Sight Sciences Q2 2025 Earnings Call Transcript

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Provided by Quartr
August 7, 2025

Key Takeaways

  • Positive Sentiment: Revenue guidance raised: Full year 2025 revenue guidance increased to $72 million–$76 million while reaffirming adjusted operating expense guidance of $101 million–$105 million.
  • Positive Sentiment: Surgical glaucoma momentum: Q2 saw record ordering accounts (up 6% sequentially, 4% YoY) and 4% sequential utilization growth, supported by solid execution and the positive launch of OmniEdge.
  • Negative Sentiment: Dry eye revenue decline: Q2 dry eye revenue dropped to $0.3 million from $1.1 million as the company prioritizes securing reimbursement coverage, with modest near-term sales expected until access is achieved.
  • Positive Sentiment: Strong financial health: The company delivered an 85% gross margin, reduced cash burn to $7.3 million, and closed the quarter with $101.5 million in cash against $40 million of debt.
  • Negative Sentiment: Patent litigation risk: SiteSciences awaits a final order on its Alcon infringement case and faces USPTO reexamination petitions that could nullify asserted patent claims and impact future royalties.
AI Generated. May Contain Errors.
Earnings Conference Call
Sight Sciences Q2 2025
00:00 / 00:00

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Operator

Good day, and thank you for standing by. Welcome to the SITE Sciences Second Quarter twenty twenty five Earnings Results Conference Call. At this time, all participants are in a listen only mode. After the speakers' presentation, there will be a question and answer session. To ask a question during the session, you'll need to press 11 on your telephone.

Operator

You'll then hear an automated message advising your hand is raised. To withdraw your question, please press 11 again. Please be advised that today's conference is being recorded. I would now like to hand the conference over to your first speaker today, Trip Taylor, Investor Relations. Please go ahead.

Philip Taylor
Principal at Gilmartin Group

Thank you for participating in today's call. Presenting today are SiteSciences Co Founder and Chief Executive Officer, Paul Badawi and Chief Financial Officer, Hallie Bauerlein. Also in attendance is SiteSciences' chief commercial officer, Matt Link. Earlier today, SiteSciences released financial results for the second quarter ended 06/30/2025, and raised its revenue guidance and reaffirmed its adjusted operating expense guidance for full year 2025. A copy of the press release is available on our website at investors.sitesciences.com.

Philip Taylor
Principal at Gilmartin Group

I'd like to remind everyone that comments made by management today and answers to questions will include forward looking statements within the meaning of federal securities laws. These forward looking statements include statements related to our 2025 revenue and adjusted operating expense guidance and the preliminary factors impacting our ability to achieve our guidance, the impact of tariffs costs on our cost of goods sold, our plans to expand our manufacturing lines to additional manufacturing locations and the expected time lines and related costs, our ability to achieve our current and long term strategic objectives and value drivers, our market opportunity and ability to compete and capture market share, the continued adoption of our products by surgeons, our product reimbursement coverage and strategy, including our ability to achieve positive reimbursement coverage and or payment decisions for tier care, expectations regarding commercial momentum, account utilization and customer engagement, our pipeline of interventional glaucoma and dry eye technologies, our clinical trial strategy and results, our investments in market development and market research and development projects, and expectations regarding the relief that we may ultimately be awarded and the potential impact of recently requested ex parte reexaminations on such relief in connection with our patent infringement case against Alcon.

Philip Taylor
Principal at Gilmartin Group

Forward looking statements are based on estimates and assumptions as of today, are neither promises nor guarantees and are subject to risks and uncertainties that may cause actual results to differ materially from those expressed or implied by these statements. A description of some of these risks and uncertainties can be found in our public filings with the Securities and Exchange Commission, including in the Risk Factors section of our annual report on Form 10 ks and quarterly reports on Form 10 Q. We undertake no obligation to publicly update or revise any forward looking statements, except as required by law. On this call, management refers to certain financial measures that were not prepared in accordance with generally accepted accounting principles in The United States, including adjusted operating expenses. We believe these non GAAP financial measures are important indicators of the company's operating performance because they exclude certain items that are unrelated to and may not be indicative of its core operating results.

Philip Taylor
Principal at Gilmartin Group

See our earnings release for a reconciliation of these non GAAP financial measures to the most directly comparable GAAP financial measures as well as additional information about our reliance on non GAAP financial measures. I will now turn the call over to Paul.

Paul Badawi
Paul Badawi
Founder, CEO & Director at Sight Sciences Inc

Thanks, Trip. Our strong second quarter performance underscores the value of our proven interventional technologies for treating glaucoma and dry eye disease. These results also reflect the dedication and consistent efforts of our team in effectively supporting eye care providers and the patients they serve. Our second quarter revenue of $19,600,000 was driven primarily by solid execution and growing momentum in our surgical glaucoma segment. Within surgical glaucoma, sequential growth in both ordering accounts and procedural utilization mark meaningful progress as we strengthen our position as the market leader in implant free MIGS.

Paul Badawi
Paul Badawi
Founder, CEO & Director at Sight Sciences Inc

We are also continuing to work towards positive reimbursement coverage decisions for tier care this year. In addition, we delivered operational excellence, achieving excellent gross margins, diligent expense management, and reduced cash usage. Reflective of this execution, we are raising our full year 2025 revenue guidance to 72,000,000 to $76,000,000 while maintaining our full year 2025 guidance on adjusted operating expenses. Now, diving into our surgical glaucoma segment. We believe the growing demand for minimally invasive glaucoma treatments represents a significant long term market opportunity, and we believe we are well positioned to capitalize on the ongoing shift in surgeon behavior towards procedural interventions.

Paul Badawi
Paul Badawi
Founder, CEO & Director at Sight Sciences Inc

As a reminder, this is only the second full quarter operating within the new MIGS environment, where Medicare coverage in most states restricts performing multiple MIGS procedures in combination with cataract surgery. We are pleased with our performance and the resilience of our surgical glaucoma segment in this environment. We continue to have conviction in our ability to drive adoption of Omni based on multiple factors, including the ongoing shift in surgeon mindset towards interventional glaucoma, our market leading position in the MIGS industry, our focus on meaningful long term surgeon relationships and customer engagement, Omni's comprehensive procedure profile and usability, and its proven long term safety and efficacy. In the 2025, our surgical glaucoma revenue was $19,200,000 down 5% compared to the 2024, and up 12% compared to the 2025. Our stronger than anticipated second quarter performance reinforces our confidence in the Omni procedure as a leading solution in interventional glaucoma care.

Paul Badawi
Paul Badawi
Founder, CEO & Director at Sight Sciences Inc

We remain focused on executing with agility in this evolving environment and are actively improving our commercial strategy to sustain momentum and drive growth. We're also making consistent progress across multiple strategic priorities designed to drive long term growth and shareholder value. These efforts include enhancing our competitive positioning, investing in targeted commercial resources, expanding the pseudophakic standalone omni market, and building on the early traction with the OmniEdge, our latest MIGS innovation. I'll now walk through our recent achievements in support of these initiatives. First, I want to expand more on the commercial progress we saw in the second quarter, where we have been focused on growing ordering accounts and increasing account utilization.

Paul Badawi
Paul Badawi
Founder, CEO & Director at Sight Sciences Inc

We reached a record high for ordering accounts in the second quarter, up 6% sequentially and 4% versus the same period in the prior year, due to both reengagement efforts with accounts who had ordered previously but had gone dormant, and also new accounts ordering for the first time. We also saw a 4% sequential increase in surgical glaucoma utilization and improvements in our average selling price, contributing to our strong quarterly performance above expectations. Next, I want to look at the early success we have seen with the recent launch of OmniEdge, the latest evolution of our Omni platform. OmniEdge is designed to meet the diverse preferences of surgeons and the evolving needs of patients in today's MIGS landscape. Since launch, surgeons have responded positively and are achieving strong outcomes with our new technology.

Paul Badawi
Paul Badawi
Founder, CEO & Director at Sight Sciences Inc

We believe that with this next generation technology, we will drive further improvements in omni utilization. Lastly, we have also been focused on educating surgeons and their clinic staff on the importance of addressing the unmet need for pseudophakic patients whose glaucoma remains uncontrolled and could benefit from a standalone omni procedure. While it is difficult to track specific metrics on adoption, we are helping more customers learn how to identify these patients and implement standalone procedures as part of their clinical practice. We believe addressing this population will help improve long term clinical outcomes for primary open angle glaucoma patients and increase adoption of Omni for use in standalone procedures. Turning to our dry eye business.

Paul Badawi
Paul Badawi
Founder, CEO & Director at Sight Sciences Inc

We have been intentionally executing our long term strategy to create reimbursed market access for our interventional dry eye technology, TiReCare. We've developed best in class interventional MGD technology, delivered superior long term clinical outcomes demonstrated through randomized controlled clinical trials, and established coding for this procedure. We've been increasing customer advocacy and advancing our market access initiatives to establish equitable reimbursement for tear care. In the 2025, our dry eye revenue was $300,000 a decrease from $1,100,000 in the 2024, primarily due to fewer SmartLid sales, which was a result of our focus on achieving reimbursed market access for tear care procedures. We were pleased to announce the publication of the twenty four month results of the Sahara RCT, demonstrating the durability of the tear care procedure for the treatment of dry eye disease.

Paul Badawi
Paul Badawi
Founder, CEO & Director at Sight Sciences Inc

The results show mean signs and symptoms for participants in stage three of the Sahara trial remain statistically significantly better than study baseline at all time points up to twenty four months. The results further validate the durability, consistency, and strong clinical benefits of TiReCare as an interventional therapy for dry eye disease. As a landmark device versus drug study, this long term data builds on the positive outcomes from the first two stages of the Sahara trial and adds to a growing body of robust clinical evidence supporting Tiered Care's effectiveness. We are encouraged that participants maintained clinically meaningful improvements in both signs and symptoms of dry eye disease with just one or two treatments per year, reinforcing Tiered Care's potential as a long lasting and efficient treatment option. We have also recently announced the publication of a cost utility analysis assessing the cost effectiveness of tier care compared to cyclosporine for the treatment of moderate to severe MGD associated dry eye disease.

Paul Badawi
Paul Badawi
Founder, CEO & Director at Sight Sciences Inc

The analysis demonstrated that tier care not only improved patient outcomes, but also resulted in significant cost savings compared to cyclosporine. Both publications will further support our discussions with payers as we articulate the long term clinical benefits of tier care and criticality of reimbursed patient access to this proven procedural intervention. There is a significant unmet need within the MGD patient population for a reimbursed interventional treatment option, and we continue to engage in meaningful conversations with both commercial and MAC payers to seek coverage and appropriate reimbursement for tier care. While formal coverage or pricing policies have not been established as soon as we would have liked, our level of confidence in our ability to ultimately ensure reimbursed market access for peer care remains high, given the compelling clinical and health economic value of peer care. This includes the most recently published Zahera Stage III long term two year clinical data and the cost utility analysis.

Paul Badawi
Paul Badawi
Founder, CEO & Director at Sight Sciences Inc

Our eye care provider partners also share our belief in the important need for tier care reimbursement and are submitting claims and processing appeals to payers to demonstrate the unmet need, real world utilization, and significant value of our technology. As we are working to support coverage and payment for the Tiered Care procedure, we have built a foundation with an established commercial infrastructure that has trained eye care providers at over 1,500 facilities and supported over 70,000 Tiered Care procedures to date. We are confident this meaningful and experienced customer base is capable of quickly ramping to meet demand if and when reimbursement determinations come. We believe Tiered Care can be a catalyst to drive growth in the robust dry eye opportunity. In summary, our top priorities are strengthening our leadership position in implant free MIGS and developing the reimbursed procedural dry eye market.

Paul Badawi
Paul Badawi
Founder, CEO & Director at Sight Sciences Inc

And we're encouraged by the progress made through the second quarter as we execute on key strategic initiatives. As a reminder, our twenty twenty five strategy centers on working towards securing equitable reimbursement for tier care, driving commercial momentum in MIGS through the ongoing rollout of OmniEdge and continued investment in customer education and engagement, publishing new clinical and economic data to support broader adoption of our technologies, and advancing our robust product pipeline. As we enter the 2025, these developments reinforce our confidence in our ability to deliver long term value across the eye care landscape. I'll now turn the call over to Allie to discuss our financial results and guidance for 2025.

Ali Bauerlein
Ali Bauerlein
CFO at Sight Sciences Inc

Thanks, Paul. Unless noted, all results are for the 2025, and all comparisons are to the same period in the prior year. In the 2025, total revenue was $19,600,000 an 8% decrease. Surgical glaucoma revenue was $19,200,000 a decrease of 5%. This expected decrease was primarily due to an 11% decrease in account utilization, which was the result of the impact on the MIGS market from the coverage restrictions in the recent Medicare LCDs, partially offset by higher number of ordering accounts and higher average selling prices.

Ali Bauerlein
Ali Bauerlein
CFO at Sight Sciences Inc

Ordering accounts were up 4%, demonstrating our ability to grow our customer base, albeit at slightly lower volumes. Our dry eye revenue was $300,000 a decrease from $1,100,000 This expected decline was primarily due to fewer SmartLid sales, which was a result of our focus on achieving reimbursed market access for tear care procedures. In the 2025, we dedicated more resources towards working with our eye care provider partners on appeals of previously submitted claims, with a lower volume of new claim submissions and a lower average selling price of our SmartLids compared to the 2025. Gross margin was 85%, down slightly from eighty six percent. Surgical glaucoma gross margin was 86 compared to 88%, primarily due to higher overhead costs per unit, tariff costs, and product sales mix, partially offset by higher average selling prices.

Ali Bauerlein
Ali Bauerlein
CFO at Sight Sciences Inc

We incurred $100,000 in surgical glaucoma cost of goods sold associated with tariffs. Dry eye gross margin was 38 percent compared to 47%, primarily due to product sales mix and higher overhead costs per unit. Total operating expenses were $28,300,000 a decrease of 9% compared to $31,000,000 primarily due to lower legal fees. Adjusted operating expenses were 24,400,000.0 a decrease of 8% compared to $26,600,000 Our net loss was $11,900,000 or $0.23 per share compared to a net loss of $12,300,000 or $0.25 per share. We ended the quarter with $101,500,000 of cash and cash equivalents and $40,000,000 of debt, excluding unamortized discount and debt issuance costs.

Ali Bauerlein
Ali Bauerlein
CFO at Sight Sciences Inc

Cash used was $7,300,000 compared to 9,100,000.0 As a reminder, we have not received any monetary damages awarded in our successful jury trial verdict in our patent infringement case against Alcott. We are awaiting the judge's final order whether to confirm the jury's verdict, establish ongoing royalty damages, and or determine any potential enhancements. And the final ruling is subject to appeal. In addition, in the second quarter, Alcon filed petitions with the U. S.

Ali Bauerlein
Ali Bauerlein
CFO at Sight Sciences Inc

Patent and Trademark Office seeking reexamination of the patents we asserted in the litigation. We intend to defend our patents vigorously in front of the USPTO. Our ability to collect past damages and ongoing royalties may be impacted if the reexamination proceedings result in final, non appealable judgments of invalidity on the asserted claims of the patents ensued before a final, non appealable judgment is entered by the court in the patent infringement litigation. Moving to our revenue outlook for full year 2025, we are raising our revenue guidance to 72,000,000 to $76,000,000 compared to our prior guidance of 70,000,000 to 75,000,000 This revenue guidance range includes revenue of approximately $1,000,000 for full year 2025 for our dry eye segment. This guidance does not contemplate achievement of reimbursement coverage and or payment decisions for Tiered Care in 2025.

Ali Bauerlein
Ali Bauerlein
CFO at Sight Sciences Inc

While we outperformed our revenue expectations in dry eye in the 2025, we expect revenue to be modest until sufficient reimbursed market access is achieved. Looking closer at the 2025, we expect surgical glaucoma revenue to be down by mid single digits compared to the same period in the prior year. I also want to expand on our tariff exposure, which is applicable only to our imported products and does not impact overhead or other cost of goods sold. Based on the current tariffs incurred to date and assuming the current 30% China tariff rate and our current revenue expectations, including product mix and related inventory on hand, we expect that our surgical glaucoma segment's tariff exposure would increase the segment's cost of goods sold by between 1,000,000 to $1,500,000 for full year 2025, down from the prior estimate of 3,500,000.0 to 4,500,000.0 However, we note that this is still a very fluid situation and the pause on China tariffs expire August 12 and it is uncertain what the tariff rate will be after that expiration. We expect dry eye gross margin in the 2025 to be similar to the gross margin seen in the 2025, taking into account expected average selling prices and overhead absorption.

Ali Bauerlein
Ali Bauerlein
CFO at Sight Sciences Inc

We expect our dry eye gross margin to expand significantly with higher volumes associated with reimbursed market access, if and when reimbursed market access is achieved. As a reminder, we have been working on additional third party manufacturing locations and we expect these facilities will begin producing a portion of our volume starting with our OmniEdge product line in the 2026. We are also reaffirming our adjusted operating expenses guidance expectations for full year 2025 of $101,000,000 to 105,000,000 representing an increase of 0% to 4% compared to 2024. Our estimated 2025 adjusted operating expenses still include investments in pseudophakic standalone surgical glaucoma market development, tier care market access, and focused research and development projects. We are proud of the progress made this quarter, both operationally and strategically, and we remain focused on further penetrating and expanding the surgical glaucoma and dry eye markets as we execute and deliver on our long term goals and build for our future. Operator, please open the line for questions.

Operator

Thank you. At this time, we'll conduct a question and answer session. As a reminder, to ask a question, you'll need to press 11 on your telephone and wait for your name to be announced. To withdraw your question, please press 11 again. Please stand by while we compile our question and answer roster.

Operator

Your first call comes from the line of Danielle Antofy with UBS. Your line is now open.

Danielle Antalffy
Danielle Antalffy
Analyst at UBS Group

Good afternoon, guys. Thanks so much for taking the question. Congrats on a good quarterly beat here. Excuse me. Sorry about that.

Danielle Antalffy
Danielle Antalffy
Analyst at UBS Group

I wanted to first touch on the surgical glaucoma business and, you know, pretty strong quarter relative to your expectations. I think you guys had had expected at least a high single, high single digit decline there and only mid single digits. So maybe talk about what's driving the underlying strength there, at least relative to your expectations, and what that means for the stand alone market opportunity. And then I'll just ask my second question up front on tier care. Appreciate the commentary on reimbursement there.

Danielle Antalffy
Danielle Antalffy
Analyst at UBS Group

Do you expect now, you know, reimbursement wins to be in 2026 versus this year? Or how we think about that? What should we be on the lookout for? Thanks so much.

Matthew Link
Matthew Link
Chief Commercial Officer at Sight Sciences Inc

Thanks Danielle. This is Matt. I'll handle at least the first one on surgical glaucoma. I appreciate the sentiments on the quarter. We felt really proud of our team's performance.

Matthew Link
Matthew Link
Chief Commercial Officer at Sight Sciences Inc

As we've talked about, as we referenced in the comments, obviously we're facing some headwinds this year relative to the LCD that went into effect in the elimination of combo mix. But I think one of things we do appreciate is a relative stability in the market, which allows us to plan, allows our teams to plan, allows them to focus on all the activities that are critical to get back to a cadence of consistent and predictable performance, which is really what we start to see coming together. And so I think that the environment is stable. It's certainly still competitive as we've shared in prior comments. We have new competitors coming into this space, but certainly it's not getting any easier.

Matthew Link
Matthew Link
Chief Commercial Officer at Sight Sciences Inc

But I do believe our team is as focused as ever and is executing on what we've always understood that the value of Omni to be as one of the leading MIGS and certainly the leading implant free MIGS in the market. We're definitely continuing to see some tailwinds with the introduction of our newest Omni Edge in the marketplace, and we're seeing good traction with that. And we believe that has some additional runway in the second half of the year. So the second part of your question as it relates to standalone, we're still early days in the standalone effort. But again, our team has been very focused and very deliberate in our approach to some early account qualification and activation efforts, and we're seeing continued traction.

Matthew Link
Matthew Link
Chief Commercial Officer at Sight Sciences Inc

We're also benefiting from and grateful for the broader awareness across the market with a focus on interventional glaucoma. There's a very healthy and robust mixed market as it exists today. But there's still a tremendous opportunity for market expansion into sub segments of the market that are being underserved, we believe based on the quality of interventional technologies such as Omni that are available. We look forward to continue to provide future updates on our market development effort. But to date, we believe we're on track in line with our expectations for where we intended to be this year.

Matthew Link
Matthew Link
Chief Commercial Officer at Sight Sciences Inc

And we'll continue to build momentum through the back half of the year into 'twenty six.

Paul Badawi
Paul Badawi
Founder, CEO & Director at Sight Sciences Inc

And Danielle, I'll just add a few things to Matt's comments on the MIG side and the growth and the performance. Look, I think we've been focused on MIGs for many years. One of the few companies that's been focused for this long, I think our technology omni in a one mgs world, it's a very competitive offering for surgeons and patients. We've said before, it's very comprehensive on its own. So, it can be used combo cataract, be used in standalone, it can be used in a mild, moderate and advanced disease.

Paul Badawi
Paul Badawi
Founder, CEO & Director at Sight Sciences Inc

And, surgeons, appreciate, its usability and its comprehensive procedure profile. And so we feel like in this new MIGS environment and in a one MIGS world, our focus team that's been commercializing OMNI for quite some time and the new iterations of our OMNI technology make us very competitive.

Ali Bauerlein
Ali Bauerlein
CFO at Sight Sciences Inc

So in regards to your second question on tier care and coverage, we still are expecting payer wins in 2025 and we're working towards that timing. But we do acknowledge that that is somewhat out of our control as well. We're certainly working on many efforts we think with the recent publication of Sahara, as well as the cost utility analysis, as well as continued growth in claims with various payers. We do think we are building that foundation, and we do think that there is still we have strong conviction in the fact that tier care should be covered and we should over time be able to establish that reimbursed market access. But being now, you know, in August of the year of 2025, and having not yet had a win, we do acknowledge that, you know, that we're slightly behind our expectations in terms of being able to execute that plan. Okay. But it doesn't make

Danielle Antalffy
Danielle Antalffy
Analyst at UBS Group

you feel like you won't ever get the it's still very much on the table, right? Or is there something conversation that make you

Paul Badawi
Paul Badawi
Founder, CEO & Director at Sight Sciences Inc

feel Yeah, less I our conviction grows, frankly. While we don't control the timing, the conversations with payers have been of high quality, continued conversations. And the more recent publications that we discussed in the prepared remarks are critical. That's the foundation to drive reimbursement and coverage. We now have, we believe, everything that's necessary to support successful coverage determinations.

Paul Badawi
Paul Badawi
Founder, CEO & Director at Sight Sciences Inc

That's Sahara Stage one published Sahara Stage two, the twelve month published now Sahara Stage three, the twenty four month published the budget impact model published the cost utility analysis published, and our RVU analysis. So those six items are kind of the foundation, which creates a very compelling story for payers and is leading to very high quality conversations. In terms of timing, it's not in our control, but we still very much believe it's a when, not if.

Matthew Link
Matthew Link
Chief Commercial Officer at Sight Sciences Inc

Okay, thank you.

Paul Badawi
Paul Badawi
Founder, CEO & Director at Sight Sciences Inc

Sure.

Operator

Thank you. Your next question comes from the line of Adam Mader with Piper Sandler. Your line is now open.

Kyle Winborne
Kyle Winborne
Equity Research at Piper Sandler Companies

Hi, this is Kyle Windborn on for Adam. Congrats on a good quarter and thanks for taking our questions. I guess, maybe first for me, if we could just kind of dig in a little more on some of the competitive dynamics. I respect kind of your commentary around there that it's still very relevant top of mind. Just with regards to kind of some of the trialing and launches that we saw throughout this year.

Kyle Winborne
Kyle Winborne
Equity Research at Piper Sandler Companies

Are you maybe seeing some of these headwinds kind of start to abate? Are you maybe taking some share given the strong performance this quarter? Just any more color on the competitive dynamics would be helpful. Thanks.

Matthew Link
Matthew Link
Chief Commercial Officer at Sight Sciences Inc

Yeah, I think the main commentary I have is we don't necessarily believe that the competitive environment I believe that we as an organization and specifically our surgical glaucoma sales team are performing better than we have in prior periods. And as I stated in my former response or previous response, I think part of that can be attributed to, again, while we're facing headwinds as a result of the elimination of combo MIGS, we at least have a stable environment. And so we're able to focus on the market dynamics in front of us that are known to us. We're able to focus on our customers and our customers' needs.

Matthew Link
Matthew Link
Chief Commercial Officer at Sight Sciences Inc

And we're able to continue to highlight the broad appeal of Omni in particular, given its comprehensive efficacy and usability for providers. And so again, I think the focus of our team has been exceptional. Certainly a bit of a tailwind as we've added edge to our portfolio to better, I think, tailor our engagement with customers based on what their needs and preferences are and what they're trying to provide to their patients. Obviously, we focus a lot on Omni, but Sion has continued to perform well in the market as well and growing. And so for those providers who are looking for an alternative solution to Omni, it's great to have that tool in our pocket.

Matthew Link
Matthew Link
Chief Commercial Officer at Sight Sciences Inc

But again, we still see a lot of competitive dynamics. It's a desirable market. A lot of interest to try to replicate the success that Omni has. I think also going back to Paul's prior comment, we have a very experienced sales organization. We have an established market leading solution in Omni. The team has continued to execute very effectively.

Operator

So we look forward to

Matthew Link
Matthew Link
Chief Commercial Officer at Sight Sciences Inc

continuing that in the second half of the year.

Kyle Winborne
Kyle Winborne
Equity Research at Piper Sandler Companies

That's super helpful. Thank you. And then maybe just quickly on guidance. I understand kind of the raise comes maybe close to where the beat was in Q2. So, maybe if you could just shed a little more light on the cadence for Q3 and Q4, I think I heard you say down mid single digits for glaucoma for Q3. Where does that does that kind of land Q4 maybe on the upper end? It could actually you know, see, be flat to positive year over year or how are you kind of thinking about the cadence for the back half?

Ali Bauerlein
Ali Bauerlein
CFO at Sight Sciences Inc

Yeah, great, great question. And as we said in the prepared remarks, we do expect around a mid single digit decline for the surgical glaucoma business, which would imply, you know, kind of at the midpoint of guidance that you're looking at slightly up for the fourth quarter. Now, remember the fourth quarter is our easiest comp of the year on a surgical glaucoma side, because you had half of the quarter already impacted by the restrictions on the stacked MIGS procedures. So it, of course, should be returning to some level of growth as we lap those restrictions. On top of that, I would also point out that, while we, are looking at that kind of mid single digit decline for our surgical glaucoma business in the third quarter, that actually is our toughest comp.

Ali Bauerlein
Ali Bauerlein
CFO at Sight Sciences Inc

We saw throughout the year last year, that the percent of combination procedures being done of stacked MIGS procedures actually increasing up into the point that the MIGS restrictions went into effect. And so because of that, the third quarter was actually the highest percent of those stacked procedures. So that it really should show our confidence in our ability to operate in this market and the fact that we are seeing a strong performance from the sales team. And then of course on the dry eye side we expect very modest sales over the next you know period until we have market access established. So that's what's reflected in guidance is that 1,000,000 total contribution from the dry eye segment. Hopefully that helps.

Kyle Winborne
Kyle Winborne
Equity Research at Piper Sandler Companies

Super helpful. Thank you. Yeah, thank you.

Operator

Thank you. Your next question comes from the line of Justin Wang with Morgan Stanley. Your line is now open.

Justin Wang
Justin Wang
Equity Research Associate at Morgan Stanley

Hey, everybody. I'm filling in for Patrick. Thanks for the questions. Can you talk a little bit more about how conversations with payers are going for TIER CARE? I appreciate the twenty four month SAHERA data in the CUA, but just wondering if you can add a little bit more color on how payers are thinking about this and what the potential target reimbursement level might be. Thank you so much.

Ali Bauerlein
Ali Bauerlein
CFO at Sight Sciences Inc

Yeah, I'm happy to take that and others jump in as well. We are pleased with the tone of the discussions. We've had multiple rounds with several payers, and we're continuing to work towards that goal of positive reimbursement coverage for payment decisions for tier care in 2025. And so I think that the tone has been good. There has been high respect for the clinical data that we have produced with the Sahara readout stage one, two, and three, as well as the health economic data.

Ali Bauerlein
Ali Bauerlein
CFO at Sight Sciences Inc

So those are very positive conversations. In terms of actual payment rate, that is something that is uncertain at this point. Obviously, we are producing data for payers, both through claim submissions, where they are requesting invoices and requesting information to justify the payment for those procedures. And, you know, we are forced having our providers provide that information to the payers establish appropriate reimbursement. We've also done an RVU analysis to kind of outline to payers what we think would be an appropriate payment given the cost of this procedure.

Ali Bauerlein
Ali Bauerlein
CFO at Sight Sciences Inc

We do think that we have robust evidence and data and we continue to expect those positive decisions at some point in time in the future. All of that is very positive. What we can't control is the exact timing of those decisions. But we know that we are building a strong case for payers to cover the tear care procedure.

Paul Badawi
Paul Badawi
Founder, CEO & Director at Sight Sciences Inc

Just to emphasize, again on the Sahara trial, This RCT was designed specifically to allow us to have the quality of conversations we're having today. So it's actually a payer design study, obviously helps with market development as well. But we're here ultimately to elevate the standard of care for patients. And the best way to do that is to innovate and develop new technologies that work better, and provide patients with better clinical outcomes than whatever else is available today. And so the Sahara trial is a head to head against the standard of care in dry eye, which today in terms of prescription eye drops is cyclosporine.

Paul Badawi
Paul Badawi
Founder, CEO & Director at Sight Sciences Inc

And so it achieves two things. It showed how tear care compares to the gold standard in dry eye cyclosporine. But it also went beyond that. Another important consideration for payers is the durability of treatment effect. And so it's very rare if you look at the dry eye category to see an RCT in a trial prospective study that follows outcomes out to two years.

Paul Badawi
Paul Badawi
Founder, CEO & Director at Sight Sciences Inc

Most dry eye RCTs are a month, three months, maybe six months max. So between the design of the study being head to head against the standard of care, and demonstrating either non inferiority or superiority, demonstrating clinically significant improvements in all signs and symptoms out to twenty four months from baseline. We believe we've delivered what payers need to see to support, successful coverage. And as Ali mentioned, we're not surprised by the quality of those conversations. We just don't control the timing. But they are advancing.

Justin Wang
Justin Wang
Equity Research Associate at Morgan Stanley

Got it. Thank you so much.

Operator

Thank you. Your next question comes from the line of Tom Steffen with Stifel. Your line is now open.

Thomas Stephan
Thomas Stephan
Vice President at Stifel Financial

Great. Hey, guys. Good afternoon. Thanks for taking the questions. Nice quarter.

Thomas Stephan
Thomas Stephan
Vice President at Stifel Financial

I'll start with MIGS. I guess two questions on MIGS. First question just on share. Paul, maybe if you can talk a bit about share dynamics in MIGS that you're seeing year to date as surgeons continue to digest the LCD impact? Any insights you have there would be great.

Matthew Link
Matthew Link
Chief Commercial Officer at Sight Sciences Inc

Hey, Tom, it's Matt. I'll take it. So I mean, the share dynamics can be a little bit tricky, right? We have a view obviously of the percentage of procedures that were combined MIG procedures and that were eliminated. And obviously we have our own internal view and estimates of what percentage of our procedures predominantly with Omni were conducted in a combined MIG setting.

Matthew Link
Matthew Link
Chief Commercial Officer at Sight Sciences Inc

And so that is essentially the offset we enter the year with. And based on that information, we believe that we are winning at a rate higher than 50%. If you look at those combined procedures of which Omni was utilized with another MIG, 50% of those units of MIG sales going away as a result of only being able to use one MIG, from our own internal view, we know that we are performing better for that. And that is certainly a contributor to the positive performance we've seen in Q1 and Q2. Again, a credit assessment to our team and their focus on engaging our customers and making sure that they understood what our surgeon providers were looking for as they reconciled the new MIGS environment, elimination of combo MIGS.

Matthew Link
Matthew Link
Chief Commercial Officer at Sight Sciences Inc

As we think about, okay, then what is the share shifting as a result of us believing that we're winning better than 50% of the procedures that we were participating in a combined manner, as well as you heard in the prepared remarks, increased number of active accounts. And while utilization was down year over year sequentially it's up. So that suggests we're growing new customers as well, not just winning our fair share in MIGS, excuse me, our fair share in the combo MIGS space. All this leads us to believe that we are doing better than simply holding steady. We believe there are share gains.

Matthew Link
Matthew Link
Chief Commercial Officer at Sight Sciences Inc

Ultimately, we'll continue to evaluate the claims data to understand where that share shifting is. Certainly from other competitors in the market space, there could be a mix of price and unit volume playing into results. It's hard to read through all that until we have more of the information from a claims perspective. But as we evaluate the environment, understanding new competitors are coming in, looking at the impact of elimination of combo mix, and looking at our own internal data, record number of active accounts and sequential growth utilization, we feel really good about how we're performing in the market. And again, PR team is doing an incredible job with focus and execution.

Thomas Stephan
Thomas Stephan
Vice President at Stifel Financial

Got it. That's great. Appreciate that, Matt. And then sort of similar question, but more market related. Matt or Paul, can you talk a bit about just what you're seeing in terms of, call it, eye or visit growth in MIGs, sort of setting aside the LCD device headwinds?

Thomas Stephan
Thomas Stephan
Vice President at Stifel Financial

How does that maybe inform your view on twenty twenty six MIGs growth once we lap the LCDs?

Ali Bauerlein
Ali Bauerlein
CFO at Sight Sciences Inc

Yeah, and I can actually start there, maybe just for a little bit of data here. Obviously, the visits have been growing slightly, and of course, the claims data has been coming down. So we look at it both ways in the MIGS category. We haven't yet seen the second quarter data, Tom, so it is a bit hard for us to, you know, kind of use what's a pretty outdated data on the first quarter. And of course, that was the first quarter post the MIGS environment.

Ali Bauerlein
Ali Bauerlein
CFO at Sight Sciences Inc

So for us to provide specific data on exactly how it's trending, I think it's harder for us to say outside of visits was maintained to slight growth in this transition period. And that is something that we expect to continue to grow. The market estimates have been in that, you know, high single digit range for MIGS procedure visits. So that's the best we can provide today in terms of procedure data, but feel free to add on to that.

Paul Badawi
Paul Badawi
Founder, CEO & Director at Sight Sciences Inc

No, we're excited, Tom. I think we're performing well. We know that the MIGS market in terms of devices used will get back to growth in 2026. And so we're excited and focused on exiting this year in a stronger position as we can so that we can capitalize on that return to growth. As Matt mentioned, I think our team has been focused.

Paul Badawi
Paul Badawi
Founder, CEO & Director at Sight Sciences Inc

I think we're demonstrating commercial excellence and we're also demonstrating the utility of the Omni technology in terms of its comprehensive procedure profile for, primary open angle glaucoma patients.

Thomas Stephan
Thomas Stephan
Vice President at Stifel Financial

Got it. Thanks, everyone.

Operator

Thank you. Your next question comes from the line of Frank Takatin with Lake Street Capital Markets. Your line is now open.

Frank Takkinen
Senior Research Analyst - Medical Device at Lake Street Capital Markets

Great. Thanks for taking the questions. Congrats on a solid quarter. Wanted to start with a follow-up related to guidance for the second half of the year. Clearly, it sounds like you're outperforming your kind of expectations on the omni side following the LCD challenges.

Frank Takkinen
Senior Research Analyst - Medical Device at Lake Street Capital Markets

Accounts looks good. OmniEdge is contributing. You had nice sequential growth. Just curious about kind of why not bring the guide a little bit higher. I think at the midpoint of the guide, it still implies sequentially down from a surgical glaucoma standpoint, but it feels like a lot of things are going your way.

Frank Takkinen
Senior Research Analyst - Medical Device at Lake Street Capital Markets

So, So I wasn't sure if there's a market dynamic you're still trying to digest or just a little bit of conservatism baked into the forward expectation.

Ali Bauerlein
Ali Bauerlein
CFO at Sight Sciences Inc

Yeah, thanks Frank. Good question here. And while we do feel good about the data, good about the performance year to date on the surgical glaucoma side. We do think it's really important in the position that we're in to have appropriate and achievable guidance. So that is part of our factors when we put out these guidance numbers that we're trying to to make sure that we don't get out ahead of any market factors or any additional headwinds that may come our way.

Frank Takkinen
Senior Research Analyst - Medical Device at Lake Street Capital Markets

Okay, fair enough. And then maybe just a follow-up on OmniEdge and apologies if this was covered earlier. I'm just curious how your customers are using it differently. And is this cannibalizing some year old Omni? Or is this an incremental patient characteristic that they're using this on?

Frank Takkinen
Senior Research Analyst - Medical Device at Lake Street Capital Markets

Any other kind of deeper thoughts into that launch would be great.

Matthew Link
Matthew Link
Chief Commercial Officer at Sight Sciences Inc

Yeah. So I think it's a combination of multiple things. And so look, I mean, the reality is Omni Ergo, which preceded Edge in the market and continues to maintain a strong presence in the market has been an outstanding device and obviously holding a market leading position in the implant free MIG space. And so there's a lot of strong utility there. As we continue to see the MIG space evolve, I think there's a lot of interest in surgeons understanding of how best to treat the underlying disease state, being able to customize the mixed procedure intervention based on either their specific physician preference or the patient needs.

Matthew Link
Matthew Link
Chief Commercial Officer at Sight Sciences Inc

And one of the considerations associated with a comprehensive procedure like Omni is how much of a canaloplasty is relied on to visco dilation of canal, as well as the trabeculotomy. And so with OmniEdge, we've introduced a higher volume of viscoelastic to be that allows the surgeon to be delivered into the canal. And that's where a lot of the interest is. But it really, I think, again, comes down to customization. The embodiment of the device and usability is in line with Ergo, with some increases in viscoelastic based on physician preference.

Matthew Link
Matthew Link
Chief Commercial Officer at Sight Sciences Inc

And this is one of the great things as we continue to engage the market and really understand the preferences of providers. We have an incredible platform in Omni that we can continue to evolve. And Paul made the comment earlier around the comprehensive nature of Omni and the fact that it has the broad utility to treat mild, moderate, moderate to severe patients with a high level of efficacy and durability, we will continue to evolve the platform and family of Omni products based on the needs of surgeons and the needs of patients and Edge is one of what we expect would be several steps moving forward to meet those needs and preferences of providers. So again, has been another example of our team engaging the market, understanding where there's a need from a provider in meeting that need with a new technology and where providers satisfied in achieving the results they desire. Ergo continues to be an incredible product in the market.

Paul Badawi
Paul Badawi
Founder, CEO & Director at Sight Sciences Inc

And just to add to Matt's comments, we talked a lot about our sales execution excellence. Our marketing team is locked in, our R and D teams are locked in on MIGS. And so we're paying, as Matt said, very close attention to the market, paying close attention to our customers and their feedback to us. And while edge is the latest, it's not going to be the last. And we continue to innovate, make edge even better and come out with future future versions of Omni that meet the evolving makes landscapes needs.

Frank Takkinen
Senior Research Analyst - Medical Device at Lake Street Capital Markets

Perfect. That's helpful. Thank you.

Operator

Thank you. The next question comes from the line of Joanne Wuensch with Citi. Your line is now open.

Joanne Wuensch.
Joanne Wuensch.
Managing Director at Citi

Thank you, and good afternoon. I feel like we've been hearing or talking about stand alone MIGS for quite some time, and I'm hearing you again talk about that a little bit more on this call. I'm curious what the obstacles are to physicians moving in that direction, and quite frankly, how you can help them get there. Thank you.

Matthew Link
Matthew Link
Chief Commercial Officer at Sight Sciences Inc

Thank you. Appreciate the question. I think one of the challenges when you think about standalone MIGS is you think of it as an exact sort of proxy of combo MIGS and it's not. I mean, the cataract patient that has glaucoma at the time of cataract surgery and is indicated and received a MIGS procedure is really a different workflow than many standalone patients because obviously they're not coming in for the cataract consult. They're not having surgery to treat another principal diagnosis.

Matthew Link
Matthew Link
Chief Commercial Officer at Sight Sciences Inc

And then the MIGs oftentimes being secondary or predominantly secondary to that cataract intervention. And so one of the things that we really tried to focus on is a very prescriptive approach to a patient population that providers have helped guide us to that has a well defined unmet clinical need. And this is a patient that had glaucoma at the time of cataract surgery, at the time of that surgery with or without a MIGS, was controlled for some period of time. But moving beyond that treatment and intervention, three to seven years down the line, statistically, it's been shown that about fifty percent of those patients will have elevated IOP and be on two or more meds. And we look at that patient, you then start to worry about patient compliance on two medications, the elevated IOP, the side effects associated with the off target impact of these medications, this is a patient that is underserved clinically and helping to be more prescriptive in identifying a specific patient population, and then working with physician practices, and they're referring to these to say, okay, how do we integrate these newly identified patients into a workflow?

Matthew Link
Matthew Link
Chief Commercial Officer at Sight Sciences Inc

So, as I had mentioned in some earlier comments, we have some really strong efforts ongoing identifying targeted practices that are motivated to identify these patient populations and to intervene. And we're starting to see more consistent adoption of a programmatic approach. And it's definitely worth mentioning that this comes in an environment where we're seeing a broad push towards a more interventional mindset to the treatment of glaucoma. We talk a lot about interventional glaucoma. And ultimately the pseudophakic standalone population that we're really targeting is a subset of that.

Matthew Link
Matthew Link
Chief Commercial Officer at Sight Sciences Inc

So one, I think this is a byproduct of a broader industry trend to more comprehensively address the needs of patients with glaucoma. And then secondarily, I think a unique focus from us as a company site sciences with an incredible technology with demonstrated efficacy and Omni to help physicians better understand how to integrate the workflow in identifying and treating these patients in their practice. So that's the progress we're making today and look forward to making further progress moving forward.

Joanne Wuensch.
Joanne Wuensch.
Managing Director at Citi

Thank you.

Operator

Thank you. I'm showing no further questions at this time and would now like to turn the call back to Paul Paul Bottowi for closing remarks.

Paul Badawi
Paul Badawi
Founder, CEO & Director at Sight Sciences Inc

Thank you for attending today's call. We appreciate your interest in SITE Sciences, and we look forward to updating you on our progress in the future. Thank you all.

Operator

Thank you. This does conclude the program, and you may now disconnect.

Executives
    • Paul Badawi
      Paul Badawi
      Founder, CEO & Director
    • Ali Bauerlein
      Ali Bauerlein
      CFO
    • Matthew Link
      Matthew Link
      Chief Commercial Officer
Analysts
    • Philip Taylor
      Principal at Gilmartin Group
    • Danielle Antalffy
      Analyst at UBS Group
    • Kyle Winborne
      Equity Research at Piper Sandler Companies
    • Justin Wang
      Equity Research Associate at Morgan Stanley
    • Thomas Stephan
      Vice President at Stifel Financial
    • Frank Takkinen
      Senior Research Analyst - Medical Device at Lake Street Capital Markets
    • Joanne Wuensch.
      Managing Director at Citi
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