Glaukos at William Blair Conference: Eyeing Innovative Growth

On Tuesday, 03 June 2025, Glaukos Corp (NYSE:GKOS) presented at the 45th Annual William Blair Growth Stock Conference, showcasing its strategic focus on innovation in ophthalmology. The company emphasized its shift towards interventional glaucoma treatments and expanding its product portfolio. Despite highlighting strong financial health, challenges like patient compliance with traditional treatments were acknowledged.

Key Takeaways

• Glaukos is transitioning from traditional eye drop treatments to interventional glaucoma solutions.
• The company reported a ten-year CAGR exceeding 20% and gross margins over 80%.
• Glaukos maintains a debt-free balance sheet with over $300 million in cash.
• Expansion into corneal health and retinal disease treatments is underway.
• A strong commitment to R&D with $700 million invested over seven years.

Financial Results

• Ten-year CAGR: Over 20%
• Gross Margins: Exceeding 80%
• Cash Balance: Over $300 million
• Debt: Eliminated all debt in the last year

Operational Updates

• Commercial Infrastructure: Over 300 personnel in the commercial sector
• International Business: Significant contribution to revenue from global operations
• Corneal Health: Growth in the corneal health sector with products like EyeLink

Future Outlook

• Interventional Glaucoma: Advancing products like iDose and iStent
• Corneal Health: Focus on Epioxa for keratoconus, with a PDUFA date in October
• Anterior Segment: Developing treatments for Demodex blepharitis
• Retinal Space: Small molecule TKI exudinib in phase one b, two a trials
• iDose Next Generation: Innovating an applicator for in-office procedures

Q&A Highlights

• Alex Thurman emphasized Glaukos’ pioneering culture: "Our company mantra and culture, we like to say, is we’ll go first."
• On patient compliance: "Ninety percent of patients do not refill their prescription. They start on these drops."
• Market opportunity in glaucoma: "There’s two and a half times as many eyes with glaucoma as there are cataracts today."

In conclusion, Glaukos aims to lead in interventional glaucoma and ophthalmology, bolstered by strong financials and a robust R&D pipeline. For more details, refer to the full transcript below.

Full transcript - 45th Annual William Blair Growth Stock Conference:

Macaulay Cobain, Analyst, William Blair: How’s it going, everyone? I’m gonna step in. My name is Macaulay Cobain. I work under Margaret Kayser covering med tech. We’re gonna have Glaukos present for us.

We have management with us today. You can go to WilliamBlair.com for a full list of our disclosures, and we’ll, we’ll have Alex kick it off here.

Alex Thurman, CFO, Glaukos: Alright. Thank you all for coming and joining us, this afternoon and to talk a little bit about Glaukos. My pleasure to, speak to you all today. My name is Alex Thurman. I’m the CFO of the company.

So, I get the, privilege to talk to you a little bit about what we’re doing, skip over the disclaimer, jump right into it. And so our company our company mantra and culture, we like to say, is we’ll go first. And why is that? And it goes back to the beginnings in the of the company, back twenty five years ago when we had one of our early founders, was a venture capitalist, who had a son who had glaucoma. And back twenty five years ago, he was considering what are the treatment alternatives for this son who had advanced glaucoma, and it was really boiling down to a procedure called trabeculectomy, which was to put a hole in in this person’s eye.

And the VC said to the doctor, there must be a better way. And from that statement, glucose was, was originated and was born, where the doctor’s response is, well, I think I have a better way, but no one will listen to me. And this VC said, well, I’m gonna listen to you. What is your idea? And over time, that became the first iStent, and, and later on, the development of the MIGS category and how glucose was born and and started its its existence.

And from there, we you know, from that birthplace, innovation has been at the core of all that we do, and we’re very focused on doing dropless therapies and to do so in with commercial excellence that we’ve developed over time. Today, we have five novel platforms, we like to say, that cover the products that we’re out there, and working on or commercialized. We have our iStent franchise, which obviously most of you know about. IDose, maybe you’ve heard about, not sure, just kidding. But that is our latest product line.

And then following that are some that are in the pipeline, which is EyeLink, which we’ll talk about, Ilucent, and Retina. Now on the right side is the therapeutic areas that we try to cover with those products. So we have glaucoma, obviously, that we’ve talked about already. We have rare what we’re calling rare disease, which is keratoconus currently, and we’ll talk a little bit about that. Then we have diseases in the anterior segment and then the posterior segment of the eye.

As we look at our five platforms on the right in this wheel, we try to show here here are the therapeutic areas that they cover from air anywhere from ocular hypertension to keratoconus to dry eye to glaucoma, etcetera. And how have we gotten there is through an investment over the last, I guess, seven years of spending more than $700,000,000 in r and d to develop these products and to get them to a point where they’re either commercialized or there’s they’re they’re coming towards, towards FDA approval. And we have 14 programs in our pipeline that we publicly disclosed. There are others that we haven’t talked about yet, and that’s from where we started when we did the IPO in 2015 of just five programs. So we continue to invest and reinvest in the business at an industry leading level to develop what we think will be a long lasting journey along ophthalmology.

As we talk about ’25 and and this year and next year, what are our key commercial catalysts? Well, first and foremost, it’s this concept of interventional glaucoma, and let me explain what that means. One of the reasons that we are interested in dropless therapies, and we’ll talk about this in a minute, is that we found that drops, while the active pharmaceutical ingredient in them works, people just don’t like to take them. I don’t know how many of you out there have drops. It doesn’t have to be glaucoma drops, but drops are just, they can be hard to take.

They can be, they can cause side effects and things of that nature. Oh, he’s got one right there. You brought them with you. You know, lot of people forget to take them when they travel. So there’s all sorts of reasons why, you know, drops just don’t work for these patients.

And so that leads us to try and and go down the pathway with our patients and our customers to say, you need to intervene sooner in patients’ journeys because with their drops, the glaucoma just doesn’t seem to get arrested soon enough. So can you intervene earlier with tools that will help to preserve these patients’ visions? That’s the idea of interventional glaucoma. What are those tools that you can intervene with? Up until just a few years ago, there weren’t a lot of tools that that our our customers could use.

But now, as we’ll talk about in the presentation, there are quite a few tools that doctors can use on their patients to help them in this journey. The next, catalyst we talk about is keratoconus, and that is, we’ll get into this a little further on, but basically it is a corneal disease that we’re tackling, and we have a product that has, been submitted for NDA approval with a PDUFA date later this year, and that’ll be our second catalyst, over the next near term. As we move into the next slide, here’s some, crazy statistics, and I see that the formatting is kind of odd. But what it’s trying to say is that speaking of drops and what we were just talking about, it is amazing to know that ninety percent of patients do not refill their prescription. They start on these drops.

They have these side effects, whether it’s stinging, whether it’s red eyes, whether it’s dry eye, whatever the case may be. They just are not compliant with their drops. And then fifty percent of those sorry. That that’s fifty percent is the next stat over. They really just never even refill.

So they take their drops or they don’t take them, and when it comes time to to to refill those prescriptions, they just forget it. And the reasons are, look, the side effects that I just talked about as well as the fact that with glaucoma, it’s a it’s a disease that is very slow progressing and one that you don’t feel. So you wake up in the morning, it’s not like your eyes hurt because you have glaucoma. It doesn’t cause a reminder to take your drops, and it’s slow progressing. You don’t see it very often.

So we, from a very early beginnings of our company, knew there was a need to change this whole dynamic and this whole paradigm, and that’s on the bottom half of the slide, where the old days, you would go in if you, may had may had noticed some vision, coming in on you. You went to your optometrist likely who then maybe checked you and and noticed, oh, you might have glaucoma. We’ll send you to to a, you know, a glaucoma guy. And that glaucoma specialist might just prescribe you a drop, and you come back six months later, and you haven’t really improved, or you may have progressed, and they do a second set of drops and maybe a third. And and then, ultimately, it led to these very invasive end of stage eye surgeries where they would literally put a hole in your eye to drain the fluid that was building up on the front of your eye.

And today, we wanna get into this bottom half where you’ve got this interventional glaucoma paradigm or interventional procedures where you may start with maybe instead of a drop, you start with a a laser, an SLT. And that after that wanes, you go to an a pharmaceutical procedure, and then maybe a MIGS procedure, and then maybe a MIBS, etcetera. But over the time of your journey with glaucoma, which is no has no cure today, there are several tools in the toolkit to allow you to intervene without having to use drops, which we know from the previous slide don’t get used, and slow or or halt the progression of your disease and and give you as much time in your life with the vision as possible. So from our standpoint, from glucose in this interventional glaucoma journey, we think we have now the set of tools in order to help our customers to progress along that path. The first and foremost, which is very, common today is iDose.

Right? We’ve talked a lot about it. We hear about it a lot from investors, which is this tool that allows twenty four seven compliance. As I mentioned earlier, the active pharmaceutical ingredient in drops really works if you take them. And so our idea here was to take that API and to formulate it in such a way that it could be put into a very small canister, which you can see on the screen there, and implant that canister inside the eye and allow that API to elute over time and treat your your symptoms without having to use the drops that have to get through and penetrate the cornea and get in there and and and you can eliminate all the side effects.

And and luckily, we’ve been able to do that. It was a it was a long journey, a fifteen year journey, and, one that we’re very proud of. And there’s some key things about there. You can see the the the size of it on the top left, five millimeters is the width. So that’s about the width of five human hairs.

That’s how small it is. You can see that the formulation of that I p API into that ball of oil that’s in the middle there, that was a, you know, that was a big engineering effort, to be able to put that much active pharmaceutical ingredient in that small canister and and have it dilute through through that membrane. And one of the really key things that we did early on was to design this so that it would be anchored and stable inside the eye and not float around and bounce around. So the the eye dose is anchored, allows that allows that drug to allude into that eye and and treat those those diseases and those symptoms. Furthermore, in this IG journey that we call it, in addition to iDose, which you can see will treat all symptoms along the spectrum from ocular hypertension all the way through refractive.

But we also have iStent Infinite, which is a three stent product that it that currently is labeled for this advanced and refractory glaucoma, and then our kind of our original iStent inject w, right, and is used pretty much in combination with cataract surgeries to treat glaucoma. So you have a lot of different tools to take you along the journey. There’s a lot of milestones that needed to happen as we as we progress on this journey, and most of these are around market access items. We talk about, getting through Max and getting coverage through Max, not only with the drug with iDose, but also the facility payments and the professional fees. Along the way, several things that have to happen.

You can see a lot of the check marks in 2024 and then a lot of the things that we continue to do in 2025, including things like phase four studies and other, clinical data to help support our customers as they go along this journey and start using these tools in a more fulsome fashion. The next thing we’ll talk about is what we’re calling interventional glaucoma and the forever patient. What a lot of people don’t realize is that a typical average glaucoma patient has the disease for twenty one years. So twenty one years of their life, they’re dealing with this disease. And traditionally, let’s say, if I was a comprehensive ophthalmologist, I was really focused on cataract surgery, And I would be focused on all my marketing dollars and acquisition dollars to get a cataract patient in and to do one surgery and one, one shot to get as much dollars out of that patient I could by by trying to pitch them a a basically, you know, an IOL that was a higher what what’s the word?

The a premium IOL, sorry, so that I could then get maximize my return. With glaucoma patient, you have the opportunity to have them for those 21 and do several iterations of procedures on them over the course of their of their lifetime. And they can do and we talked about it earlier with the IG, modeling, right, where they they can start out with a laser. They can get into the several products that we have along the way between iDose, iStent, iStent inject, etcetera. And by the way, you’ll get the cataract surgery along the way if they have one as well.

So this forever patient model helps our customers understand that it’s a long journey, and there’s a lot of opportunity for them both to treat these patients effectively as well as do the right thing for their business economically as well. Going back to iDose and our phase three data, just again, sorry for the formatting issues, but the main thing here that happened was for seventy percent of our patients in both the phase two and the phase three trials, they were these patients were well controlled with their pressures over a over a three year period or three thirty six months, which is just a phenomenal result. I think when we started the iDose journey, our CEO said if he’s able to get a product that would last between six and nine months, he’d have a winner. And we were fortunate to see these, pressures being really controlled for three years. And in in many pace in many cases, the the the patients were medication or drop free as during that time or at the end of that time.

From a safety profile, iDose stacks up very well. Really, you can see there in both the phase three and the phase two trials, really no adverse events of any kind and very strong safety profile. We believe that’s with the design of the product and how it’s working and and seeing that. And one of the key things we’ll we talk about today is now that iDose has been approved and commercialized is the clinical results we’re hearing from our customers in the real world are even as good or better. And, there’s a lot of clinical excitement for the product as it’s gone out into the what we call the real world now.

Talk a minute about combined therapy, which is the, you know, combination of two different things. You know, on that pie chart on the top left, over half of patients today use what they’ll call combined therapy, meaning more than two drops, right, two or more drops today. And so surgeons and and doctors understand the power that can be done with multiple APIs or multiple procedures in the same patient. And so we’ve we’ve looked at it in combination of having cataract and iDose together, and there were some profound reductions in the pressures of those patients that had cataract surgery along with an iDose, and you can see that on the bottom part of the graph where 44% reduction in pressure from the baseline, and that represents about an 11.3 drop in in millimeters of mercury. From a market opportunity perspective, we like to show this because on the far left of those funnels is the cataract market, and that is the historical market glucose played in when we had to do our stents in combination with cataracts.

And you can see it’s only about a five hundred thousand, market. When we look at the total amount of patients in The United States that either have ocular hypertension or some form of glaucoma is twenty two million eyes, of which thirteen million have been diagnosed, of which twelve million are being actively treated in some fashion today. And that’s a huge step up in the opportunity for Glaukos and others to get into this, what we call, the stand alone market and taking it away from just having to do things in combination with cataract surgery. So here’s the IG pro the road map that Glaukos has and all of the different things. You can see in green the stent products that we have either already approved or, you know, in clinical trials.

The blue talks about our iDose. And, again, iDose, we’ve only got generation one out there right now currently approved. Some of you know about our next generation, which is called the T Rex or TR Extended, which we hope and, that in theory would be twice the amount of, of pharmaceutical ingredients and hopefully or we’ll see twice the duration. That is in a phase two, phase three trial. And then beyond that, we have other generations of iDose.

We have Ilucean, which we’ll talk about in a minute, which is a cream based drug delivery system and then some other tools at the bottom. But all of these tools are available for our our customers to treat their glaucoma patients along the spectrum. So as we build this business, we’ve always said that the journey for interventional glaucoma is not a six month journey. It’s not a two year journey. It’s more like a ten year journey.

And there’s various phases that we like to think about. The first phase was just getting these surgeons to buy in the idea that they need to intervene earlier and get away from this knee jerk reaction or historical reaction to just prescribe a drop and then more drops and drops. What, is very encouraging to us is that in the recent ASCRS conference, the very first day was a three quarter day, symposium that was put on by the society called the Business of Interventional Glaucoma Surgery, where they met with not only the surgeons, but also practice administrators, back office staff, revenue cycle managers, etcetera, to talk about what IG means, what that could mean to their practice, and how do they operationalize it. So very encouraging as we get along, and what we’re seeing in in this step one as we continue to push that messaging. Step two, we’ve already talked about is this idea of combination therapy.

So for example, an iDose, the design of that, API is to slow down the production of fluid in the in in the eye as opposed to the stent, which is designed to drain the fluid naturally in the back of the eye. So together, those two are complementary. So can they be done in combination? Can they and should they be done in combination? Every surgeon will have his or her own algorithm, but we believe that that combination therapy can be very effective and very powerful.

And we’re gonna continue to support our customers through data and and other things to help them to, understand that and and push that. Three is that we have many customers that would like to do, for example, procedures in the office. You know, today, iDose is done primarily in the surgery center. Can it be done in the office? It can.

And how do we support that? Well, we have a next generation iDose where we will design an applicator or an inserter that allow iDose to be done in the office setting, and and we want to be to a place where we are agnostic as to whether our customers choose to do a procedure in their surgery center or in their office setting, and so we’ll move towards that over time. The next step is to again, as I mentioned earlier, the T Rex product, where you can get an iDose that’s that is basically, hopefully, twice as long last twice as long as our original iDose. So continuing to offer longer solutions to patients, less invasive for them, and hopefully just as good at outcomes as we see today. Beyond that, we talk about the fact that PE groups today are really, consolidating the the ophthalmology practices around the country, and they really, understand financial side of this idea of interventional glaucoma in the forever patients as well.

So we continue to build upon that, as those PE groups continue that trend. And last but not least is is really this long term vision where you see our ophthalmology, you know, comprehensive surgeons as well as glaucoma specialists who understand what the glaucoma patient and the disease means, the opportunity to all, and the idea that they can have a practice that is very robust and doing treating glaucoma just as much or more than today with with their cataract practices. Based on that funnel we talked about earlier, there’s two and a half times as many eyes with glaucoma as there are cataracts today. So there’s a huge opportunity for them if they can see that vision. We’ll help them to do that.

Okay. Switching gears a little bit to corneal health. There is this disease called keratoconus, which is basically when there you have a cornea that has weak weakness in the cornea, and the cornea bulges out, and you can see that in the bottom bottom left. And there’s really no no, other FDA approved procedure other than our EyeLink, where Vitrexa is the name of the product, goes in and and arrests that that development, restrengthens the corneal fibers through something called crosslinking. The challenge with Vitrexa today is that you have to, for better for lack of a better word, scrape off the outer layer of your cornea in order to put this drug on it.

And then it’s very effective, but it’s also, you know, very invasive. Our next generation, product is called Epioxa. Epioxa allows you to treat that patient without touching the cornea, so to speak, not having to scrape off that outer outer, outer part of the cornea to to apply the drug. And this will allow, you know, obviously, a a much less painful procedure and a quicker recovery time for all of these patients, most of which are in their teenage years, and so it’s, difficult for them to spend time recovering when they’re in school and other things like that. We have submitted our our NDA, which was accepted last December.

We have a PDUFA date on this in October of this year, and we’re excited for the opportunity to, allow this product to go out to our customers and to hopefully be a much better and much more easy and painless solution than what we have today to treat this rarely diagnosed disease called keratoconus. And then what if you could take the next generation of this product idea where it’s more targeted and you could you can basically map the cornea, figure out where those weaknesses are in the cornea, and actually specifically target the, the treatment in order to strengthen those fibers and get the that cornea to even a better state and maybe a better vision outcome. And that’s what we talk about here in our in our third generation eye link therapy, which is under development today. So from an EyeLink or keratoconus product road map, we’ve spoken about all of these things, and, we’re continuing to really focus in and and try to help this patient population that’s out there that has this disease in people that you may not know have it, like Steph Curry. He has this keratoconus disease.

But it is rarely diagnosed, and we want to help those that have it, to be able to to arrest the development of that. I’ll talk briefly about Ilucian. Ilucian is a cream or a formulation that we, we have the rights to that allow us to introduce a pharmaceutical into that cream to treat certain diseases. Today, we’ll focus on, what we call Demodex blepharitis, which is a disease that has little Demodex mites that crawl on the follicles of your eyelash. Yep.

It’s they’re nasty to look at, but people have them. And the ability then to take the the pharmaceutical that will treat well, it’ll kill those little critters, put it onto a little dab of lotion and wipe that right on your right on the follicles of your eyelid and hopefully, get rid of them is highly attractive. And so we’re working through, and we’ll start a clinical trial on that this year to allow us to pursue that particular therapeutic area. And then last, we talk about that glucose has the temerity to try to want to be in the retinal space and to tackle a a market that is fully developed today at at $10,000,000,000 and to do it in in, again, a different way. So today, most of those treatments that are out there on the market are are based on anti VEGFs, which are large protein molecules.

Our approach being different is to take a TKI exudinib, which is a small molecule, put that into a bioerodible pellet, so to speak, and inject that into the eye. In our in our animal models, we’ve seen success where the the the duration of that particular application lasts approaching three years, and we’ve just started a kind of a phase one b, two a trial on our retina products to, to get that into humans and to watch and see what happens, and and hopefully that advances along. And we can try and change that marketplace as well through longer duration and and less burden on the patients. Building the business in stages. Stage one is interventional glaucoma, where where we’ve come a long ways with all of our different products.

Stage two, we just talked about with kind of rare disease keratoconus and what we’re doing with that. Stage three is the anterior segment. These are the dilution things that I was just mentioning. We’ve got, in addition to the blepharitis, you know, presbyopia dry glaucoma, other things. And then the phase four would be the retina products that we were just talking about.

So there’s our our portfolio. We feel it’s one of the industry’s most formidable. We’re very proud of what we’ve been able to do and and what’s left to do. There’s still a lot to go, and we’re excited for the future and and what’s happening today as well. And I know I’m running out of time, so I’ll just hit really quickly.

These are the key milestones in 2025 that we’re shooting after, all of which are in the clinical area as we move towards some of these newer products and and putting them forward. Last but not least is some of the key highlights operationally from the company. We’re very proud to have grown a ten year CAGR of over 20%. The the commercial infrastructure that has grown over the over the last several years where we have over 300 people now in that in the commercial area. We have a very, very nice and attractive gross margins at over 80%, and we have a not only US Glaucoma, but we have a large international business now that, that provides a lot of revenues, and and then we have our, corneal health business that we’ve talked about.

Last but not least is the fact that our balance sheet is strong. Been able to, you know, generate cash, cash balance of over 300,000,000. And then last year, we were able to eliminate all of our debt, so that’s, that’s no debt in the 300 millions. And with that, I will I will say thank you again for listening. And This presentation has now finished.

Please check back shortly for the archive.

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