Glaukos at Jefferies Conference: Eyeing Interventional Success

On Wednesday, June 4, 2025, Glaukos Corp (NYSE:GKOS) took the stage at the Jefferies Global Healthcare Conference 2025, presenting a strategic shift in glaucoma treatment. Led by President Joe Gilliam and CFO Alex Thurman, the discussion highlighted the company’s focus on interventional glaucoma solutions like iDose, while addressing challenges in practice-level adoption and reimbursement.

Key Takeaways

• Glaukos is driving a paradigm shift towards interventional glaucoma treatments, moving away from traditional eye drops.
• The iDose launch is central to this strategy, with efforts to simplify Medicare reimbursement.
• The company aims for free cash flow breakeven, leveraging iDose’s scaling potential.
• Glaukos is navigating changes in the MIGS market, focusing on standalone procedures.
• The company is investing in future product launches and clinical trials to sustain growth.

Financial Results

• Glaukos is striving to achieve free cash flow breakeven, with iDose expected to enhance gross margins as volumes increase.
• The company reported revenue growth outpacing operating expenses in Q1, indicating effective cost management.
• Investments continue in clinical trials and product launches, balancing revenue generation with strategic growth.

Operational Updates

• The iDose launch is strategically focused on standalone procedures, addressing a larger market than combination cataract surgeries.
• Glaukos is working through Medicare Administrative Contractor (MAC) reimbursement complexities, ensuring clean claims processing.
• The company is enhancing customer support in revenue cycle management to facilitate iDose adoption.

Future Outlook

• Glaukos anticipates that interventional glaucoma will redefine standard care over the next decade, benefiting patients and the company.
• The company is pursuing FDA approval to remove the single-use limit on iDose, which could expand its application.
• The Trio system for in-office procedures is under trial, with potential clearance by 2026.

MIGS Business

• LCD changes have impacted the MIGS market, but Glaukos remains optimistic about underlying growth dynamics.
• The company is promoting standalone utilization of iStent Infinite and iDose, with a focus on maximizing return on investment.
• Mid-single-digit growth is expected in combination cataract MIGS, driven by increased standalone utilization.

Q&A Highlights

• Joe Gilliam emphasized the long-term journey of shifting towards interventional care, highlighting its benefits for patients.
• The focus on standalone procedures aims to alter practice patterns and expand market reach.
• MACs are generally supportive of covering FDA-approved products, aligning with Glaukos’s reimbursement strategy.

Readers are encouraged to refer to the full transcript for a detailed account of the conference call.

Full transcript - Jefferies Global Healthcare Conference 2025:

Michael Sarcone, Analyst, US Medical Supplies and Devices Team: Good morning. This is the session for Glaukos. My name is Michael Sarcone. I’m an analyst on the US med medical supplies and devices team. And with us from the company we’ve got Joe Gilliam, President Alex Thurman, CFO and we also have Chris Lewis here who heads the IR function.

Gentlemen, thank you for joining us today.

Joe Gilliam, President, Glaukos: Thanks for having us, Mike.

Michael Sarcone, Analyst, US Medical Supplies and Devices Team: So I figured we could kick off on the interventional glaucoma opportunity that you talk about. Can you talk about the concept of interventional glaucoma? And can you walk us through how you’re thinking where we stand today as it relates to the glaucoma treatment paradigm and where you think we’re going?

Joe Gilliam, President, Glaukos: Yeah. In some ways, path to this interventional glaucoma paradigm shift, if you will, has been, I’ll call it a twenty year overnight success story. The founding of the company really was this idea that all patients could have a path to better care by proactively intervening earlier in the treatment paradigm simply because the classic paradigm of treating with drops, while those drops work, patients don’t take them. Time and time again, studies have shown this. Even the clinical data now we look at at EMRs, at the practice groups, etcetera, validate that fact that with an asymptomatic slowly progressing disease, patients can’t be counted on to proactively manage themselves.

And as a result, the interventional glaucoma approach is pretty widely accepted from a clinical perspective. And so you fast forward to today, and we’ve had numerous, numerous engagements around the world on this topic, as have others in the industry. And what you hear consistently is positive feedback around the why clinically of intervening and using surgical procedures or sustained pharmaceuticals to manage a patient’s disease proactively. When we sit here today, I think the primary challenges that we all face over the next decade in adopting that is really changing the actual operating behaviors at the practice level. So clinical adoption, that’s a good start, but ultimately you have to change the practice patterns as well.

How they educate the referring OD networks, how they think about scheduling, how they think about all those blocking and tackling things that happen inside of a practice to really bring this to life. And that’s where our focus is at. But I can tell you, when we sit back and compare to the challenges of the early days from a Glaukos perspective of trying to pioneer the category in combination with cataract surgery and the inertia that existed that, it’s a very different feeling today. We’re certainly pushing, I guess, a little less uphill on this one. But even with that, this will be a journey.

This will be a ten year journey of really changing the standard of care to a more interventional approach. I think that patients will benefit the most, and certainly we will by extension of that.

Michael Sarcone, Analyst, US Medical Supplies and Devices Team: Got it. That’s helpful. And when you think about changing practice patterns, on average, how receptive are doctors that you’re speaking to? Is it a big lift to get them? They may be very set in their ways.

How do you address that, and what do you typically see? Well,

Joe Gilliam, President, Glaukos: it won’t surprise you that every doctor is a bit different in how they think about that journey and their pace of adopting it. And I would say that again, the physician response and the clinical need and desire and recognition of that is not the most challenging part of that equation. It’s turning that into action in the practice. So it’s changing for the rev cycle managers. It’s changing for the administrators.

It’s changing for, again, how they think about educating the referral networks. It’s that type of moving the office furniture around activities that take time, and you’ll get small wins and in some cases you get big wins where they will pretty quickly change their practice patterns to really adopt this fully, and that’s what you then propagate amongst from the podium and the various places to continue to show the path towards adoption in the average practice group. And so I think it’s much more that latter challenge that you go through, and sometimes that may take five visits, sometimes that may take ten, and sometimes that may take a couple of years or change an administrator or whoever it is for them to ultimately get it. But we’re definitely heading down that path of opening that up. I think the last year since really we’ve had iStent infinite iDose approved and Glaukos has been able to sort of really lean into this changing of the guard, if you will, in the standard of care, you’ve seen a real acceleration of those changes at the practice level.

Michael Sarcone, Analyst, US Medical Supplies and Devices Team: Definitely. You often talk about the concept of blocking and tackling and this is what you’re talking about now. Are there any other kind of milestones or things that could catalyze more uptake, whether that be are there any impediments from a reimbursement standpoint, guidelines? How do think about that?

Joe Gilliam, President, Glaukos: Any time you’re going through this, there’s a list of dozens of things that you’re trying to tackle. I mean, you can go all the way back to changing of academic standards and curriculum that these new residents and fellows are coming out with in terms of their background and how they think about that treating, that can be a long investment in terms of changing the way academic institutions think about their own curriculums. There, mean, we’ve been doing combo cataract MIGS for ten years, right, ten years plus, and it’s really only been in the last couple of years they’ve adopted that as a part of their teaching curriculum. So that’s an example of the kind of thing that you’re doing along that way. There’s a whole host of things from a medical affairs perspective and publication strategies and different things that you’re doing alongside of that.

There There’s a lot of industry related activities. At the recent ASCRS conference, on the first day, the ASOA hosted a Business of Interventional Glaucoma Symposium. That’s important. That’s sharing amongst the industry best practices on how to adopt this in the practice itself. That’s more impactful than anything that a sales rep or someone from Glaukos might say.

So investing in that kind of activity continues to be important as we go along the way.

Michael Sarcone, Analyst, US Medical Supplies and Devices Team: Great. We hear a lot about the resurgence of SLT. We’ve heard some excitement about Alcon’s new Voyager digital SLT. Bausch and Lomb recently acquired a laser based glaucoma intervention product. So guess when you think about interventional glaucoma, how do you think about the various treatment modalities and where iDose can fit in there?

And understanding you said it varies across, but are you seeing anything in particular in the physician community about how their treatment algorithms, know, how they’re adopting these different technologies.

Joe Gilliam, President, Glaukos: Yeah. And I think that and even going back to your your prior question a bit, when when you think about the things that are unlocking this opportunity, FDA approvals follow product innovation and and really being able to find across the product spectrum tools or solutions that where the risk benefit equation makes sense clinically from the physician standpoint. Drops obviously have a degree of side effects that come with them, but even with that, the surgeon wants to know that whatever they’re doing and intervening is safe and effective, they’re not increasing the risk profile for that patient. And I think that’s where we’re at today. Market access reimbursement comes out the result.

That’s a never ending job of working to unlock this. But as you do and folks start then focusing more on the treatment algorithm that they’ve got in their practice, you’ll hear a wide variety of answers. That’s not uncommon at this stage of changing standard of care. Today, you’ll see more and more of these surgeons leaning into what I would say is either SLT or procedural pharmaceuticals as their desired first and second line therapy. I think it’s not uncommon, and advancements are part of that.

The SLT system that Alcon acquired, I think, is another step forward in advancing that. For all of these patients, the most important thing to us is that interventional is happening. So whether or not a surgeon is moving forward with SLT first line or procedural pharmaceuticals first line or whatever their algorithm may, what matters most is that they’re engaging in the conversation with a patient and they’re actually going down the path with that patient of an interventional approach. If they’re doing that, most roads at some point lead to the tools that we’ve got in our portfolio today and certainly as we move forward into the future. I think you remember, with these patients, the average patient is in a practice over twenty years, twenty one years on average.

That will require multiple interventions to keep them off those drops and keep their disease controlled over that period of time. So I think this is truly one of those paradigm shifts where everyone in the industry can win with multiple technologies and multiple solutions to meet that patient wherever they’re at in their journey.

Michael Sarcone, Analyst, US Medical Supplies and Devices Team: Sure, makes sense. And then maybe we can pivot to iDose. The launch has gone very well for you and obviously the key area focus has been reimbursement progress. So maybe with that said, can you level set us on where we stand with MAC coverage on both the facility drug free and professional sides of the equation?

Joe Gilliam, President, Glaukos: Sure. And I’ll try to it at relatively high level and if you’ve got things you want to go deeper on, we can. I kind of break it into three primary tiers, if you will. The first tier, I think everybody knows fairly well. So for Noridian, Novitas and First Coast, where you’ve got established recurring and predictable payment on both the drug, the facility, and the professional fee now that they’ve got professional fee schedules.

As of the sort of end of the first quarter, really all three of those were paying and adjudicating those claims as they should be. And so I think from that standpoint, you can kind of put them to the side. You focus on the stuff that I know our sales team really enjoys, which is having the clinical conversation around adopting iDose and driving both the hunting and farming activities, if you will, associated with growing the product in those areas. The second tier, I would put Palmetto and WPS into. For them, you see a more regular recurring pattern of payment, timely payment of the drug in the facility.

And so the real battleground, if you will, on that is a professional fee. With that certainty of payment on the drug, you can drive incremental volumes. Obviously in practice groups, there’s less nos from the administrative suite now that they know that they’re going to get paid on the primary product acquisition. And so as you try to drive that, you try to drive the volumes that ultimately give the information to the MAC so that they’re able to hopefully provide a professional fee schedule in a timely manner. There’s no statutory timeline on that.

You try to drive those activities through both advocacy as well as volumes. The last group I would put CGS and NGS. In both of those, we actually are seeing the payment on the drug side as well. It just may not be quite as predictable in the context of the timing, and some of the additional documentation requests that come alongside of that can be a little less predictable. But we’re making progress in both of those as well.

And the last thing I’ll say, maybe two things. First, we are seeing professional fees in all of the MACs, so it’s not as if you’re not seeing those payments. It’s just the amount of effort and work that comes with it in those early days when they’re sending in those additional documentation requests and things like that. And it’s just fraught with complexity that can lead to mistakes, and mistakes lead to either underpayment or denials or whatever it might be. And so it’s that process of getting through that that we’re really in the middle of with these other, I’ll call it, formats that are still going through that process.

And the last thing is, and I just think it’s important for folks to understand, that the MACs themselves, they actually want to pay this. So it’s not I think it’s true in general. The mandate of Medicare administrative contractors are to actually cover these things that are approved by the FDA and provide that. The process we’re going through is normal and ordinary course. As frustrating as it can be for the providers at times, it’s not new or unusual.

It’s really a data collection effort by the MACs to make sure that the product itself is being done on label, it’s medically necessary, and that they can ultimately get enough information to calculate what those payments should be on the professional side, which is why I say it’s really a game of volume and it’s a matter of when, not if things get streamlined as we’ve certainly seen in the case of Novitas, Meridian and First Coast.

Michael Sarcone, Analyst, US Medical Supplies and Devices Team: Got it. That’s very helpful. And over the past two quarters, three quarters you’ve provided some data points around MAC reimbursement and iDOS contribution. So I think you’ve said in 4Q, Noridian was kind of the predominant piece of the volume. And then in 1Q, you mentioned that was about 40% of iDose volume.

And so that means the other MACs are starting to layer in. So I guess just from a qualitative standpoint, can you talk about how you see the rest of those MACs layering into the contribution in 2025?

Joe Gilliam, President, Glaukos: Yes. I think just to add one additional data point on that, I think what we said coming out of the first quarter was that the combination of Noridian Novitas were about 75% of the volumes, just to give a sense, despite the fact that they’re somewhere between 4045% of the covered fee for service lives. So that gives you a relativity gauge on the impact that they’re having versus the other Macs. Now, what I will say is that actually the chart, if you will, of volume growth in all of the MACs, maybe with the exception of CGS because it’s so small, there’s a little bit more noise in it, but for all of the MACs is actually moving up into the right. So there’s growth consistently happening in all of them.

The difference is that when you don’t have that streamlined reimbursement, the N is much smaller, which is what leads to that dynamic. So I think as we continue to execute on the confidence side of the J code and the facility in these areas and hopefully get them into the place where MACs have got it streamlined and they start adjudicating the ten to twenty day timeframe that they do on typical procedures, that we can continue to see that growth and contribution in the coming quarters. I don’t know. I mean, it’s very difficult. There’s a variety of scenarios if that how much that mix will shift in the coming quarters simply because, you know, obviously our teams in Meridian Novitas aren’t slowing down either.

So the fact they’ve got a little bit of a head start means they’re going to continue to drive both on the hunting and farming as I said earlier. And that may or may not lead to different mixes as we move forward. But I certainly do believe that the other Macs continue to grow in their volume and I would expect that to continue to accelerate as we make our way through the year.

Michael Sarcone, Analyst, US Medical Supplies and Devices Team: Great. And we all understand there’s an economic element as well particularly for the implanters and I think you’ve been very strategic about how you’re establishing professional fees at the max, maybe a focus on standalone iDose versus in the combo cataract setting and we do speak to multiple doctors who tell us the low hanging fruit is in that combo cataract setting. Just wanted to get your thoughts on how you think about what’s the volume that you’re kind of leaving on the table by focusing on the standalone only and could we start to see an increasing contribution from iDose in the combo cataract setting as you become more comfortable with the prophyse?

Joe Gilliam, President, Glaukos: Well, and there’s no question that we could have moved the adoption curve, if you will, or those early adopting volumes much faster than we chose to. And we tried to signal this to everybody that when we launch products, do it the right way for the ten year timeframe versus any one quarter or even year in that regard. And what I mean by that in this case, and you alluded to it to a certain extent, is two things. First, when you think about changing the standard of care is where we started from an interventional perspective. If we just started with the product launch being focused on combination cataract surgery, you wouldn’t be changing the mindset of these surgeons alongside of that.

So by forcing the standalone adoption, you’re forcing some additional conversations and changing practice patterns that is just a much larger market. I mean, when you think about interventional glaucoma, you’re talking about a market that has twenty one, twenty two million eyes, thirteen million of which are diagnosed and you’re given twelve million of which are diagnosed and treated. That’s two and a half times the size of the cataract market. So from our standpoint, relative to the 500,000 or so addressable market size for combo cataract, so from our perspective it’s imperative that we’re leading with the standalone conversation because it’s what’s going to ultimately drive the results over the long term. Now within that, you referenced market access, and so from reimbursement perspective, we wanted to make sure that the claims processing was clean.

So the more things you add into that, the more things that they’re doing as a part of that procedure, the more places where that claim adjudication can go wrong when the MAC is asking for additional information or whatever it might be. So our ability to get through that execute, make sure the focus is on iDose and iDose procedures alone is an important step in that. And as we move forward, you can imagine to that exact point, the lower hanging fruit for many of these folks is they don’t have to change their practice patterns to adopt in combination cataract. And if they’ve got glaucoma and they think that iDose is the right solution clinically and it fits where it’s in their treatment algorithm, doing it in combo cataract is the same as doing it from a stand alone standpoint and I certainly would expect that as we move forward, and more folks will be doing exactly that.

Michael Sarcone, Analyst, US Medical Supplies and Devices Team: And it seems like the strategy has been bearing fruit. I mean, the doctors that we speak to say they get reimbursed $800 or $850 versus $500

Joe Gilliam, President, Glaukos: for

Michael Sarcone, Analyst, US Medical Supplies and Devices Team: a cataract.

Joe Gilliam, President, Glaukos: Yeah. On the professional fee side, what we’ve said is I’d say the wider band range is probably $600 to $1,000 It depends upon the MAC and certainly the geography and the cost of living index that they’ve got within each of those MACs. But the sweet spot seems to be sort of in that $700 7 50 dollars to $808.50 dollars range across the country, which is in line more broadly with glaucoma procedures and so not a huge surprise from where the MACs are landing as they calculate the value associated with the professional fee.

Michael Sarcone, Analyst, US Medical Supplies and Devices Team: And I think this year you’re starting to really address the commercial payers. So just wanted to get your sense of are there any strategic differences or structural differences that change how you kind of target commercial payers and making progress there versus on the Medicare max side?

Joe Gilliam, President, Glaukos: Yeah, and you’ve heard this analogy from me before, but this is a crawl walk, jog run strategy, and we’re definitely going to take the crawl phase again slowly simply because you want to make sure that your customers are having success in the revenue cycle management side of the commercial book of business. And to the heart of your question, it is very different. The MAC and the Medicare process is one where there’s an awful lot of this initial effort to educate. Once they’ve got it and they know what’s there, it becomes a more predictable payer, both in terms of what they pay and when they pay and the timing associated with the certainty that’s there. Inherent with the commercial and even Medicare Advantage by extension is the challenges that come with the complexity of that system in terms of prior authorizations, denials that come alongside of that, appeals of those denials.

Even after you’ve got a prior authorization and you do the procedure, the certain percentage of the time you know you’ll get a denial on the back end of the payment and going after the appeals and the process there. And having practice groups that are, from a rev cycle management standpoint, are confident in how they execute that, similar to the way a hospital might be inside of their department. So a big lift for us is supporting the customer from that standpoint, making sure they understand at a macro level and a micro level how that works. And there certainly are many practice groups out there who are fantastic at this and many others who it’s an area of investment because maybe they haven’t done as much of the pharmaceutical side. They’ve been relegated more to premium IOLs and cataract surgery or LASIK, which is a cash pay procedure.

They may be great practice groups, but we need to really make sure we’re investing in a bit of hand holding up front so that they’re successful with that. But ultimately, underneath that, and I think this is probably a lesser known or understood element, is that our payer relations team has been out since the day of approval, and our coverage both on the commercial lives as well as on Medicare Advantage is quite robust. So we have over 50% covered in policies today. Those policies look an awful lot like Darista from AbbVie Allergan. In many cases, they’ve just dropped iDose into the existing policy they had for that sustained pharmaceutical.

And for the other 50%, we’re seeing prior authorizations go through to confirm that when it’s medically necessary, you can get coverage for those procedures. So I think we’re in a good spot from a payer perspective on that. Our job now is to make sure that our customers and those HCPs are prolific at actually executing against it.

Michael Sarcone, Analyst, US Medical Supplies and Devices Team: Okay, great. I have one or two more on high dose, but I wanted to make Alex do some work. So maybe just Alex, can you talk about I believe you guys are still focused on free cash flow breakeven. Can you talk about where we stand there and what the priorities are?

Alex Thurman, CFO, Glaukos: Absolutely. So in the short term, that’s absolutely the goal to get back to cash flow breakeven. If you look at our history prior to COVID, we generally we call it lived within our means and generated either breakeven or just a small amount of cash and built that up. But then we went through a period of investment and a lot of it had association with iDose and getting ready for that launch and building a manufacturing facility, etcetera. But now we’re back to that point where we should be able to live within our means on as iDose continues to have success and that’s our near term goal for sure.

Michael Sarcone, Analyst, US Medical Supplies and Devices Team: Got it. I guess can you speak to how you’re thinking about iDose gross margin contribution?

Alex Thurman, CFO, Glaukos: Sure. No, we definitely expect that given the profile of iDose that that product can be accretive to our overall gross margin over time as the product scales and we have more success with iDose over time.

Michael Sarcone, Analyst, US Medical Supplies and Devices Team: Got it. I mean, have you shared at all how you’re thinking about, you know, what kind of the dollar sales need to be or or volumes before iDose gets to be accretive?

Alex Thurman, CFO, Glaukos: We haven’t shared that, but, let’s just say it’s in the near term for sure.

Michael Sarcone, Analyst, US Medical Supplies and Devices Team: And then I guess, know, one of the interesting things about this is you have a sales force already and you can just drop iDose in the bag. So I guess how do you think about operating leverage, you know, as we go forward? And I guess also if you can kind of weave in there in the context that you’re still running some clinical trials, right? You’re working on iDose T Rex and some other things or actually a lot of other things. But how do you think about OpEx leverage?

Alex Thurman, CFO, Glaukos: Yeah. No, absolutely. The good news is that if you look at our first quarter results, we already are seeing it, right? We had 25% growth on the revenue line and the OpEx line was only growing at about 12%. So we’re already starting to see leverage in the model.

We expect to see that on the back of iDose and its success. But again, as you mentioned, the balance will always be the revenue and cash generation versus the investments we need to make both in the iDose launch and in the future launches as well as our pipeline. So that’s always the balance that we’re going to be playing and that Joe and Tom and I are always discussing, and trying to make sure we we just do that along with other episodic event investments that need to be made or that become available to us.

Michael Sarcone, Analyst, US Medical Supplies and Devices Team: Okay. And, and maybe last one on this topic, when you think about the the size of the rep base today, where do you see it growing or what do you view as a sufficient number of reps?

Joe Gilliam, President, Glaukos: I think our sales force actually the sort of the mainline sales team is in a pretty good place. That doesn’t mean we won’t continue fill in geographic gaps as they emerge. That’s more in ones and twos versus wholesale change. If you look at some of the larger established ophthalmic sales forces, they tend to peak out at 100, one hundred and 20 five, at least for surgical procedures or in our case surgical pharmaceutical procedures. So I think that we’re in a pretty healthy spot on that.

That doesn’t mean I think where the investment will come, to Alex’s point, in the coming years, will be much more around how we support that from a reimbursement perspective, from a side of care perspective, all the various things that are there to really help drive access for patients. And then ultimately, the broader sort of marketing apparatus, whether that’s traditional marketing to HCPs or patients, etcetera, that’s something that we plan to scale alongside for a period of time here both with the iDose launch as well as with the Epioxidant launch hopefully later this year.

Michael Sarcone, Analyst, US Medical Supplies and Devices Team: Okay, great. And back to iDose, do you have any updates on the or I guess what’s the latest and greatest on the readjudication efforts to get the single use limit removed? I know we have the exchange trial but just you know can you comment on anything else that the FDA would would like to see beyond that or whatever you can share there?

Joe Gilliam, President, Glaukos: No real updates there. I think what we said on the first quarter call was that package, if you will, has been submitted to the FDA. So they’re in their review process and we hope to hear back obviously from them later this year and we’ll keep you apprised as we do versus sort of the play by play. But as you know and we’ve said in the past, the safety profile, we’ve got the data associated with the exchange of an iDose procedure that was collected as a part of the original iDose trials and so hopefully we’ll be successful in our efforts with the FDA on that front.

Michael Sarcone, Analyst, US Medical Supplies and Devices Team: Okay, great. And then just last one on iDose, on the Trio, can you give us the latest and greatest there? I think you’ve said in the past you have to run a small safety study, so maybe what are timelines and KPIs we should be looking out for?

Joe Gilliam, President, Glaukos: Yeah. From that standpoint, you’re really talking administration, which I break into kind of both a reimbursement market access activity as well as the development. And you referenced the development side. So the Trio system, it’s the same iDose implant. It’s just an injector system that’s designed to minimize the incision size as a part of an in office procedure.

And so from that standpoint, we do have to run a small safety trial, confirmatory safety trial, something that we’re well underway and heading down that path. And I would expect that, you know, that’s a twenty twenty six type activity, get that cleared. That doesn’t mean that a practice or a doctor couldn’t do an in office procedure with the existing. They certainly could. It was done as a part of our iDose clinical trial.

But I think the next level of adoption and willingness to adopt will come with the Trio system when we get that cleared. In parallel, as you establish both the facility and the professional fee in the max, you start to apply for an office coverage and that’s an activity that is well underway as well. And

Michael Sarcone, Analyst, US Medical Supplies and Devices Team: I think I’ve asked you this in the past because you have the J code, you’d look to ideally price iDose the same in the in office setting.

Joe Gilliam, President, Glaukos: It wouldn’t be priced the same. Yeah, from that standpoint, the process of billing and payment for the J code is quite similar. It’s much more just about the site of service and the reimbursement attached to that site of service from the Medicare administrators.

Michael Sarcone, Analyst, US Medical Supplies and Devices Team: Got it. Then I did, in the last few minutes, want to touch on the MIGS business. You know, we’ve seen the fallout across the board from multiple vendors from the LCD changes. And, you know, I think you’ve talked about the LCDs removed about 10% to 15% of of the MIGS market. Know, iStent Infinite has been growing for you in the standalone.

Is there any way you can help us think about the differences in growth in in the standalone business versus the combo cataract?

Joe Gilliam, President, Glaukos: Well, it’s difficult because from our standpoint at a superficial level, when an account orders in ICE 10 INFINITE, we don’t know whether it’s being utilized in standalone or in combination with cataract surgery or otherwise. We just know that they’re ordering it. So it’s somewhat anecdotal and obviously directional from the data we’re seeing and the same things that you’re seeing in terms of the performance certainly in the first quarter on a relative basis to some of the other technologies that are out there. I think we did quite well and I’m not so sure that really was because of combo cataract that was somehow we’ve got more share in the combo cataracts and maybe there’s a little bit of that. I think it much more has to do with the continued increase utilization in standalone for iStent infinite for those patients who failed medical and surgical therapy.

I think that is the delta. So if you’re going to do a calculation, you might look at how other trends are out there and say, well, if Glaukos is doing a little bit better, it’s probably because of the stand alone growth that’s that’s coming with ICE and Infinite.

Michael Sarcone, Analyst, US Medical Supplies and Devices Team: That’s fair. And then I guess, when we move past or when these changes are are fully adjusted and and that’s in the base, how do you think about, you know, MIGS market growth? How do you think about your MIGS business growth? Is this a mid single digit grower longer term? Can we get to high single digits?

How do you think about that?

Joe Gilliam, President, Glaukos: Well, I think certainly as you lap this year and you’ve absorbed the impact of taking these procedures out of the market, the underlying dynamics around growing the number of patients getting access to MIGS technologies, that’s not changing. And so I think from that standpoint in combination cataract, you’re still in the mid single digit type growth environment. You just can’t see it because of obviously the masking of taking some of those procedures out in 2025. So I have no reason to believe that that won’t continue as we move forward. I think the path to mid single digit and higher is back to a function of standalone utilization and the choice of tools, and this comes a little bit into the glucose component of this, it’s a little harder for us to predict simply because from an iDose perspective and the results that you’re seeing from that clinically, and quite frankly, selfishly, every iDose has a higher return on investment than an iStent infinite, if you will, the adoption that we’re driving may lean much more towards the iDOS side of the equation than the stent side.

And it’s hard to predict exactly how some of those algorithms will play out. Again, what our focus on is driving that increased standalone utilization. And as a result, how they choose between their technologies, iDose or iStent infinite, we remain a bit agnostic to.

Michael Sarcone, Analyst, US Medical Supplies and Devices Team: Okay. Great. I think we’re we’re at time.

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