Sight Sciences at 24th Annual Needham Conference: Strategic Growth Insights

On Tuesday, 08 April 2025, Sight Sciences (NASDAQ: SGHT) participated in the 24th Annual Needham Virtual Healthcare Conference. The company presented a strategic overview that highlighted both opportunities and challenges. While optimistic about revenue growth and product innovation, Sight Sciences also addressed the impact of tariffs and regulatory restrictions.

Key Takeaways

• Sight Sciences anticipates sequential revenue improvements in 2025 despite a Q1 slowdown due to MIGS restrictions.
• The company is actively pursuing reimbursement policy changes for its TearCare product, expecting significant progress in 2025.
• Tariffs on products manufactured in China could impact Q3 and Q4, but pre-tariff inventory is expected to mitigate early-year effects.
• Sight Sciences is developing new technologies for glaucoma and dry eye, aiming to strengthen its market position.

Financial Results

• Revenue guidance is set between $70 million and $75 million, with the dry eye segment expected to remain flat at around $1 million annually.
• Gross margins for the surgical glaucoma segment are approximately 87%.
• Q1 is expected to see a revenue decline due to MIGS restrictions, but Q4 is anticipated to recover strongly on a year-over-year basis.
• The tariff rate decreased from 54% to 4%, but larger impacts are expected later in the year.

Operational Updates

• Surgical Glaucoma (Omni):

- Approximately 350,000 MIGS claims were billed, with 20% to 25% potentially affected by new LCD restrictions.

- The company is reinforcing Omni's value proposition to surgeons.

• Dry Eye (TearCare):

- 1,500 TearCare systems installed, with over 65,000 cash-pay cases performed.

- The average patient requires one to two treatments per year.

Future Outlook

• Glaucoma:

- Development of a helical cannellicular scaffold and sustained-release technology is underway.

• Dry Eye:

- Sight Sciences expects reimbursement coverage for TearCare to begin in 2025, aiming to create a significant category in eye care.

Q&A Highlights

• Reimbursement:

- The company is collecting data on combination procedures to influence reimbursement policies and working with payers to demonstrate TearCare's value.

• Competitive Landscape:

- Drug-eluting stents and other interventional solutions are viewed as complementary to Sight Sciences' portfolio.

Sight Sciences remains confident in its strategic initiatives and market opportunities. For more details, please refer to the full transcript below.

Full transcript - 24th Annual Needham Virtual Healthcare Conference:

David Saxon, Analyst, Needham and Company: Good afternoon, everyone. Thanks for joining us on day two of the twenty fourth Annual Needham Healthcare Conference. My name is David Saxon. I'm an analyst on the med tech research team here at Needham and Company. With me today, we have, the site sciences team, including Paul Badawi and CFO, Ali Baraline.

This afternoon, we'll do a fireside chat. For those on the conference portal, there should be a box where you can submit questions. Alternatively, you can feel free to email me any questions you might have, and I'll try my best to fit them in. So with that, Ali and and Paul, thanks so much for joining us this afternoon. Maybe to to just jump in, probably not surprising, we'll we'll get to tariffs in in a minute, but I I wanted to actually start with a variation of the question we're asking all our companies this week.

And the question is, do you think consensus is modeling the quarterly cadence correctly for 2025? And I guess, you know, has anything happened over the last couple of months that kinda gives you any more or less confidence in kind of hitting what the street's modeling from a cadence perspective?

Ali Baraline, CFO, Sight Sciences: Yeah. Thanks, David. I can I can take that? And, you know, obviously, we're we're not going to be reiterating or updating our guidance today just given where we are in the earnings cycle, and we do expect to report, within the next few weeks. But just talking about our prior guidance called for revenue of 70 to 75.

That included the expected impacts to the business associated with our surgical glaucoma, segment with the restriction on multiple MIGS done at the same time as a cataract procedure and really took into account our dry eye segment being flat at around a million dollars in annual sales so that when we receive those positive reimbursement policy or payment decisions, those will be upside to guidance. So we do expect that we've set the bar appropriately for guidance. And in terms of cadence, you know, we do expect kind of sequential improvements in our results throughout the year with some seasonal impacts to the third quarter. Obviously, as we communicated on our prior call, we do expect q one to be a step down from q four associated with that being the full quarter impact of the multiple MIGS restrictions versus a half quarter impact in the fourth quarter of twenty twenty four. Because of that, also, q four should be our strongest recovery on a year over year comp basis just because of the MIGS restrictions being fully lapped at that point.

So, you know, obviously, there's a lot of moving parts. It's a dynamic MIGS environment right now, but we do feel like we are well positioned competitively that we have a good understanding of the fundamental market dynamics, and that, you know, we provided upside in guidance on the dry eye side as we get some wins. So we feel like we're well positioned, and the street has, you know, kind of bracketed the, revenue guidance that we gave, which seems seems appropriate.

David Saxon, Analyst, Needham and Company: Okay. Great. Yeah. We'll we'll touch on reimbursement in a in a bit. But obviously, have been a topic over the last week or so or longer, I should say.

But can you just remind us what is currently baked into guidance? And then how the most recent slate of tariffs, specifically for for China as it relates to you, how might that impact site finances?

Ali Baraline, CFO, Sight Sciences: Yeah. I mean, obviously, this is a very dynamic situation as well with the changes even today on the the China tariffs going from, the 54% tariff rate to a 4% tariff rate. We don't give explicit gross margin guidance. So our last guidance, you know, is revenue and adjusted operating expense, so we don't give, either earnings or gross margin explicit guidance. However, as as you mentioned and as we discussed on our last earnings call, a significant portion of our Omni and Scion products and certain TiareCare system components are produced and assembled in a manufacturing facility in China.

So we do have China exposure in our supply chain. Obviously, that will have some impact to gross margin. We do have some, inventory pre tariff that should mitigate that at least in, you know, certainly the first quarter and into the second quarter. You'll start seeing some impact, but the larger impacts come in the third and the fourth quarter, if these tariff environments continue. We are assessing the impact here and remediation and looking at what we can do here both with our current partners and and other partners and what what is the appropriate remediation, particularly because this is, an escalating environment on the the China side, and we are working to try and offset some of these costs through other business adjustments as well.

So our plan is we'll provide an update on our next earnings call. I do wanna note, you know, we have very strong gross margins in our business. And if you just look at our surgical glaucoma segment, you know, our our gross margins for, you know, are in the 87 and change percentage, points. So it's very strong, so we do have some room there. Of course, obviously, we would like to pay as minimal tariffs as possible, and so we will work to remediate this as much as possible as quickly as we can as many, many other companies are also looking to remediate.

Yeah.

David Saxon, Analyst, Needham and Company: Okay. And then maybe just a a follow-up. I I think you have a manufacturing partner in The US. Is that right? Okay.

And so

Ali Baraline, CFO, Sight Sciences: Another a a US based manufacturer. Now as we said on our prior call, at the 20% tariff level, it didn't make sense to reconsider that. So that is certainly an option we'll be looking at there as well as our manufacturing partner also has other locations that they manufacture at. So we will consider all of those options when we look at, you know, what's the right solution for us here with our partners.

David Saxon, Analyst, Needham and Company: Okay. And then just given, you know, some news or headlines around, you know, recession, you know, are we in one? Are are we going to be in one? Wanted to get your take. So on a glaucoma on the glaucoma side, you you're exposed to older patients on dry eye.

You're kind of transitioning to be reimbursed from from cash pay. So, you know, what is your view on how a recession might impact the business and kinda underlying demand?

Ali Baraline, CFO, Sight Sciences: Yeah. I think we're relatively insulated there from the recession. Obviously, a strong majority of our business is covered by Medicare reimbursement or other third party reimbursement on the surgical glaucoma side. And on dry eye side, well, you know, there is at least it's a small portion of our total business at this point. And the upside is really if we can establish reimbursement, which should minimize the out of pocket exposure to our patients.

So, we think that those are minimal impacts to us. Certainly, the the tariff impact is a much larger immediate, impact to the business than, potential recession influence.

Paul Badawi, Sight Sciences: And I I would just add to Ali's comments, David. Glaucoma is a a serious disease. It's the world's leading cause of irreversible blindness. Omni is chosen by glaucoma surgeons when efficacy is needed. Patients tend to listen to their ophthalmologist or optometrist as it relates to treatments.

So being reimbursed and being a serious disease and the nature of the physician patient relationship, I think, leads to a pretty insulated business on the glaucoma side. Dry eye today is cash pay. Obviously, cash pay businesses tend to be more impacted by a recession. We're working on reimbursement, obviously, and we're making great progress. And we expect coverage policy wins this year, given that we're treating interventional procedures for dry eye will be first leveraged in moderate to advanced patients coupled with reimbursement.

I think that tailwind would certainly outweigh any co pay headwind in a recessionary environment.

David Saxon, Analyst, Needham and Company: Okay, great. All right. Let's get into the the portfolio. We'll we'll start with the surgical glaucoma side. I'm gonna start with a set of mainly reimbursement related questions.

So we're about five months, you know, post the LCDs being implemented. Can you just remind us what your estimated exposure was to stack procedures in 2024?

Ali Baraline, CFO, Sight Sciences: Sure. Happy to. So, when we look at the claims data and, for MIGS procedures, we see there was approximately 350,000 MIGS claims built. And out of that, there's about 300,000 patient visits. So there's about 50,000 or 15% of claims billed that under this new, you know, LCD restrictions would not be allowed.

Now, obviously, some portion of that, it's five zero seven max. It's not all max, so that won't go to zero. Commercial plans also can have some level of it. But at broad strokes, you know, 50,000 or 15% is the market, headwind associated with the MIGS, restrictions. We estimate our impact to be slightly higher than that, 20 to 25%, just looking at, the combination of how our product has been used in the market.

Now, obviously, it is important to remember that in a one mgs world, efficacy is very important. And, Omni has a very strong efficacy profile and, you know, addresses multiple areas of resistance, and that is important for clinicians. And we've seen good success in messaging that to win as many of these procedure volumes as as possible.

David Saxon, Analyst, Needham and Company: Okay. And I I guess just on that last point, like, what is baked into kind of the portion of the SAC procedures that you win over? Like, what's what's assumed in guidance?

Ali Baraline, CFO, Sight Sciences: Yeah. So we've assumed we've win our fair share, which we kinda define as about 50% of the the procedures that we're winning about half. Obviously, we're trying to win more than that, but that's kind of what's inherent in guidance.

David Saxon, Analyst, Needham and Company: Okay. And then it sounds like Alcon is gathering data to submit to try to appeal the LCD. So are you working on anything similar? And I guess, like, is there a collective response from industry?

Paul Badawi, Sight Sciences: There's a lot of interest, as you can imagine, in in the ophthalmic community, maintaining that flexibility to offer patients what the surgeon believes they need. So, yeah, we're we're aware of a number of different efforts. Canaloplasty and stent often with Omni is a is a common combination, so data is being collected there. Some of that data does include Omni. We're aware of that.

We've spoken with a number of our Omni surgeons who are also collecting combination data. We'll see we'll see how robust the data the combination data is today and what is needed. I suspect over time, if there's sufficient rigor in the long term clinical data showing that multiple procedures is better than a single procedure, this could return.

David Saxon, Analyst, Needham and Company: Okay. Alright. And then so right now, there's from a combination perspective there's a code for combo cataract with a stent. At AAO last year, we heard that there'll be new coding introduced for the combo with canaloplasty and the combo with goniotomy. So I guess, like, what have you heard on that topic, and and what's the expected timeline?

Ali Baraline, CFO, Sight Sciences: Yeah. So this is something that's always always the case. If you reach a threshold of more than seventy five percent of claims being done in combination with each other, then they will look to establish a a combination code reflecting that joint procedure. And that, of course, happened, many years ago or, a few years ago with the the, stent codes. Now, we haven't heard a specific timeline, but I think this change that we've seen in the LCD restrictions will, get to the point where both canaloplasty and goniotomy reach that threshold in combination with cataract.

One of the reasons they haven't, even though stand like, what we call stand alone procedures for canaloplasty and goniotomy, are still, you know, a fraction of the market, 10% or so of the market are done on a stand alone basis. The reason you haven't seen that seventy five percent threshold triggered is because a portion of the time those have been billed in combination with a stent and cataract, and now, of course, that code combination is restricted in five of seven max. So, it would not be surprising that now the 75% threshold would be triggered as we they start to evaluate twenty twenty five codes, which would be probably twenty twenty seven implementation. But, again, we haven't heard any specific timelines here. You know, obviously, we're focused on optimizing reimbursement to reflect the value of the Omni procedure, and, you know, we'll continue to evaluate this as as things move forward.

But this likely will happen at some point. It's just a matter of time.

David Saxon, Analyst, Needham and Company: Mhmm. Okay. Alright. Maybe we'll switch gears to utilization. So can you just talk about the trends you're seeing with Omni, trying as best you can at least to to exclude the impacts of the LCDs?

Paul Badawi, Sight Sciences: Yeah. I I think our team is doing a great job getting into our accounts as, you know, ever since the finalization of the LCDs as the requirement to transition from stacked procedures to a single procedure. Team's done a great job reminding surgeons about the comprehensive nature of Omni, the fact that it can treat all three points of resistance in the disease outflow pathway. It's unique in that regard. The fact that it can, through a single incision, provide surgical access to all 360 degrees of Schlump's canal, it's unique in that regard.

And so that if you have to choose one MIGS procedure in a one MIGS world, Omni is your choice. As Ali mentioned, we are indeed winning our fair share. You know, in terms of procedural selection, we think about safety, efficacy, usability, professional fees, and facility fees, and Omni Omni does well across the board. And we're going in there and into all of our accounts and reminding our surgeons that Omni is their choice, and our team's doing a great

David Saxon, Analyst, Needham and Company: job. Mhmm. Okay. And then maybe how about ordering facilities? Like, how's the team how's the sales team doing with engaging new reps to to either drive, you know, deeper penetration among docs who are who aren't doing procedures, but also kind of trying to win share?

Ali Baraline, CFO, Sight Sciences: Yeah. So at a high level, I think we're we're doing a good job, you know, with this transition here of maintaining accounts and making sure that surgeons continue to use Omni for the appropriate patients within their population. In terms of, you know, growing that patient pool, I think that's something that will take, you know, quarters. Obviously, every quarter, we add new surgeons and train new surgeons. But, you know, really, this education effort is ongoing to make sure people understand how, Omni fits into the overall treatment paradigm and driving awareness both in combination cataract and the fact that there are still many combination cataract patients that have glaucoma that are not receiving a MIGS treatment at the time of cataract surgery as well as the stand alone market opportunity and, in particular, the pseudophagic stand alone market opportunity that we've identified as a high unmet clinical need when patients are continuing to worsen and they're, you know, multiple years out from their cataract procedure.

David Saxon, Analyst, Needham and Company: Mhmm. Okay. I guess from a market perspective, where do you think MEG's penetration is at at this point?

Ali Baraline, CFO, Sight Sciences: Yeah. I think we're we're still you know, obviously, it's it's hard to know exactly where we're at, but, you know, the estimates are there are about a million cataract procedures done per year on glaucoma patients. And if we say there are about 300,000, you know, MIGS visits, obviously, a portion of those are stand alone procedures. But just for high level math, know, obviously, you're you're still a fraction of it. And then you have a couple hundred thousand of additional kind of advanced glaucoma procedures being done per year.

So there's still a large number of patients that may benefit from a MIGS procedure that aren't getting it in that combination space. And then stand alone, we are absolutely in the early stages here. We're still working with the surgeon community. We've had some good success at AGS earlier this year and at upcoming the ASCRS conference events planned to really help engage with the surgeon community on these patients that are are have an opportunity to see much better outcomes by receiving a MIGS procedure instead of just another medication on top of what they've already received.

David Saxon, Analyst, Needham and Company: Mhmm. Okay. So, you know, one thing we've heard at at a lot of the industry conferences over the last couple years is this whole interventional mindset, IG kind of is I think how how they're branding it. But it seems like, to me, at least, that that kind of framework and and mindset would help the device mix companies. So how are you thinking that of that trend as it relates to site?

Paul Badawi, Sight Sciences: Significant. I think it's it's very meaningful. I think that's what has to happen. You know, stand alone stand alone MIGS, with Omni. The data is there.

It's clear. It's a it's a great solution to intervene earlier with Omni with a comprehensive procedure before a patient advances to the point where they need a highly invasive highly invasive and complication prone solution. The interventional mindset is what has to happen throughout the ophthalmic community. That's both within the surgeon community as well as the referring provider community. It is happening now, and there's multiple players in this space.

There's multiple new technologies, and there's it's kinda groundswell of of thinking to intervene earlier, whether that's with procedural pharmaceuticals, whether that's with SLT or more accessible SLT, with direct SLT as an example. We believe all of these technologies are great to help, you know, educate the ophthalmic community around interventions and and the fact that intervening earlier is better for this chronic lifelong disease to help delay the progression and help avoid the need for a patient to ever get to an invasive alternative. So it's one of those I think the the the tailwind of an interventional glaucoma mindset will far outweigh any individual competitive headwind from this technology or that technology. So we're excited about it. We've obviously been working on it.

It felt like solo for a number of years, and we're just happy to see other players in the interventional glaucoma space, in the standalone space, trying to educate the broad ophthalmic community on the benefits of procedural intervention as opposed to daily pharmaceutical intervention.

David Saxon, Analyst, Needham and Company: Mhmm. Okay. And then, you know, I I know kind of the workforce is is Omni, but I I wanted to touch on Scion. So, like, how is that product doing? Has it how is it helping penetrate the market where, you you know, it might be harder for Omni?

And then I guess the second part of the question is, maybe it was a a year or so ago, you said Scion was, like, mid single digits million. So, you know, is that still a a good way to think about the size of that product, or or has it grown?

Ali Baraline, CFO, Sight Sciences: Yeah. Sure. So it it's Scion was always designed to be a complementary product to Omni, really targeting surgeons that were looking for, something that was a more straightforward procedure and for patients who didn't need that comprehensive efficacy that Omni delivers. It's still in that same general range of revenue, so it hasn't materially changed. Obviously, there also was questions around goniotomy and the LCDs, and now we have the similar restrictions on goniotomy plus stents as we do canaloplasty plus stents.

So but we do see this as an important part of the, treatment paradigm, and it is a good entry way for doctors looking to start doing some canal based procedures, but not yet ready to do an Omni procedure.

David Saxon, Analyst, Needham and Company: Okay. Alright. Maybe a couple on the competitive landscape, and then we'll get into the pipeline. So obviously, it's been a drug eluting launch. I guess it was earlier in 'twenty four.

So has that caused any disruption in kind of the core mix market that you can tell?

Paul Badawi, Sight Sciences: We we think, again, whether whether it's there's a second drug eluting stent, drug eluting solution. There was a, you know, initial one from from Allergan. We view these as all, you know, great alternatives to to daily pharma. That's a problem that needs to change. So I, again, view these companies and new technologies that are helping to educate the ophthalmic community on interventional glaucoma, whether that's with a drug eluting stent or a direct SLT, that's helpful.

I think it's creating a tailwind. I don't think we're bumping up and competitive. These are large markets. The combo cataract market, as Ali had mentioned, maybe 30% to 40% penetrated, there's plenty of runway there. The standalone market is a multiple of that and is highly unpenetrated.

So we don't we don't view these not anytime soon as being directly competitive. I I do think it's net net helpful that everyone is trying to educate on the benefits of earlier intervention with any of these solutions, whether that's MIGS, whether that's laser, or procedural pharmaceutical.

Ali Baraline, CFO, Sight Sciences: And, of course, just to clarify, you know, those those can be done in combination with Omni or stents or goniotomy. You know, there there are not restrictions from a coverage perspective of whether those can be be combined. So we have seen also doctors choosing to do MIGs alongside those drug eluting products.

David Saxon, Analyst, Needham and Company: Mhmm. Okay. So just on the pipeline and maybe taking a a different angle on this so that the Alcon IP dispute, I think it centers on or centers around, like, conicular scaffold products and IP. So is that correct? And, I mean, I guess that implies you have something in the pipeline.

So when would, know, when could we see that product hit hit the market?

Paul Badawi, Sight Sciences: Yeah. We we we do. We're working on it. We're excited about our helical cannellicular scaffold as well as other pipeline in the glaucoma space. I think we'll be talking in greater detail soon.

We'd like to get ideally into humans when we can we'll be excited to share a lot more about them.

David Saxon, Analyst, Needham and Company: Okay. And then outside of that, you know, what else do you have in in the pipeline on the glaucoma side?

Paul Badawi, Sight Sciences: Yeah. So we're we're we're active, obviously, with the with the scaffold and other other MIGS interventions as well as an exciting, you know, sustained release technology platform. Again, as we approach getting into humans, we're we'll be excited to to share more on those solutions.

David Saxon, Analyst, Needham and Company: Okay. Alright. Let's maybe talk a little about dry eye. So maybe can you just start with a a broad overview of, like, where you are, what Sahara is, and then, you know, what you've done over the last couple quarters to transition the business to be reimbursed and kinda leverage that Sahara date data.

Paul Badawi, Sight Sciences: Yeah. We're super excited about the state of TiaraCare today, 2025. It's TiaraCare's year. We've worked for many years to get to this point. Years ago, we determined that patients needed access to reimbursed interventional treatments like tear care, that the market of, you know, procedural interventions for meibomian gland disease or evaporative dry eye is primarily cash pay.

That's a problem. We spoke with payers, a number of different payers, and said, look. We have this we have this technology. It works. Doctors, ophthalmologists, optometrists love to use it.

Patients love the results. It's cash paid today. It needs to be reimbursed. You're paying all this money for costly prescription Rx that doesn't necessarily address the root underlying cause of disease like TiaraCare does in terms of actually addressing the obstructed meibomian glands, what clinical data do you need to see to support that will support coverage for TiaraCare? And that is the Sahara trial.

The blueprint was designed in collaboration discussion with payers. They wanted to see ideally superiority to this to the standard of care, which is, you know, the prescription therapeutic restasis. We showed superiority in our primary science endpoint at six months. That's tier care versus twice daily, six months of compliant Restasis use. At twelve months, we showed if you cross patients over from Restasis to tier care, give them a single treatment, They continue to show clinically and statistically significant improvements in all signs and all symptoms at twelve months.

And then lastly, payers wanted to see what's the durability of treatment effect of tear care. So if we decide to cover it, paying for one treatment a year, two treatments, three treatments, Based on the 65,000 plus cash pay cases we've done today and the 1,500 or so installs we've made and trainings, we know that, you know, the average patient requires one to two care care treatments per year. We've completed the twenty four month. We've submitted it for publication. It should be published this year.

So with all of that, with the Sahara RCT, as well as additional studies, both prospective and retrospective studies that have been peer reviewed published, coupled with a budget impact analysis that talks about the health economic benefits of tier care that has now also been published, a cost utility analysis that which has been submitted and will be published this year. We're taking all of that together and working with payers and speaking with their medical directors and working on coverage policies. We've stated that we expect coverage policies in 2025. So those conversations, which are progressing nicely, are underway. In parallel with that, David, we're working with our top dry eye customers who are true believers in tear care, and they've seen it in their own hands with their own patients, how effective it is.

And we are ensuring that they're able to submit claims while we're having coverage policy conversations at the medical director level. Customers are submitting claims to these same payers, demonstrating the unmet need that I, you know, I did a tier care. This patient was not doing well on everything else we tried. We did tier care. It needs to be reimbursed.

And so those claims are going in in parallel. We're making good progress in terms of claims getting paid with a number of different payers, and we'll just keep advancing these efforts in parallel. And, again, we are we are confident that 2025 is the year, and we should see some coverage policy wins. We think that this category, we can create a very significant and necessary category in eye care with interventional dry eye. It should

David Saxon, Analyst, Needham and Company: be a, you know, all $12

Paul Badawi, Sight Sciences: category. There's tens of millions of patients that need to have access to a reimbursed interventional procedure like Tear Care.

David Saxon, Analyst, Needham and Company: Okay. So there there were some in the fourth quarter, there were some tier tier volumes shipped under legacy contracts, which kind of skewed the ASP mass following the the price increase October 1. So my math is I'm coming around, like, 50 to 60 cases were shipped under the new ASP. So I'd those are all being used in reimbursed cases. So is that the right ballpark, or are the volumes that were being shipped under the legacy contracts, are those also being used in some reimbursed procedures?

Ali Baraline, CFO, Sight Sciences: Yeah. So those are really for cash pay purposes, the reimbursed volume. That's relatively close. It's a little light. We you know, the ASP, that list price was 1,200.

ASP was more like a thousand. So slightly higher under that new pricing than the 50 to 60. But, in general, yes, those are the claims that we are working with targeted KOLs to get submitted to show patient interest and have the right conversations with payers around why they should be reimbursing for for the tear care procedure. Yeah.

David Saxon, Analyst, Needham and Company: Okay. And then so we'll just, like, fast forward, you know, you you get some coverage policies. I guess, what what does the adoption curve look like in kind of the months following that? You know, why wouldn't most or or all of the the accounts in that region, you know, treating those covered patients kind of adopt fairly quickly?

Ali Baraline, CFO, Sight Sciences: Yeah. I think it's a great question. And and, frankly, I think we're in a great position based on what we've already built on the cash pay side of the business with 1,500 accounts already trained on tier care, done 65,000 cash procedures that and we also have a level of commercial infrastructure already built into our p and l. We can really hit the ground running with reimbursement wins. Now we have to see what the sizes of those wins and what areas, what's the, you know, how does that layer versus our current accounts and the team that we have built.

But, we will certainly leverage that quickly, and that's why we didn't bake this into guidance. We said, you know, as we get a win, then we can have the conversation of what that means in terms of, revenue opportunity, for for the company. So but I I do think your your point is fair. We we have a great opportunity in front of us that with a win, we can leverage what we've already built and what we've already invested to be able to have a fast start with these accounts.

Paul Badawi, Sight Sciences: And, David, just to add, it's a it's a really interesting model, and we're looking forward to getting a a policy win so that people start building out their models like like we have. But it's got tier care reimbursed has the appeal of procedural intervention, and the efficacy, that goes with procedural interventions addressing the root underlying cause of disease, procedural economics, and the incentive to perform these procedures, which is not the case with prescription pharma. Yet the procedure, like a MIGS, this one this one is being done in the office. So it's got that high volume in office procedure profile. And unlike glaucoma or MIGS where you'll do a glaucoma surgery and hopefully the patient's gonna be good for five years plus, in this case, it's likely to be one to two treatments per year.

So it's kinda like the dental model of eye care where the patients do well for a period of time, but they need to come back and get a retreatment. And so it's it's a very interesting model that I think I think people are gonna pay a lot of attention to the minute we get our first important coverage policy when.

Ali Baraline, CFO, Sight Sciences: And, David, just to expand on that, like, the rate of reimbursement is obviously really important. And then also what's just the coverage density? You know, how many covered lives? How easy is it for providers to identify the patients that could qualify for it? Is it a needle in the haystack, or do we have enough coverage that we can that it's easier for them to find and prescribe the the tier care treatment.

And the more wins we have, the easier that we'll get over time.

David Saxon, Analyst, Needham and Company: Okay. And maybe just a question on on the comment around, like, rate of reimbursement. You know, I I've done some checks, and I I get a number. But and and I don't wanna, you know, put you on the spot now. But, like, in terms of the variability around the rate of reimbursement, like, is it fairly consistent, or are you seeing payers come in kind of all over the place?

Ali Baraline, CFO, Sight Sciences: There is a rate of variability in in what we're seeing. And, but we are seeing more and more consistency, particularly with a handful of payers that are really understanding the economics and what we're looking for. And so there's always variability early in this process, but I think we're we're in a good spot, and we have a good path forward here.

Paul Badawi, Sight Sciences: Yeah. And, David, I think that's typical when you're starting off from scratch with a number of different payers who are understand the technology and the treatment and the clinical outcomes differently, and you're you're just starting to educate them. It can be all over the place. But over time, the important thing is over time, it starts to tighten up, and you start to see positive trends. And I think I think that's it's early days, but that's starting to happen.

David Saxon, Analyst, Needham and Company: Okay. Alright. Maybe just we'll close out with with a couple financial related questions. So gross margins, obviously, really strong, high eighties despite, you know, the LCD turmoil and disruption and and then also the dry eye transition. You know, we'll we'll get more of that in in 2025, but and maybe there's some tariff impact incremental to that.

But how should investors think about gross margins this year and going forward? At this point, maybe we'll just exclude the you know, tariff stuff.

Ali Baraline, CFO, Sight Sciences: Yeah. I think that's probably fair given given the environment. So we do think that, you know, the surgical glaucoma, we have, you know, really market leading gross margins there in the business, and we expect we can maintain that in the business. And on the dry eye, I think there's a huge opportunity for us to materially expand those gross margin profiles as we get volume and as we see, you know, these higher ASPs and reimbursement rates roll into the model. So I think we are well positioned on the gross margin side.

Obviously, you know, the tariffs are the biggest variable here, but we will work very diff very hard to offset these and look for other solutions. And remember, because our gross margin is so high, that also means the product cost is relatively small, and the tariff is only on the product BOM cost, not on the overhead portion of this cost. So, certainly, as we get into earnings, we'll provide more details there of how people should really think about that tariff impact, especially as we get more details on what these actually will be.

David Saxon, Analyst, Needham and Company: Okay. Great. Maybe just with the last minute, you know, anything you'd like to close with or or leave investors with?

Paul Badawi, Sight Sciences: I'll just say one thing, and, Ali, you can add. Look. We're we're excited. We're we're working to build a leading interventional eye care company. We have two leading interventional technologies and two of the biggest unmet needs in eye care, both glaucoma and evaporative dry eye disease with Omni and Tear Care.

Both of those technologies and products have exciting growth opportunities. You know, Omni has got a solid combo cataract business, and there's a tremendous standalone market development opportunity, especially with the interventional glaucoma mindset increasing. So that's very exciting. And then TiaraCare with reimbursement is another significant market development opportunity that we have in front of us. And then we have a rich pipeline of additional interventional technologies in these two categories that we're excited to to start sharing more details with in due course.

Those are my thoughts. But, Ali, anything else to add?

Ali Baraline, CFO, Sight Sciences: You hit it. Yeah. Thanks, David.

David Saxon, Analyst, Needham and Company: Great. Alright. Yeah. Well, Paul and Allie, thanks so much for joining us this year again, and thanks to everyone who tuned in.

Paul Badawi, Sight Sciences: Appreciate it. Thank you all.

Ali Baraline, CFO, Sight Sciences: Bye.

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