Glaukos Q1 Earnings Call Highlights

Key Points

• Record Q1 and raised guidance: Glaukos reported Q1 net sales of $150.6 million, up 41% YoY, and raised full‑year 2026 net sales guidance to $620–$635 million, citing strong execution and two “transformational” drivers—iDose TR and Epioxa.
• iDose TR is the growth engine: U.S. glaucoma sales totaled $93.5 million with iDose TR contributing about $54 million in Q1 and showing broad-based adoption across MAC regions, expanding commercial/Medicare Advantage access and early successful re‑administrations.
• Epioxa launch and access dynamics: Epioxa is commercially available with initial sales and O2n system deployment covering ~65% of the U.S. population (target ~95%), but launch progress depends on payor adjudication until the permanent J‑code (J2789) takes effect July 1, 2026.

Glaukos NYSE: GKOS reported record first-quarter 2026 consolidated net sales of $150.6 million, up 41% on a reported basis and 39% on a constant-currency basis versus the prior-year period, as the company highlighted accelerating momentum in its interventional glaucoma business and the early-stage launch of its new keratoconus therapy.

Chairman and CEO Tom Burns said the quarter’s outperformance led the company to raise full-year 2026 net sales guidance to $620 million to $635 million, up from $600 million to $620 million previously. Burns attributed the results to “strong execution across our global commercial and development priorities,” and pointed to two “transformational growth drivers” the company expects to fuel performance: iDose TR in glaucoma and Epioxa in corneal health.

Glaucoma franchise driven by iDose TR growth

In the U.S. glaucoma franchise, Glaukos posted record net sales of $93.5 million, up 58% year over year. Burns said iDose TR generated approximately $54 million in first-quarter sales and continues to see “strong physician interest and adoption.” He added that iDose TR is supported by “22 peer-reviewed publications” and a “broad portfolio of active phase IV studies.”

President and COO Joe Gilliam described iDose TR strength as “very broad-based,” citing ongoing momentum in early adopting Medicare Administrative Contractor (MAC) regions, as well as increasing signs of uptake in other geographies. Gilliam said the combined share of volumes from Noridian, Novitas, and First Coast declined to about 73% in the first quarter from 78% in the fourth quarter, which he framed as evidence that other regions are scaling. He also pointed to increased “funnel” activity tied to commercial and Medicare Advantage patients.

On commercial coverage, Gilliam told analysts that about “99% of patients have an access pathway in the commercial and Medicare Advantage arena,” with roughly 50% of those covered lives in plans that have a specific policy and the remainder in plans where there is “silence,” but where the company is seeing successful pull-through.

Gilliam also confirmed early progress following iDose re-administration approval, noting “numerous successful re-administration procedures” among early patients, though he said it remains “a small fraction” of procedures today. Over time, he expects re-administration to become “a much more material part of that overall mix.”

On procedure mix, Gilliam said the majority of iDose patients last year were treated with a standalone procedure, though the mix is “shifting towards” use in combination with cataract surgery and/or other MIGS procedures. Burns added that the company’s phase IV studies are aimed primarily at payer needs—particularly commercial and Medicare Advantage—rather than changing surgeons’ confidence in combination use.

International glaucoma grew, with FX expected to wane

International glaucoma franchise net sales were $35.8 million, up 23% on a reported basis and 16% on a constant-currency basis. Burns called growth “broad-based” as the company continues to scale infrastructure and expand adoption of MIGS across regions. He reiterated expectations for “comp-competitive product trialing headwinds” in some major markets as 2026 progresses, partially offset by contributions from iStent infinite following EU MDR certification and the European launch late last year.

In discussing full-year modeling assumptions, Gilliam said the company expects currency benefits to fade and anticipates high single-digit growth for the remainder of 2026 in the international glaucoma business, translating into low double-digit growth for the full year.

Epioxa launch begins; access and workflow remain key early focus

Glaukos’ corneal health franchise delivered $21.3 million in net sales, up 15% year over year, including $17.7 million from Photrexa and “very early Epioxa” net sales. Burns said the company achieved commercial availability of Epioxa by the end of the first quarter and described the product as an “incision-free alternative” to traditional corneal cross-linking because it does not require removal of the corneal epithelium. Burns said the oxygen-enriched topical therapy is designed to reduce pain, streamline procedures, and minimize recovery while delivering “clinically meaningful outcomes.”

Management emphasized that early adoption will be influenced by typical payer dynamics. Gilliam said that, until a permanent J-code is in place, the claims process is slower because it relies on a miscellaneous code and “claim-by-claim” adjudication. He said it is “hard to judge too much” until the post-J-code period.

Burns reported that acquired O2n systems are deployed across locations serving roughly 65% of the U.S. population, with a pipeline that the company expects will expand reach to approximately 95%. Gilliam said progress toward that 95% target has, in some respects, been accelerating due to increased interest following commercial availability, though he noted hospital systems can have longer implementation cycles.

On payer coverage, Burns said Glaukos has established access pathways for more than 100 million covered commercial lives, including four of the five largest payers, and said CMS assigned a product-specific J-code—J2789—scheduled to take effect July 1, 2026. Burns said the permanent J-code should help streamline reporting and reimbursement over time; until then, Epioxa will be commercially available under a new technology miscellaneous J-code. Gilliam added that much of the company’s stepped-up launch spending is focused on “claims prosecution and adjudication,” prior authorizations, and ensuring hub and specialty pharmacy processes operate efficiently.

The company also discussed patient-facing and provider support elements, including a co-pay assistance program for eligible patients and a specialty pharmacy partner network. In response to questions about the transition from Photrexa, Gilliam said there is “no change” to expectations that the transition will occur in the third quarter, with Photrexa remaining available in limited quantities afterward through a different mechanism for physicians who require an epi-off procedure.

Updated outlook assumptions and profitability focus

Gilliam provided franchise-level color embedded in the updated full-year outlook. For U.S. glaucoma, he said Glaukos now expects “low 30% type growth for the full year,” driven by iDose TR, while maintaining an assumption of “flattish non-iDose sales” until there is sustained evidence to change that view. For the second quarter, he said the company expects “flat non-iDose” with continued sequential iDose TR expansion.

For corneal health, Gilliam said the company expects “high single-digit growth” for the full year but warned of volatility due to the Photrexa-to-Epioxa transition and the temporary-to-permanent J-code transition, particularly across the second and third quarters. He reiterated expectations for “a bit of a dip” in the second quarter year over year due to the transition.

CFO Alex Thurman said gross margin was 84% in the first quarter, up 120 basis points from the prior year. He reiterated full-year gross margin expectations of 84% to 86%, with expected accretion as Epioxa becomes a larger share of mix.

On operating expenses and profitability, Thurman said Glaukos remains focused on reaching cash flow breakeven while driving operating leverage, which he said the company saw in the first quarter. He said operating expenses are still expected to grow year over year and, following first-quarter outperformance, management discussed “adding additional fuel” to the commercial launches. Thurman said investors should expect operating expenses to “tick up slightly and modestly,” still growing in the “high teens” while maintaining operating leverage.

Pipeline updates and market opportunity commentary

Burns highlighted a pipeline spanning five therapeutic platforms with “13 publicly disclosed programs,” including pivotal trials for iDose TREX, iStent infinite in mild-to-moderate patients, and PRESERFLO MicroShunt, as well as a phase II trial for iLution for Demodex blepharitis and continued work on the iLink platform. Burns also noted a planned market introduction of a keratoconus screening device later this year.

On iDose TRIO, Gilliam said the clinical study has been completed, patients will be monitored through this year, and the company plans to file by the end of 2026 with a targeted approval timeframe in the fourth quarter of 2027. He also referenced prior human factors work showing a “strong preference” for the new design “on the order of 90%.”

Regarding keratoconus, Gilliam said the company believes the historical 18,000 to 20,000 eyes treated annually represents only “a fraction” of the potential market. He told analysts Glaukos estimates that “between 50,000 and 100,000 keratoconic eyes a year at a minimum” should be diagnosed and treated with cross-linking, and suggested the condition may prove to be “more of a rarely diagnosed disease than a rare disease” as awareness and detection efforts expand.

About Glaukos NYSE: GKOS

Glaukos Corporation is a medical technology company specializing in the development, manufacturing and commercialization of innovative therapies for patients with glaucoma and other chronic eye diseases. The company's core offerings focus on micro-invasive glaucoma surgery (MIGS), designed to reduce intraocular pressure and manage glaucoma more safely and effectively than traditional surgical approaches. Glaukos's flagship products include the iStent, iStent inject and iStent infinite trabecular micro-bypass stents, which are implanted during cataract surgery to improve aqueous outflow and help control eye pressure.

Beyond its MIGS portfolio, Glaukos has expanded into sustained drug-delivery solutions.

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