning round here and see if I can squeeze a few in and and they should be easy to answer , but the first one is just around the how you think about the interplay between the readministration of existing idose and TRX and just how to think you how you think about whether there's a cannibalistic effect there .

Brian Zimmerman: Hey, guys. Thanks for taking the questions. I'm gonna try and do a little lightning round here and see if I can squeeze a few in. And they should be easy to answer. But, you know, the first one is just around how you think about the interplay between the re administration of existing iDose and T-Rex, and just how to think, you know, how you think about whether there's a cannibalistic effect there. And then, you know, just for clarity, you know, you called out 50% coverage on Epioxa, but I just wanna make sure you don't have 50% covered lives. You're just in dialogue with those payers right now. And I'll just leave it there for now.

Ryan Zimmerman: Hey, guys. Thanks for taking the questions. I'm gonna try and do a little lightning round here and see if I can squeeze a few in. And they should be easy to answer. But, you know, the first one is just around how you think about the interplay between the re administration of existing iDose and T-Rex, and just how to think, you know, how you think about whether there's a cannibalistic effect there. And then, you know, just for clarity, you know, you called out 50% coverage on Epioxa, but I just wanna make sure you don't have 50% covered lives. You're just in dialogue with those payers right now. And I'll just leave it there for now.

Speaker #6: And then, just for clarity, you called out 50% coverage on Foxa. But I just want to make sure—you don’t have 50% covered lives.

Speaker #6: You're just in dialogue with those payers right now, and I'll just leave it there for now.

Speaker #4: Okay . Well , I'll start with the second part of your question . And if Tom wants to jump on Readministration , he can .

Joe Gilliam: Okay. Well, I'll start with the second part of your question, and if Thomas can jump in on re administration, he can. So as it relates to the Epioxa coverage, now remember, in rare disease and unmanaged categories, it's quite common that you won't have any formal coverage policy. You're monitoring actual prior authorizations and approvals to therapy over time to determine that you've actually got access. That access may come in the form of formal coverage policies, and it may come in informal ways, just through simple adjudication patterns, and you'll have the confidence that patients who seek that therapy are able to get it if they qualify.

Speaker #4: So as it relates to the the FDA coverage , now , remember , in Rare disease and unmanaged categories , it's quite common that you won't have any formal coverage policy .

Speaker #4: You're monitoring actual prior authorizations and approvals . The therapy over time to determine that you've actually got access . That access may come in the form of formal coverage policies , and it may come in informal ways , just through simple adjudication patterns and being able to have confidence that patients who seek that therapy are able to get it .

Speaker #4: If they if they qualify . So we're we're ahead of that time . And I think what what Tom was saying in the prepared remarks that we've engaged in a meaningful way in clinical conversations with , with payers that represent over 50% of those of those covered lives .

Joe Gilliam: So we're ahead of that time, and I think what Tom was saying in the prepared remarks, that we've engaged in a meaningful way in clinical conversations with payers that represent over 50% of those covered lives. And as a result, we've even got some early, you know, positive policy wins. It's important to remember that, you know, cross-linking as the standard of care, that's not new, right? We've obviously been at that for some time with Fotrexa and the Epioxa procedure. And so as we move forward here, we certainly expect them to continue to recognize that and provide the access that these patients deserve on a clearly superior therapy in the form of Epioxa.

Speaker #4: And as a result , we've even got some early positive policy wins . It's important to remember that that cross-linking as the standard of care , where that's not new , right ?

Speaker #4: We've obviously been at that for some time with Botox and the procedure. And so, as we move forward here, we certainly expect them to continue to recognize that and provide the access that these patients deserve.

Speaker #4: On on a clearly superior therapy in the form of foxa as it relates to readministration and the interplay between that and Trex , I think as we if you're thinking about that , if the question was meant to go from a long term kind of modeling standpoint , Ryan , you know , clearly the goal has always been to provide patients and surgeons with as many options as possible .

Joe Gilliam: As it relates to re-administration, and the interplay between that and T-Rex, I think if you're thinking about that, if the question was meant to go from a long-term kind of modeling standpoint, Ryan, you know, clearly the goal has always been to provide patients and surgeons with as many options as possible. And depending upon the disease severity and where things are at clinically, we certainly expect different surgeons to have different algorithms around whether they choose to re-administer a patient with iDose TR or T-Rex, based upon the clinical profile that exists with T-Rex when we ultimately get it through the FDA process that it's there. And when I think about from a modeling standpoint, Ryan, the part of that is to think about, you know, obviously, there's a trade-off there potentially on duration.

Speaker #4: And depending upon the disease severity and where things are at clinically, we certainly expect different surgeons to have different algorithms around whether they choose to re-administer a patient with ETOAC.

Speaker #4: TR or T-Rex, based upon the clinical profile that exists with T-Rex. When we ultimately get it through the FDA process and it's there.

Speaker #4: And I think about it from modeling standpoint , Ryan , that part of that is to think about , you know , obviously there's a trade off there potentially on duration .

Speaker #4: We have to prove that through the clinical trials . And there's the pricing considerations around a longer acting therapy as well . And ultimately , I think where we land is most importantly , we now or hopefully with approval of T-Rex , we have multiple options for patients to remain on sustained pharmaceutical therapies for the duration of their their life , if you will , with the disease , which the average patient from , from diagnosis till no longer needs , therapy will be in a in a glaucoma surgeons care for over 20 years .

Joe Gilliam: We have to prove that through the clinical trials, and there's the pricing considerations around a longer-acting therapy as well. And ultimately, I think where we land is, most importantly, we now or hopefully with approval of T-Rex, would have multiple options for patients to remain on sustained pharmaceutical therapies for the duration of their life, if you will, with the disease. Which the average patient from diagnosis till no longer needs a therapy, will be in a glaucoma surgeon's care for over 20 years. So multiple, you know, shots to continue to treat these patients, whether it's with T-Rex or TR.

Speaker #4: So multiple shots to continue to treat these patients , whether it's with T-Rex or TR

Speaker #6: And Joe , just a follow up . Are you going to let Alex just spend uncontrollably for this epic launch ? And I'm wondering if that's a subtle way of asking .

Brian Zimmerman: Joe, just a follow-up. Are you gonna let Alex just spend uncontrollably for this Epioxa launch? I'm wondering if, you know, that's a subtle way of asking Alex, kind of what your thoughts are on operating expense spend in 2026 as you prepare for this Epioxa launch. Because, you know, certainly it's gonna, you know, I think, be a question around, you know, margins and, and operating profit and so forth, which, you know, frankly, I do have you start to show some profitability in late 2026, despite your ability to kind of spend, you know, aggressively here.

Ryan Zimmerman: Joe, just a follow-up. Are you gonna let Alex just spend uncontrollably for this Epioxa launch? I'm wondering if, you know, that's a subtle way of asking Alex, kind of what your thoughts are on operating expense spend in 2026 as you prepare for this Epioxa launch. Because, you know, certainly it's gonna, you know, I think, be a question around, you know, margins and, and operating profit and so forth, which, you know, frankly, I do have you start to show some profitability in late 2026, despite your ability to kind of spend, you know, aggressively here.

Speaker #6: Alex , kind of what your thoughts are on operating expense spend in 26 as you prepare for this launch ? Because , you know , certainly it's going to you , I think be a question around , you know , margins and operating profit and so forth , which , you know , frankly , I do have you start to show some profitability in late 26 , despite your ability to kind of spend aggressively here .

Speaker #7: Well , let me step in before Joe speaks for me . Ryan and address the three questions that he asked . So let's talk about opex first and foremost .

Alex Thurman: Let me step in before Joe speaks for me, Ryan, and address the three questions he asked. So let's talk about OpEx first and foremost. You know, our philosophy as a corporation still hasn't changed from what we experienced in 2025, which is we're gonna continue to balance our capital investments against our revenues such that we're driving towards cash flow break-even and potentially some cash flow generation over the course of 2026. And with that in mind, you know, you would expect to see our operating expenses have growth next in 2026. If you think about what does that growth look like, what I would tell you today, or what I would guide you to, is somewhere in kind of a mid-teens year-over-year growth percentage off our base of $42 million in 2025.

Speaker #7: You know , our philosophy as a corporation still hasn't changed from what we experienced in 2025 , which is we're going to continue to balance our capital investments against our revenues such that we're driving towards cash flow break even and potentially some cash flow generation over the course of 2026 .

Speaker #7: And with that in mind , you know , you would expect to see our operating expenses have growth in 2026 . If you think about what does that growth look like , what I would tell you today or what I would guide you to , is somewhere in kind of a mid-teens year over year growth percentage off our base of 42 and 2025 .

Speaker #7: That should put you in the neighborhood of operating expenses around 555 to 500 and 60 in 2026 . Now that is still going to show operating leverage in 2026 , which is another of our goals as we continue to march forward within the business and what we're trying to achieve So that's kind of where we're thinking .

Alex Thurman: That should put you in the neighborhood of operating expenses around $555 to 560 in 2026. Now, that is still gonna show operating leverage in 2026, which is another of our goals as we continue to march forward within the business and what we're trying to achieve. So that's kind of where we're thinking. And again, those are the key things that you know, even though you know, we're doing this, we have these two really key growth drivers that we're investing in, in Joe's organization between the iDose launch and the Epioxa launch and that. And then we have what we believe is a best-in-class R&D pipeline that we have to invest in as well. And all, all those things are driving our decisions around our capital allocation.

Speaker #7: And again Those are the key things that , you know , even though , you know , we're doing this , we have these two really key growth drivers that we're investing in .

Speaker #7: And Joe's organization between the launch and the launch and that. And then we have what we believe is a best-in-class R&D pipeline that we have to invest in as well.

Speaker #7: And all those things are driving our decisions around our capital allocation.

Speaker #4: And I think there's no question for for all of us , Ryan , that with the launch and the reset moment , with it comes a significant investment in patient access .

Joe Gilliam: I think there's no question for all of us, Ryan, that with the Epioxa launch and the recent... With this comes a significant investment in patient access, and whether that's on the hub, with the specialty pharmacy, with the DTC investments, or all the various things that are designed to drive, you know, awareness, diagnosis, detection, and ultimately, the pull-through of these patients in as fast a time as possible. We're prepared to make those investments, obviously, within the framework that Alex alluded to.

Speaker #4: And whether that's on the hub with the specialty pharmacy , with the DTC investments or all the various things that are designed to drive awareness , diagnosis , detection and ultimately the pull through of these patients in as fast as time as possible .

Speaker #4: We're prepared to make those investments . Obviously , within the framework that Alex alluded to .

Speaker #6: Yeah . Thank you . Appreciate you taking the questions

Brian Zimmerman: Yeah. Thank you. Appreciate taking the question.

Ryan Zimmerman: Yeah. Thank you. Appreciate taking the question.

Speaker #2: Your next question comes from the line of Larry Biegelsen with Wells Fargo . Please go ahead

Operator: Your next question comes from the line of Larry Biegelsen with Wells Fargo. Please go ahead.

Speaker #8: Good afternoon . Thanks for taking the question . Why on I dose one on OXA . So so on the I dose on the repeat label .

Larry Biegelsen: Good afternoon. Thanks for taking the question. One on iDose, one on Epioxa. So on iDose, on the repeat label, excuse me, how do you think about the percent of de novo patients who will get a second iDose? And how do you think about the potential halo effect of this repeat dosing label to new iDose starts? And I had one follow-up.

Speaker #8: Excuse me. How do you think about the percent of de novo patients who will get a second, II dose? And how do you think about the potential halo effect of this repeat dosing label to new high starts?

Speaker #8: And I had one follow-up.

Speaker #4: Well , I think Larry , from a re-administration we're going to have to watch that , right . In terms of those patients , I mean , certainly , and we've actually already seen our first re-administration happen in the Or , and it's driven by the things that you would hope to hear , which is that the patient themselves was seeking that an early patient who was getting into the area where they would they would potentially benefit from an incremental administration , and they were seeking it because they didn't want to go back on drops .

Joe Gilliam: Well, I think, Larry, from a re-administration side, we're gonna have to watch that, right, in terms of those patients. I mean, certainly, and we've even actually already seen our first re-administration happen in the OR, and it's driven by the things that you would hope to hear, which is that the patient themselves was seeking that, you know, an early patient who was getting into the area where they would potentially benefit from an incremental administration, and they were seeking it because they didn't wanna go back on drops. They appreciated the value, if you will, of having the iDose working for them. And so I think over time, we'll have to continue to monitor that.

Speaker #4: They appreciated the the value , if you will , of of having the idose working for them . And so I think over time , we'll have to continue to monitor that .

Speaker #4: But clearly , if you go back to what I said earlier , if the average patient is in the care of of a glaucoma specialist or a comprehensive doctor for a little over 20 years with the disease , we expect there to be considerable opportunity for , you know , multiple administrations within the same patients over time .

Joe Gilliam: But clearly, if you go back to what I said earlier, if the average patient is in the care of a glaucoma specialist or a comprehensive doctor for a little over 20 years with the disease. We expect there to be considerable opportunity for, you know, multiple re-administrations within the same patients over time. And I think, you know, that can certainly be a significant part of, I'll call it, the overall mix, if you will, relative to first-time therapy. Certainly, as we get further and further out into the planning period.

Speaker #4: And I think that can certainly be a significant part of I'll call it the overall mix , if you will , relative to first time therapy .

Speaker #4: Certainly , as we get further and further out into the the planning period , and I do think that there's a incremental halo effect because at a baseline , surgeons can confidently have the conversation with patients about interventional glaucoma , knowing that they've got tools and solutions , including the repeat administration of idose with those patients to manage their disease .

Joe Gilliam: And I do think that there's a incremental halo effect, because at a baseline, surgeons can confidently have the conversation with patients about interventional glaucoma, knowing that they've got tools and solutions, including the repeat administration of iDose, with those patients to manage their disease that way for hopefully their lifetime.

Speaker #4: That way for hopefully their lifetime.

Speaker #8: That's helpful . Joe , on Epilepsia , can you talk a little bit about , you know , how quickly you expect to upgrade accounts to the new capital equipment and can you put a finer point on when Photrexa is expected to be completely phased out ?

Larry Biegelsen: That's helpful. Joe, on Epioxa, can you talk a little bit about, you know, how quickly you expect to upgrade accounts to the new capital equipment? And can you put a finer point on when Fotrexa is expected to be completely phased out? Thank you.

Speaker #8: Thank you .

Speaker #4: Yeah . As you heard in the prepared remarks , we're already well down that that path of of at least installing the the capital equipment required to administer epi oxa .

Joe Gilliam: Yeah. As you heard in the prepared remarks, we're already well down that path of at least installing the capital equipment required to administer Epioxa, and we would expect that journey to continue. I think as Tom mentioned in the remarks, we've already installed or are installing capital equipment at locations that would cover over 50% of the lives in the United States. And we've got various levels of approvals at various systems and providers, where we'll be north of 90%, as we make our way through here into the launch. So I think we feel really good about where we're at in terms of establishing that foundation, if you will, as we move forward.

Speaker #4: And we would expect that that journey to continue. I think, as Tom mentioned in the remarks, we've already installed or are installing capital equipment at locations that would cover over 50% of the lives in the United States.

Speaker #4: And we've got a various levels of approvals at various systems and providers where we'll be north of 90% . As we as we make our way through here into the launch .

Speaker #4: So I think we feel really good about where we're at in terms of establishing that , that foundation , if you will , as we move forward as it relates to Photrexa and the transition , you know , it makes sense .

Joe Gilliam: As it relates to Fotrexa and the transition, you know, it makes sense, Larry, without getting too specific on dates, that, with a July 1 J-code, we wanna make sure that Fotrexa certainly remains available to physicians through that period. And then, you know, as we make our way into and through the third quarter, we'd expect to transition that more fulsomely over to Epioxa.

Speaker #4: Larry , without getting too specific on dates that with a with a July 1st j-code , we want to make sure that Photrexa certainly remains available to physicians through that period .

Speaker #4: And then as we make our way into and through the third quarter , we'd expect to transition that more fulsomely over to Biaxin .

Speaker #8: Thank you

Larry Biegelsen: Thank you.

Speaker #2: Your next question comes from the line of Alan Gong with J.P. Morgan. Please go ahead.

Operator: Your next question comes from the line of Allen Gong with J.P. Morgan. Please go ahead.

Speaker #9: Hi. Thanks for the question. I just wanted to start with a quick one on iDose. You know, we're roughly halfway through the quarter, and you talked about sequential growth throughout the year and starting in the first quarter as well.

Allen Gong: Hi, thank you for the question. I just wanted to start with a quick one on iDose. You know, we're roughly halfway through the quarter, and you talked about sequential growth throughout the year and starting in Q1 as well. But I guess, you know, Q4 had a little bit of one-time dynamics, so it was a little bit weaker than expected. So when we think about sequential growth, how—like, what's the right baseline, I suppose, to be using in Q4 to then grow off of in Q1? Or is that not the right way to think about it?

Speaker #9: But I guess , you know , fourth quarter had a little bit of one time dynamics . It was a little bit weaker than expected .

Speaker #9: So when we think about sequential growth , how like what's the right baseline , I suppose to be using in fourth quarter to then grow off of in first quarter , or is that not the right way to think about it

Speaker #4: Well , no , I think , Alan , I certainly understand the question . I think that may be getting a little too precise for what we'll cover on a , on a call like this .

Joe Gilliam: Well, I think, Allen, I certainly understand the question. I think that may be getting a little too precise for what we'll cover on a call like this. I think from our standpoint, overall, we gave the guidance that we gave. I gave the color on the Q1 dynamics and that expectation around iDose. I think we've been really pleased with the trending that we've seen so far in the quarter with iDose and the continued expansion thereof. And as you may know and may recall, March tends to be a pretty important month in the Q1. And so we still got that in front of us, but very pleased with what we've seen so far as it relates to iDose.

Speaker #4: I think from our standpoint overall , we gave the guidance that we gave and I gave you the color on the first quarter dynamics and that that expectation around Idose .

Speaker #4: I think we've been really pleased with the trends that we've seen so far in the quarter with Idose and the continued expansion thereof .

Speaker #4: And as you as you may know and may recall , March tends to be a pretty important month in the first quarter . And so we've still got that in front of us .

Speaker #4: But but very pleased with what we've seen so far as it relates to Idose

Speaker #9: Got it . And then I suppose you know your installed base , I think the we've already gotten a few questions on this , but you're installed base of epi oxa h2 n is already it feels like coming a little bit faster than expected .

Allen Gong: Got it. And then I suppose, you know, your installed base, I think the, we've already gotten a few questions on this, but your installed base of Epioxa O2N is already, it feels like, coming a little bit faster than expected. So. And there's clearly a lot of excitement and even, you know, more durability in Fotrexa, than I think us on the street were expecting. So how, like, why wouldn't you be able to convert cases over, you know, fairly quickly, like just converting the cases you were doing on Fotrexa over to Epioxa fairly quickly once you have that J-code?

Speaker #9: So and there's clearly a lot of excitement and even , you know , more durability in photrexa . And I think us on the street were expecting .

Speaker #9: So how like , why wouldn't you be able to convert cases over , you know , fairly quickly , like just converting the cases you were doing on Photrexa over to epi Oxa fairly quickly .

Speaker #9: Once you have that J code,

Speaker #4: Yeah , I think that's a great question , Alan . So I can confirm that our team has done a terrific job of getting ahead of even what our initial planning was around the I'll call it the installation and the procurement process associated with the O two system .

Joe Gilliam: Yeah, I think that's a, that's a great question, Al. So, I can confirm that, our team has done a terrific job of getting ahead of even what our initial planning was around the, I'll call it, the installation and, and the, the procurement process associated with the O2N System, and really establishing the foundation, if you will, from which we can make that happen. The reason why we talk about the guidance in the context of Q2 and Q3 and the various things are there, you got to take a step back first. In the first half, you'll have a miscellaneous code that comes with its own set of unique challenges associated with patient access and working your way through.

Speaker #4: And really establishing the foundation, if you will, from which we can make that happen. The reason why we talk about the guidance and the context of Q2 and Q3 and the various things that are there, you’ve got to take a step back first.

Speaker #4: In the first half , you'll have a miscellaneous code that comes with its own set of unique challenges associated with patient access and working your way through the approval processes can be a bit elongated at times .

Joe Gilliam: The pre-approval processes can be a bit elongated at times when you're using the miscellaneous code. And then once you have the J-code established, there's the various, you can imagine, payer notifications and things that go alongside of that. The combination of those things, alongside of just the early days of the approval process in any rare disease, let alone, you know, in this case, Epioxa, means that you're gonna have a fair amount of patient conversation that translates into, I'll call it, warehousing.

Speaker #4: When you're when you're when you're using the miscellaneous code , and then once you have the J code established , there's the various you can imagine payer notifications and things that go that .

Speaker #4: The combination of those things alongside of just the early days of the approval process in any rare disease , let alone , you know , in this case , epi oxa means that you're going to have a fair amount of patient conversation that translates into , I'll call it warehousing .

Speaker #4: It's not really warehousing , but as they're going into the approval processes , we certainly expect those approval processes to be much more elongated as we're trying to go through that because of the miscellaneous code , because of the conversion to J code , because of what you expect in terms of the initial technical denials and then having to overcome those through appeals and peer to peer and all the things that go alongside of that , it just means that you'll probably have a bit of a of a gap , if you will , from when those initial patient conversations happen to where you start to see a hopefully a more normalized , you know , patient pull through dynamic into treated eyes

Joe Gilliam: It's not really warehousing, but as they're going into the approval processes, we certainly expect those approval processes to be much more elongated as they're trying to go through that because of the miscellaneous code, because of the conversion to J-code, because of what you expect in terms of the initial technical denials, and then having to overcome those through appeals and peer-to-peers, and all the things that go alongside of that. It just means that you'll probably have a bit of a gap, if you will, from when those initial patient conversations happen to where you start to see hopefully a more normalized, you know, I'll call it, patient pull-through dynamic into treated Epioxa eyes.

Speaker #2: Your next question comes from the line of David Roman with Goldman Sachs. Please go ahead.

Operator: Your next question comes from the line of David Roman with Goldman Sachs. Please go ahead.

David Roman: ... Thank you. Good afternoon, everybody. I was hoping maybe we could dive in a little bit more on iDose, iDose utilization. I know you've talked about strategically prioritizing iDose standalone cases, but maybe can you give us some flavor on how the different categories of utilization gear evolve through the course of 2025, what your expectations are for 2026, and any considerations coming out of the November CAC meeting that are either reflected in your outlook or that may be percolating behind the scenes?

Speaker #5: Thank you . Good afternoon everybody . I was hoping maybe we could dive in a little bit more on dose utilization . I know you've talked about strategically prioritizing idose standalone cases , but maybe can you give us some flavor on how the different categories of utilization here evolve through the course of 2025 , what your expectations are for 26 and any considerations coming out of the November meeting that that are either reflected in your outlook or that may be percolating behind the scenes ?

David Roman: Thank you. Good afternoon, everybody. I was hoping maybe we could dive in a little bit more on iDose, iDose utilization. I know you've talked about strategically prioritizing iDose standalone cases, but maybe can you give us some flavor on how the different categories of utilization gear evolve through the course of 2025, what your expectations are for 2026, and any considerations coming out of the November CAC meeting that are either reflected in your outlook or that may be percolating behind the scenes?

Speaker #4: Yeah . David , you covered a fair amount of ground in that So maybe I'll start a little bit in reverse as it relates to the the meeting and what that we do or don't expect there .

Joe Gilliam: Yeah, David, you covered a fair amount of ground in that question. So maybe I'll start a little bit in reverse as it relates to the CAC meeting and what we do or don't expect there. I mean, I think so far, this process is really, it's really aligned with kind of our expectations as the MAC, you know, somewhat understandably, want to understand iDose TR better and a goal that hopefully was achieved during the CAC meeting they had late last year. We've not really seen any signs of an LCD. I know there's considerations around that, and continue to believe it will be premature at this stage of the launch.

Speaker #4: I mean, I think so far this process is really, it's really aligned with kind of our expectations, as the max somewhat understandably want to understand iDose TR better, and a goal that hopefully was achieved during the meeting.

Speaker #4: They had late last year. We've not really seen any signs of an LCD. I know there's considerations around that and continue to believe it would be premature at this stage of the launch.

Speaker #4: Of course, these things can be unpredictable and sometimes opaque, so it certainly remains possible, even if it's not probable at this point.

Joe Gilliam: Of course, these things can be unpredictable and sometimes opaque, so it certainly remains possible, even if it's not probable at this point. The guidance that we've given has multiple different, you know, directions we can ultimately achieve that. As it relates to kind of where we saw the trending from 2025 and going into 2026, you know, from a handful of different spots, starting with kind of the MACs, as you can imagine, we continue to see more growth from the MACs, where we have established professional fees.

Speaker #4: And and the guidance that we've given has multiple different directions . We can ultimately achieve that as it relates to kind of where we saw the trending from 2025 and going into 2026 , you know , from a handful of different spots , starting with kind of the max , as you can imagine , we continue to see more growth from the max where we have established professional fees .

Speaker #4: So in that sense , Novitas Meridian , First Coast , we were pleased to see the addition of of NGS to that mix in the latter part of last year .

Joe Gilliam: So in that sense, Novitas, Meridian, First Coast, we were pleased to see the addition of NGS to that mix, in the latter part of last year, and that certainly contributed, as we you know made our way from Q3 into Q4 and continuing into the early part of this year, we see NGS added benefits. You know, we have continued to see a relative percentage of procedures done, you know, where physicians are treating glaucoma at the same time as a cataract procedure increasing. That was expected, given you know we've already changed the standard of care for those patients over a prolonged period of time.

Speaker #4: And that's certainly contributed as we as we , made our way from the third quarter into into the fourth and continuing into the early part of this year , we see NGS added , added benefits .

Speaker #4: You know , we have continued to see , you know , a relative percentage of procedures done . You know , where physicians are treating glaucoma at the same time as cataract procedure increasing .

Speaker #4: That was expected given , you know , we've already changed the standard of care for for those patients over a , over a prolonged period of time .

Speaker #4: And as we enter into 2026 , I think the expectations should be kind of going back to those same things that we knocked down the remaining Max .

Joe Gilliam: And as we enter into 2026, I think the expectations should be, and kind of going back to those same things, that we knock down the remaining MACs. I think at this point, I can confidently say that we're the closest with Palmetto. I think we're on the doorstep there, and hope to see that in the coming, you know, days, if not weeks. And we certainly are making a lot of progress since the beginning of the year with them, as well as with WPS and CGS. And then I think I've mentioned this before, but the other big initiative for us in 2026 is really focused on driving increasing utilization in that broader patient population that's also represented by commercially covered lives as well as Medicare Advantage.

Speaker #4: I think at this point , I can confidently say that we're we're the closest with with Palmetto . I think we're on the doorstep .

Speaker #4: There and hope to see that in the in the coming , you know , days if not weeks . And we we certainly are making a lot of progress since the beginning of the year with , with them as well as with Wpps and KGS .

Speaker #4: And then I think I mentioned this before , but the other big initiative for us in 2026 is really focused on driving increasing utilization in that broader patient population .

Speaker #4: That's also represented by commercially covered lives, as well as Medicare Advantage.

Speaker #5: That's very helpful . And then maybe just a follow up , as you kind of think about the shape of 26 , I know a few others have asked this , but you went down the path of introducing 26 guidance earlier than you would normally do in November .

David Roman: That's very helpful. And then maybe just a follow-up as you kind of think about the shape of 2026. I know a few others have asked this, but you went down the path of introducing 2026 guidance earlier than you normally do in November, and I think that was probably in anticipation of how we might perceive the pricing impact in Epioxa and trying to keep numbers at a reasonable place. But maybe you could just help us think about when you introduced that guidance to now and as you kind of sit here a few months later, what, if anything, has changed? Where do you have more confidence, or where do you see risks that you want to make sure we reflect in the outlook?

Speaker #5: And I think that was probably in anticipation of how we might perceive the pricing impact on FOxA and trying to keep numbers at a reasonable place.

Speaker #5: But maybe you could just help us think about when you introduced that guidance to now . And as you kind of sit here a few months later , what's what , if anything , has changed and where do you have more confidence or where do you see risks that you want to make sure we , we , we reflect in the outlook ?

Speaker #4: Yeah , I think that's a great question . I mean , first , when we introduced it , your your you're correct . I mean with the pronounced change in how we thought about the both the pricing dynamics as well as all the considerations around the market access element of of the transition from Photrexa to Foxa .

Joe Gilliam: Yeah, I think that's a great question. I mean, first, when we introduced it, you're correct. I mean, with the pronounced change in how we thought about the, both the, the pricing dynamics as well as all the considerations around the market access element of, of the transition from Fotrexa to Epioxa, we did want to make sure that folks didn't mistranslate that and get ahead of us in the context of the way we think it'll actually play out on the ground as we make our way through 2026. You know, I think since that time, pretty much across the board, things have probably played out somewhat favorably. But as you can imagine, even inherent in the question, a lot of the things that we're talking about are later in 2026.

Speaker #4: We did want to make sure that folks didn't miss, translate that, and get ahead of us in the context of the way we think it will actually play out on the ground as we make our way through 2026.

Speaker #4: You know , I think since that time , pretty much across the board , things have probably played out somewhat favorably . But as you can imagine , even inherent in the question , a lot of the things that we're talking about are later in 2026 .

Speaker #4: And so whether it's the continued sequential growth and and getting a feel for how that continues to play out in Idose TR or as we've talked , a fair amount about the dynamics , which are really largely weighted towards the second half and even the fourth quarter , it was premature , despite the call it the positive underlying fundamentals of the site of care network for Foxa or the payer progress , or even the trends that we've been seeing with Idose .

Joe Gilliam: So whether it's the continued sequential growth and getting a feel for how that continues to play out in iDose TR, or as we've talked a fair amount about the Epioxa dynamics, which are really largely weighted towards the second half and even the fourth quarter, it was premature, despite all the positive underlying fundamentals of the site of care network for Epioxa or the payer progress, or even the trends that we've been seeing with iDose, I think, to make any adjustments to, you know, our guidance at this early stage.

Speaker #4: I think to make any adjustments to our guidance at this at this early stage

David Roman: Very helpful. Thanks for taking the multi-part questions.

Speaker #5: Thanks for taking the multi-part questions .

Speaker #4: Thanks , David .

Joe Gilliam: Thanks, David.

Speaker #2: Your next question comes from the line of Richard Newitter. Please go ahead.

Operator: Your next question comes from the line of Richard Newitter with Truist. Please go ahead.

Speaker #10: Hi . Thanks for taking the questions . Two for me . I'm just curious , what are you factoring in ? Readministration at all in the sequential improvement in the in the color that you gave on us , glaucoma .

Richard Newitter: Hi, thanks for taking the questions. Two for me. I'm just curious, are you factoring in readministration at all in the sequential improvement in the color that you gave on US glaucoma? And, you know, we can all back into the iDose number. Sounds like you're pretty comfortable with where the consensus is based on your comments. So that's the first question: What, if anything, readministration is even factored in there? And I'll just ask my second one. When you talk about co-pay assistance or market access programs that you're investing in, can you elaborate a little bit more on what exactly you're doing with the specialty pharmacy access to make adoption more fluid for payers and patients or providers and patients? And are you also talking about your ability to move things through the denial process?

Richard Newitter ]: Hi, thanks for taking the questions. Two for me. I'm just curious, are you factoring in readministration at all in the sequential improvement in the color that you gave on US glaucoma? And, you know, we can all back into the iDose number. Sounds like you're pretty comfortable with where the consensus is based on your comments. So that's the first question: What, if anything, readministration is even factored in there? And I'll just ask my second one. When you talk about co-pay assistance or market access programs that you're investing in, can you elaborate a little bit more on what exactly you're doing with the specialty pharmacy access to make adoption more fluid for payers and patients or providers and patients? And are you also talking about your ability to move things through the denial process?

Speaker #10: And , you know , we can all back into the idose number . It sounds like you're pretty comfortable with where the consensus is based on on your comments .

Speaker #10: So that's the first question . What , if anything , for Readministration is even factored in ? There . And I'll just ask my second one when you when you talk about copay assistance or market access programs that you're investing in , can you elaborate a little bit more on what exactly you're doing with the specialty pharmacy ?

Speaker #10: Access to make adoption more fluid for payers and patients, or providers and patients, and are you also talking about your ability to move things through the denial process?

Speaker #10: Does that denial process go away once you have the J code in place ? Now it's a drug . Thanks

Richard Newitter: Does that denial process go away once you have the J-code in place, because now it's a drug? Thanks.

Richard Newitter ]: Does that denial process go away once you have the J-code in place, because now it's a drug? Thanks.

Speaker #4: Sure . Richard , I think I took all that down , but if I didn't miss something , you can , you can , you can circle back .

Joe Gilliam: ... Sure, Richard. I think I took all that down. But if I didn't miss something, you can circle back. I think it's fair to say that readministration was not a material consideration as we thought about the guidance, certainly as we said it back in November, and then, you know, as we've affirmed it here. We're sitting here today, given my earlier comments, we would expect there to be some readministration as we make our way through the year. And some of those very early patients get into the window of where readministration becomes a viable option.

Speaker #4: I think it's it's fair to say that that Readministration was not a material consideration as we thought about the guidance , certainly as we said it back in November .

Speaker #4: And then , you know , as we've affirmed it here , we we sit here today , given my earlier comments , we would expect there to be some readministration as we make our way through the year and some of those very early patients get into the window of where Readministration becomes a viable option .

Speaker #4: I think Readministration becomes a much more material , you contributor to how we think about the business in 2027 , 2028 and beyond than it is to that we're thinking about in 2026 .

Joe Gilliam: I, I think readministration becomes a much more material, you know, contributor to how we think about the business in 2027, 2028, and beyond, than it is to something that we're thinking about in 2026. And, you know, inherent in your question, and I, I from an iDose standpoint, I'll, I'll say it again, there, there are multiple different directions for us to try to achieve the numbers we put out. And, and in the context of both the existing MACs that we've got professional fees established today, the incremental professional fees that we expect to have on schedule, if you will, from the remaining three MACs that represent another 30% of the covered lives out there, or our initiatives that we're, we're certainly investing a whole lot more in on the commercial and Medicare Advantage side.

Speaker #4: And inherent in your question , and I , from an standpoint , I'll say it again , there are multiple different directions for us to try to achieve the numbers we put out and and in the context of both the existing Macs that we've got professional fees established today , the incremental professional fees that we expect to have on schedule , if you will , from the remaining three Macs that represent another 30% of the covered lives out there , or our initiatives that we're certainly investing a whole lot more in on the commercial and Medicare Advantage side , each of those , I think , drive the confidence in the commentary both around the overall guidance as well as the sequential improvement that we expect .

Joe Gilliam: Each of those, I think, drive the confidence in the commentary, both around the overall guidance as well as the sequential improvement that we expect. Now, on Epioxa, and I'll call it the investments we're making, both to drive or optimize patient access as well as, you know, turnaround time. I guess the best way you can say it on some of the support elements is there are always, from a service provider standpoint, you know, good, better, best type programs. And when you launch a rare disease, you clearly have to invest in, quote, unquote, the best, the best from a hub standpoint, the best level of service from a specialty pharmacy standpoint, incentivized maximizing access, and driving the most experienced professionals within those organizations, and the turnaround times associated with them.

Speaker #4: Now , on on Foxa . And I'll call it the investments we're making both to drive or optimize patient access , as well as , you know , turnaround time .

Speaker #4: I guess the best way you can say it on some of the support elements is there are always from a service provider standpoint , you know , good , better , best type programs .

Speaker #4: And when you launch a rare disease , you clearly have to invest in quote unquote , the the best , the best from a standpoint , the best level of service from a specialty pharmacy standpoint .

Speaker #4: Incentivize maximizing access and driving the most experienced professionals within those organizations . And the turnaround times associated with them . I think we've been on record as saying from a copay assistance that , you know , we'll have a $0 copay program for commercially covered lives that you hope that in the vast majority of cases , patients can qualify for that to make sure that that's not an impediment to access .

Joe Gilliam: I think we've been on record as saying from a copay assistance that, you know, we'll have a $0 copay program for commercially covered lives, that you hope that in the vast majority of cases, patients can qualify for that to make sure that that's not an impediment to access. And again, really, all of these things, as well as our broader efforts that we'll have on DTC, provider, and patient education, are all meant to be a substantial increase in the investment we're making to drive the awareness and the detection, and then ultimately, the treatment turnaround time, for those patients who are afflicted with this disease.

Speaker #4: And again , really , all of these things , as well as our broader efforts that we'll have on DTC provider and patient education , are all meant to be a substantial increase in investment .

Speaker #4: We're making to drive the awareness and the detection . And then ultimately , the treatment turnaround time for those patients who are afflicted with this disease

Speaker #2: Your next question comes from the line of Mason Carrico with Stephens . Please go ahead

Operator: Your next question comes from the line of Mason Carrico with Stevens. Please go ahead.

Speaker #11: Hey , guys . Thanks for the questions . Could you quantify the number of sites that have received the equipment to perform at the exit procedures or the numbers that that have committed to it ?

Mason Carrico: Hey, guys. Thanks for the questions. Could you quantify the number of sites that have received the equipment to perform the Epioxa procedures, or the numbers that have committed to it? I know that you called out the O2N system had been deployed to locations covering something like 40% of the population. But should we be interpreting that as a single Epioxa site now covering a much larger geographic area than the average Fotrexa site?

Speaker #11: I know that you called out the O2 system had been deployed to locations covering something like 40% of the population, but should we be interpreting that as a single site?

Speaker #11: Now covering a much larger geographic area than the average site.

Speaker #4: Yeah , I mean , I think I'll probably start short stop short of giving the specific numbers around the sites at the in the various things and simply say that , you know , when you when you look at it to your example , if you have a site within the Atlanta metro area , for example , that's , you know , designed to cover that patient population .

Joe Gilliam: Yeah, Mason, I think I'll probably stop short of giving the specific numbers around the sites and the various things, and just simply say that, you know, when you look at it, to your example, if you have a site within the Atlanta metro area, for example, that's, you know, designed to cover that patient population. And again, that's not uncommon. So when you think about the launch, you wanna make sure that you've got the providers who are the best at going through the process we're about to, that are committed to the care and are willing to go through the payer hurdles, if you will, and make sure that they're being properly educated.

Speaker #4: And again , that's not uncommon . So when you when you think about the launch , you want to make sure that you've got the providers who are the best at going through the process .

Speaker #4: We're about to that are committed to the care and are willing to to go through the payer hurdles , if you will , and make sure that they're being properly educated .

Speaker #4: So you you focus your efforts on on those while trying to make sure that you've got the geographic reach that you need . And then over time , you start to supplement that to make sure again , that that patient's don't have to wait an unnecessarily long period of time to get access to care .

Joe Gilliam: So you focus your efforts on those, while trying to make sure that you've got the geographic reach that you need. And then over time, you start to supplement that to make sure, again, that patients don't have to wait an unnecessarily long period of time to get access to care. And so I would expect, and we're happy with where we're at for the initial launch. The wave one customers, you heard Tom reference earlier, are wave one for a reason. And then ultimately, over the, you know, coming, you know, months, quarters, and years, we'll continue to expand that network out and be offering more and more sites within a particular geography to make sure that we're getting the access to those patients.

Speaker #4: And so I would expect we're happy with where we're at for the initial launch . The wave one customers , you heard Tom referenced earlier are wave one for a reason .

Speaker #4: And then ultimately over the coming months , quarters and years , we'll continue to expand that network out and be offering more and more sites within a particular geography to make sure that we're that we're getting the access to those patients .

Speaker #11: Got it. And then on the coverage front, I think you said you're in conversations with four of the five top commercial payers.

Mason Carrico: Got it. And then, on the coverage front, I think you said you're in conversations with 4 of the 5 top commercial payers. Do you believe that you could realistically have a positive coverage decision from one or more of those in 2026? Do you, you know, do you guys have an internal target for the number of covered lives that you could have by year-end?

Speaker #11: Do you believe that you could realistically have a positive coverage decision from one or more of those in 2026 ? Do you , you know , do you guys have an internal target for the number of covered lives that you could have by year end ?

Speaker #4: Yeah . You know , Mason , I think I would take a step back to what I was saying earlier . And , you know , we'll see whether or not we have positive coverage , determination , policy and the variety of other things that that help expedite patient access .

Joe Gilliam: Yeah, you know, Mason, I think I would take a step back to what I was saying earlier, and, you know, we'll see whether or not we have a positive coverage determination/policy and the variety of other things that help expedite patient access, you know, in 2026, whether it's with those top payers or others that are out there. The thing that we're watching most closely as we launch is that patients are able to work their way through the approval process, the prior authorization process, with each of these payers and the broader network of payers that are out there, such that we're able to confidently believe that we've got access pathway for the vast, vast majority of patients. That's the initial goal.

Speaker #4: You know , in 2026 with whether it's with those top payers or or others that are out there , the thing that that we're watching most closely as we launch is that patients are able to work their way through the approval process , the prior authorization process with each of these payers and the broader network of payers that are out there , such that we're able to confidently believe that we've got access , a pathway for the vast , vast majority of patients .

Speaker #4: That's the initial goal . From there , you start to focus more and more on optimization , whether or not they're getting that access through the pharmacy benefit or the medical benefit , whether they're getting that through on the on the initial prior authorization or through the appeal process , and ultimately , whether or not they're achieving that access through an established positive policy that provides the cleanest and clearest pathway for them to get access to the drug

Joe Gilliam: From there, you start to focus more and more on optimization, whether or not they're getting that access through the pharmacy benefit or the medical benefit, whether they're getting that through the initial prior authorization or through the appeal process, and ultimately, whether or not they're achieving that access through an established positive policy that provides the cleanest and clearest pathway for them to get access to the drug.

Speaker #11: Got it . All right . Thanks .

Mason Carrico: Got it. All right, thanks.

Speaker #4: Thanks , Mason .

Joe Gilliam: Thanks, Mason.

Speaker #12: Thanks .

Speaker #2: Your next question comes from the line of David Saxon with Needham . Please go ahead .

Operator: Your next question comes from the line of David Saxon with Needham. Please go ahead.

Speaker #13: Great . Thanks and good afternoon . Maybe two two on the glaucoma business . First on Idose you talked about , you know , commercial cases .

David Saxon: Great. Thanks, and good afternoon. Maybe two on the glaucoma business. First, on iDose, you talked about, you know, commercial cases. So, you know, what are you hearing in terms of doctors starting to really get into that patient population? I mean, is it kind of, you know, more of a trickle, or are you seeing that build? And then the second question is just on the iStent franchise. You talked about flat growth expectations for the year, I think it was. I mean, is that just because of how you're incentivizing the reps? Obviously, iDose is the focus right now, but, you know, what's the view there? Is that more of a market dynamic, or anything around competitive dynamics? Thanks so much.

Speaker #13: So what are you hearing in terms of doctors starting to really get into that patient population ? I mean , is it kind of , you know , more of a trickle or are you seeing that build ?

Speaker #13: And then the second question is just on the iStent franchise. You talked about flat growth expectations for the year, I think it was.

Speaker #13: I mean , is that just because of how you're incentivizing the reps ? Obviously , Idose is a a focus right now , but you know , what's what's the view there ?

Speaker #13: Is that more of a market dynamic or anything around competitive dynamics ? Thanks so much

Speaker #4: Yeah , David , I think so . First , as it relates to the commercial and I lump them in with , you know , Medicare Advantage because obviously those are shepherded by commercial carriers .

Joe Gilliam: Yeah, David, I think so first, as it relates to the commercial, and I, I lump them in with, you know, Medicare Advantage, because obviously those are shepherded by commercial carriers. It's very provider specific. So in those geographies where we've obviously had the proper Medicare fee-for-service coverage for a while, we're starting to see providers turn on where they're offering it to a wider swath of patients. And for those that are, that are good at it, we're seeing them do that in a more fulsome way. Our efforts in 2026 are to really try to expand that in a much more significant and profound way as we make our way through the year. I think about in kind of three, you know, call it key pillars.

Speaker #4: It's very provider specific . So in those geographies where we obviously had the proper Medicare fee for service coverage for a while , we're starting to see providers turn on where they're offering it to a wider swath of patients .

Speaker #4: And for those that are that are good at it , we're seeing them do that in a more fulsome way . Our efforts in 2026 are to really try to expand that in a much more significant and profound way as we as we make our way through the year .

Speaker #4: I think about it in kind of three, you know, call it key pillars. We've been talking a fair amount about payer access on the side.

Joe Gilliam: We've been talking a fair amount about payer access on the Epioxa side. It's obviously relevant on the iDose side as well. The good news is our foundation here is pretty strong. We've seen successful authorizations for therapy and the payment of both the J and the T code from payers that cover the majority of patient lives, including 4 of the 5, in that case as well, largest payers on the Medicare Advantage side. So I think we've got a pretty solid foundation from which to expand in terms of the payer side. The second is process optimization.

Speaker #4: It's obviously relevant on the Ido side as well . The good news is our foundation here is pretty strong . We've seen successful authorizations for therapy and the payment of both the J and the T code from payers .

Speaker #4: That that cover the majority of patient lives , including four of the five in that case as well . Largest payers on the Medicare Advantage side .

Speaker #4: So, I think we've got a pretty solid foundation from which to expand in terms of the payer side. The second is process optimization.

Speaker #4: It's going again , sound fairly familiar ? What we're talking about in OXA , but it's in driving the entire ecosystem from our Idose hub , our Idose SP providers , to the payers and the accounts themselves to reduce the barriers and and increase the patient access and optimize the time to treatment for for patients on that side of the house .

Joe Gilliam: It's gonna again sound fairly familiar when we're talking about Epioxa, but it's in driving the entire ecosystem from our iDose hub, our iDose SP providers, to the payers and accounts themselves to reduce the barriers and increase the patient access and optimize the time to treatment for patients on that side of the house. And then the last thing, which we've talked about, not in a while, but the patient economics. Similarly, we have established programs to support commercially insured patients, where most of them should pay as little as $0 out of pocket.

Speaker #4: And then the last thing which we've talked about , not in a while , but the patient economics . Similarly , we have established programs to support commercially insured patients where most of them should pay as little as $0 out of pocket .

Speaker #4: And then for Ma patients , I think from the very early days of the launch , we've said that the data suggests that about 20% of those patients have no to to low out of pockets in terms of their plan designs .

Joe Gilliam: And then for MA patients, I think from the very, you know, early days of the launch, we've said that the data suggests that about 20% of those patients have no to low out-of-pockets in terms of their plan designs, and then access tends to increase from there throughout the year as patients meet those out-of-pocket requirements on other procedures. So I think we're still in the early innings, but we are seeing obviously encouraging signs on a provider-by-provider basis that we hope to expand as we make our way through 2026.

Speaker #4: And then access tends to increase from there throughout the year as patients meet those out-of-pocket requirements on on other procedures . So I think we're still in the early innings , but we are seeing obviously encouraging signs on a provider by provider basis that we hope to expand as we make our way through through 2026 as it relates to the franchise .

Joe Gilliam: As it relates to the iStent franchise, so it's interesting, obviously, and implied when you go back and have done the work on the Q4 results, you'll probably see or have seen that we actually were, we're back into the growth equation for our non-iDose portion of our US glaucoma business. And we talked about the trending heading this direction, you know, before, and so we were encouraged by the Q4 in that regard, but I think it's a little too early to call it a trend. And really, it is a large part about, I think, the first part of how you asked the question, which is, yeah, there's a lot of rep incentive and focus and company incentive and focus around interventional glaucoma and iDose in particular.

Speaker #4: So, it's interesting. Obviously, as implied, when you go back and have done the work on the fourth quarter results, you'll probably see, or have seen, that we actually were back into the growth equation for our non-dose portion of our U.S. glaucoma business, and we talked about the trending heading in this direction.

Speaker #4: You know , before . And so we were encouraged by the fourth quarter in that in that regard . But I think it's a little too early to to call it a trend .

Speaker #4: And and really it is a large part about , I think , the first part of how you , how you ask the question , which is , you know , there's a there's a lot of rep incentive and focus and company incentive and focus around interventional glaucoma and idose in particular .

Joe Gilliam: So we'll have to see a couple more quarters to determine whether what we saw in Q4 was a trend or an anomaly as it relates to that. And as a result, I think we've said for a little while now, it's safer to just assume that the iStent or broader non-iDose franchise remains flat on a year-over-year basis when assessing our 2026 guidance.

Speaker #4: And so, we'll have to see a couple more quarters to determine whether what we saw in the fourth quarter was a trend or an anomaly as it relates to that.

Speaker #4: And as a result , I think we've said for a little while now , it's safer to just assume that the Istent or broader non dose franchise remains flat on a year over year basis when assessing our 2026 guidance .

Speaker #13: Great . Thanks so much , Joe

David Saxon: Great. Thanks so much, Joe.

Joe Gilliam: Mm-hmm.

Speaker #2: Your next question comes from the line of Danielle Antalffy with UBS . Please go ahead Danielle , your line is open .

Operator: Your next question comes from the line of Danielle Antalffy with UBS. Please go ahead. Danielle, your line is open.

Speaker #14: Oh , sorry about that . Thanks so much for for taking the question . Good afternoon guys . Forgot how to use the mute button just to follow up on on some of some of the questions around Idos and standalone use .

Danielle Antalffy: Oh, sorry about that. Thanks so much for, for taking the question. Good afternoon, guys. Forgot how to use the mute button. Just to follow up on, on some of, some of the questions around iDose and standalone use. I'm just curious, if you look at the business as a, as a whole, so iDose plus iStent infinite, what are you seeing there as far as the shift to, to standalone use? And at a higher level, maybe talk about some of the, the market development lift that's necessary to really, build that, that market, and, and what you're seeing. I know it's early days, but I was at AO, and I felt like there was a big focus on this. So I'm just curious what you can say there. Thanks so much. I'll keep it to one. Thanks.

Speaker #14: I'm just curious if you look at the business as a , as a whole , so idose plus I-stent infinite , what are you seeing there as far as the shift to standalone use ?

Speaker #14: And at a higher level, maybe talk about some of the market development lift that's necessary to really build that market, and what you're seeing.

Speaker #14: I know it's early days , but I was at AAO and I felt like there was a big focus on this . So I'm just curious what you can say there .

Speaker #14: Thanks so much . I'll keep it to one . Thanks .

Speaker #4: Yeah , thanks . Thanks , Danielle . I'm glad you were at EO and you were able to witness that . And I think you'll continue to see more and more of that , whether it's at the upcoming , you know , AGS meeting here later this week or , or Asx's short while later .

Joe Gilliam: Yeah, thanks. Thanks, Danielle. I'm glad you were at AAO, and you were able to witness that. I think you'll continue to see more and more of that, whether it's at the upcoming, you know, AGS meeting here later this week or ASCRS, a short while later. I'll probably start in reverse that, it is a significant investment. We've been at this since the approval of iDose really, in making that happen. It's not our first time going through transforming a marketplace. Obviously, we did it successfully over the course of the last decade for those patients that were that were faced with the disease in combination with cataract surgery.

Speaker #4: And I'll probably start in reverse, that it is a significant investment. We've been at this since the approval of iDose, really, in making that happen.

Speaker #4: It's not our our first time going through transforming a marketplace . Obviously , we did it successfully over the course of the last decade .

Speaker #4: For those were that were faced with the disease in combination with cataract surgery , and really is a combination of of incentive for your sales force alongside of the marketing efforts that we're making .

Joe Gilliam: It really is a combination of incentive for your sales force, alongside of the marketing efforts that we're making, the medical affairs efforts that we're making, the publications and the like. And when you put all that together, and really build upon, I think, the enthusiasm that surgeons have out there for a disease that they know is interventional, is asymptomatic and slowly progressing. And there's a really large patient population in need for a variety of reasons. It's about being on that journey on a consistent basis, at industry conferences and all the moments in between that we engage with those surgeons, and really changing the actual, you know, practice dynamics, and shifting towards the standalone treatment of these patients.

Speaker #4: The medical affairs efforts that we're making the publications and the like , and when you put all that together and really build upon , I think the enthusiasm that surgeons have out there for a disease that they know is interventional is asymptomatic and slowly progressing .

Speaker #4: And there's a really large patient population in need for a variety of reasons . It's about being on that journey on a consistent basis .

Speaker #4: IT industry conferences and all the moments in between that we engage with those surgeons and really changing the actual , you know , practice dynamics and shifting towards the standalone treatment of these patients and aligning the I'll call it the behaviors at the practice level with the clinical belief that exists in the vast majority of the physicians that I'm sure you're speaking to or have spoken with in the past .

Joe Gilliam: And aligning both the behaviors at the practice level with the clinical belief that exists in the vast majority of the physicians that I'm sure you're speaking to or have spoken with in the past. And, you know, when we put all that together, we continue to see substantial growth from standalone procedures, whether that be iDose or iStent infinite. And it's not a big surprise, given everything I've mentioned, as well as the fact that you have a market that's 20 million eyes, 12 million of which are actively diagnosed and treated.

Speaker #4: And , you know , when you put all that together , we continue to see substantial growth from standalone procedures , whether that be idose or Ice .

Speaker #4: And infinite . And it's not a big surprise given everything I've mentioned , as well as the fact that you have a market that's 20 million eyes , 12 million of which are actively diagnosed and treated , and and so , you know , you probably heard us say and certainly , Tom , say at other conferences and the like that over time , we expect that the number of glaucoma procedures done in the United States will exceed the number of cataract surgery patients that are treated .

Joe Gilliam: you know, you've probably heard us say, and certainly Tom say at other conferences and the like, that over time, we expect that the number of glaucoma procedures done in the United States will exceed the number of cataract surgery patients that are treated. It'll take time, but that's ultimately our focus and the reason why we're making such a substantial investment, to the benefit of those patients.

Speaker #4: It will take time , but that's , that's that's our ultimately our focus . And the reason why we're making such a substantial investment to the benefit of those patients .

Speaker #14: Thank you so much

Operator: Thank you so much. Your next question comes from the line of Joanne Lynch with Citibank. Please go ahead.

Speaker #2: Your next question comes from the line of Joanne French with Citibank. Please go ahead.

Speaker #15: Good evening. Thank you for taking the question. I have so many, in no particular order. Are you saying physicians are creating a wait list for Foxa?

Joanne Wuensch: Good evening. Thank you for taking the question. I have so many, in no order. Are you seeing physicians creating a wait list for Epioxa? Would that imply a stronger second half once the J-code is applied or put into place versus the first half? Could you see 2027 or even 2026? And if I do my math correctly, iDose guidance is $225 million for the year. What makes that the right number? And thank you.

Speaker #15: Would that imply a stronger second half once the J code is applied ? Or put into place versus the first half , could you see 20 , 27 , 2026 ?

Speaker #15: And if I do my math correctly, your guidance is $225 million for the year. What makes that the right number?

Speaker #15: And thank you .

Speaker #4: Would you mind repeating that? You cut out a little bit on the 2027 versus 2026 part of your question.

Joe Gilliam: Joanne, do you mind repeating that? You cut out a little bit on the 2027 versus 2026 part of your question.

Speaker #15: Do you think revenue growth in 2027 will be faster than in 2026, given the momentum of OXA?

Joanne Wuensch: Do you think revenue in 2027 growth rate will be faster than 2026, given the momentum of Epioxa?

Speaker #4: Okay , so I'll try to go through those in the order that you asked them . So from an OXA perspective , you know , we are starting to see and we , you know , I'll give you the example .

Joe Gilliam: Okay. So I'll try to go through those in the order you asked them. So from an Epioxa perspective, you know, we are starting to see, and we-- you know, I'll give you an example. We certainly are seeing patients be enrolled in our hub for approval of Epioxa. So inherently in that means that a "wait list" is being created. I don't know that it's enough to "obviously impact our Q1." I think there'll still be enough of Fotrexa there, as I said earlier, to drive, you know, year-over-year growth.

Speaker #4: We certainly we're seeing patients be enrolled in our hub for approvals at the axis . So inherently in that means that a quote unquote waitlist is , is being created .

Speaker #4: I don't know that it's enough to quote unquote obviously impact our first quarter . I think there will still be enough of photrexa there .

Speaker #4: As I said earlier , to to drive , you know , year over year growth . But we do expect that waitlisting dynamic .

Joe Gilliam: But we do expect that wait listing dynamic, if you will, to be, you know, much more material in the second quarter, to the detriment of that for the cornea business and probably the benefit of the latter part of the year, certainly the fourth quarter, perhaps, even the tail end of the third quarter, as those patients start to get approvals, and access the therapy and ultimately treat it. So we absolutely expect the second half to be the key contributor to those results. And as we learn more about that, we'll obviously dial in our expectations, in a much more meaningful way. As we think about 2027 versus 2026, yeah, I probably will stop short of giving, you know, this, at this stage, 2027 guidance implied by the comment.

Speaker #4: If you will, to be much more material in the second quarter, to the detriment of that for the cornea business and probably the benefit of the latter part of the year.

Speaker #4: Certainly the fourth quarter, perhaps the tail end of the third quarter, as those patients start to get approvals and access to the therapy and ultimately treat it.

Speaker #4: So, we absolutely expect the second half to be the key contributor to those results. And as we learn more about that, we'll obviously dial in our expectations in a much more meaningful way.

Speaker #4: As we think about 2027 versus 2026 . Yeah , I probably will stop short of giving , you know , this at this stage , 2027 guidance implied by the comment , but but clearly , you know , you've from us that the combination the one two , if you will , of continued acceleration with idose alongside of of what we hope will be a meaningful acceleration with OXA makes not just 2026 an attractive year , but 2027 and beyond .

Joe Gilliam: But, but clearly, you know, you've heard from us that the combination, the one, two, if you will, of continued acceleration with iDose, alongside of, of what we hope will be a meaningful acceleration, with Epioxa, makes not just 2026 an attractive, year, but 2027 and, and beyond as, as we look out and think about what it could, it could do in terms of, driving our business, and the top line associated with it. I think your last comment was the implied, and we didn't give the exact number, but as you get into the numbers, I think there'll be a range of estimates that come in, in that, that, that general ZIP code. And what makes it the, the, the right number?

Speaker #4: As we look out and think about what it could do in terms of driving our business and the top line associated with it.

Speaker #4: I think your last comment was the implied , and we didn't give the exact number , but as you get into the numbers , I think there'll be a range of estimates that come in in that , that , that general zip code .

Speaker #4: And what makes it the right number . Look , we're always looking at a bell curve of scenarios . The various puts and takes within these and trying to establish guidance both on a macro level as well as on a more macro level that we think is achievable for us .

Joe Gilliam: Look, we're always looking at a bell curve of scenarios, the various puts and takes within these and trying to establish guidance both on a macro level as well as on a more micro level that we think is achievable for us. And in this case, as I've said, you know, previously, I think we've got multiple pathways to both grow and continue to grow sequentially as well as achieve that. And as we make our way through the year, we'll continue, obviously, to update those views and provide them as we go forward here.

Speaker #4: And in this case , as I've said , you know , previously , I think we've got multiple pathways to to both grow and continue to grow sequentially as well as achieve that .

Speaker #4: And as we make our way through the year , we'll continue to update those those views and provide them as we as we go forward here .

Speaker #15: Thank you so much. And thank you for taking my multi-part question.

Joanne Wuensch: Thank you so much, and thank you for taking my multipart question.

Joe Gilliam: Yeah. Thank you, Joanne.

Speaker #12: Thank you

Speaker #2: Your next question comes from the line of Steve Lichtman with William Blair . Please go ahead

Operator: Your next question comes from the line of Steve Lichtman with William Blair. Please go ahead.

Speaker #5: Thanks . Evening , guys . Question on Idose . Can you give us a sense of how many surgeons you trained last year and to date , or even qualitatively , can you talk about where you are in that process and still early to mid innings , any color on that would be helpful ?

Steve Lichtman: Thanks. Evening, guys. Question on iDose. Can you give us a sense of how many surgeons you trained last year and to date? Or even qualitatively, can you talk about where you are in that process, or still early to mid innings? Any color on that would be helpful.

Speaker #4: Yes , Steve . Welcome to William Blair . And I think from a from a surgeon training perspective , it's not really been a focus for us in terms of what we've communicated .

Joe Gilliam: Yes, Steve. Welcome to William Blair. I think from a surgeon training perspective, it's not really been a focus for us in terms of what we communicate to Street, and that's by intention. That's really not the gating or limiting item for us. Our surgeon training activities have been as strong as they've ever been. The vast majority of these surgeons have already been angle trained over the course of the last 10 years of utilizing MIGS technologies. So from a sustained pharmaceutical standpoint, we're good there. And it's really not been the step function that's driving where we're at.

Speaker #4: Street . And that's by intention that that's really not the I'll call it gating or limiting item for us . Our surgeon training activities have been as strong as they've ever been .

Speaker #4: The vast, vast majority of these surgeons have already been trained over the course of the last ten years of utilizing MIGS technology.

Speaker #4: So from a sustained pharmaceutical standpoint , we're good there . And it's really not been , I'll call it the the step function .

Speaker #4: That's driving where we're at . I think broader office administrative related considerations , reimbursement , confidence , professional fee . And then , you know , as we move forward here , bringing commercial and Medicare Advantage online are much more key drivers to where we're at and where we're going .

Joe Gilliam: I think broader office administrative-related considerations, reimbursement, confidence, professional fee, and then, you know, as we move forward here, bringing commercial Medicare Advantage online, are much more key drivers to where we're at and where we're going. But so far, we've been extremely pleased with the pace and the overall ability for our sales force to train these doctors in the OR and get them comfortable with the iDose procedure.

Speaker #4: But so far, we've been extremely pleased with the pace and the overall ability for our sales force to train these doctors in the O.R.

Speaker #4: and get them comfortable with the iDose procedure.

Speaker #5: Makes sense . And then just secondly , I want to actually ask about international glaucoma . You it came in above initial expectations last year despite competitive dynamics .

Steve Lichtman: That makes sense. And then just secondly, I wanted to actually ask about international glaucoma. You know, it came in above initial expectations last year, you know, despite competitive dynamics you flagged going into 25. Do you think there was a delay in some of the competitive headwinds that we could see this year, and that's what's embedded in your 26 thoughts, or just staying on the conservative side? Because it would seem like Infinite could be a nice catalyst there. Thanks.

Speaker #5: You flagged going into 2025. Do you think there was a delay in some of the competitive headwinds that we could see this year?

Speaker #5: And that's what's embedded in your 26 thoughts, or just staying on the conservative side, because it would seem like it could be a nice catalyst there.

Speaker #5: Thanks .

Speaker #4: Yeah . And I think it is a balance and we'll see how it plays out over the course of 2026 . You have competitive insurance in particular in some of our larger markets .

Joe Gilliam: Yeah, and I think it is a balance, and we'll see how it plays out over the course of 2026. You have competitive entrants, in particular, in some of our larger markets. In 2025, it did go a little bit more slowly than maybe we anticipated or certainly built into our forecast. And that's a credit to our teams that operate in those markets and the relationships they've built, and I think the differentiated positioning of our technologies.

Speaker #4: In 2025 . It did go a little bit more slowly than maybe we anticipated , or certainly have built into our forecast . And that's a credit to our teams that operate in those markets and the relationships they've built .

Speaker #4: And I think the differentiated positioning of our technologies as we move forward, we do expect those efforts to continue to accelerate.

Joe Gilliam: As we move forward, we, we do expect those efforts to continue to accelerate, but to your point, they're also balanced against our launch and, and launching of iStent infinite throughout the European region and some of the affiliated markets that, that follow European approvals or clearances, as well as, you know, continued sort of blocking and tackling that we have around opening up markets or markets within markets, and that journey never, never, never stops. So I, I think as we, as we make our way through here, it'll be that interplay. You're, you're right.

Speaker #4: But to your point , they're also balanced against our launch and launching of ice and infinite throughout the European region . And some of the affiliated markets that that follow European approvals or clearances , as well as , you know , continued sort of blocking and tackling that we have around opening up markets or markets within markets .

Speaker #4: And that journey never , never , never stops . So I think as we as we make our way through here , it'll be that interplay .

Speaker #4: You're right . And , you know , coming off of constant currency growth in the fourth quarter of of 13% . And as you heard me say earlier , we expect sort of high single digit to low double digit , you know , in the first part of the year , ultimately abating to something a little bit slower in the second half to be in the high single digit range for the year .

Joe Gilliam: You know, coming off of Constant Currency growth in the Q4 of 13%, and as you heard me say earlier, we expect sort of high single digit to low double digit, you know, in the first part of the year, ultimately abating to something a little bit slower in the second half to be in the high single digit range for the year. I think is a good place for us to start off the year as it relates to our guidance for that part of our business.

Speaker #4: I think is a good place for us to start off the year as it relates to our guidance for that part of our business .

Speaker #5: Makes sense . Thank you

Steve Lichtman: Makes sense. Thank you.

Speaker #2: That concludes our question and answer session . I will now turn the call back over to the company for closing remarks

Operator: That concludes our question and answer session. I will now turn the call back over to the company for closing remarks.

Speaker #1: Okay. I want to thank you all for your time and attention today. And thanks again for your continued interest and support of Glaukos. Goodbye.

Tom Burns: Okay. I want to thank you all for your time and attention today, and thanks again for your continued interest and support of Glaukos. Goodbye.

Operator: Ladies and gentlemen, this concludes today's call. Thank you all for joining. You may now disconnect.

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