Sight Sciences at Stifel Forum: Strategic Growth Amid Challenges

On Tuesday, 27 May 2025, Sight Sciences (NASDAQ:SGHT) participated in the Stifel 2025 Virtual Ophthalmology Forum. The conference call, led by CEO Paul Boudouille and CFO Ali Bauerlein, offered a strategic overview of the company’s performance in surgical glaucoma and dry eye treatments. Despite new challenges in MIGS reimbursement, the company reported resilience and outlined future growth opportunities.

Key Takeaways

• Sight Sciences is navigating new MIGS reimbursement restrictions but outperformed expectations.
• The company is expanding its reach in the combination cataract and standalone pseudophakic patient segments.
• Ongoing discussions are in place to secure payer coverage for TearCare by 2025.
• Surgical glaucoma sales declined less than anticipated, with only a 6% year-over-year decrease.
• The dry eye market presents significant potential, with over 19 million diagnosed patients in the U.S.

Financial Results

• Sight Sciences reported a better-than-expected performance in the surgical glaucoma segment, with a smaller decline of 6% year-over-year, compared to the anticipated 10-15% drop.
• The company is actively working to mitigate the impact of MIGS reimbursement changes by leveraging its strong product lineup, including Omni and Scion.

Operational Updates

• The company is focusing on expanding its presence in the combination cataract surgery segment and penetrating the standalone pseudophakic market.
• For the TearCare dry eye treatment, Sight Sciences is engaging with both small and large commercial payers, aiming for coverage decisions by 2025.

Future Outlook

• With over 19 million dry eye patients in the U.S., the company sees a significant opportunity in addressing the needs of those with Meibomian Gland Dysfunction (MGD).
• Sight Sciences estimates one procedure per year for moderate dry eye patients and two for severe cases, highlighting the potential volume in this market.

Q&A Highlights

• During the call, executives emphasized the company’s leadership position and commitment to innovation in both glaucoma and dry eye treatments.
• The discussion underscored the importance of clinical data and commercial execution in driving future growth.

In conclusion, Sight Sciences remains optimistic about its strategic positioning and growth prospects. For a complete understanding, readers are encouraged to refer to the full transcript below.

Full transcript - Stifel 2025 Virtual Ophthalmology Forum:

Tom Steffen, Analyst, Stifel: Alright. Good afternoon, everyone. Tom Steffen with Stifel. Very excited to have Site Sciences here with us today. Pleased to be joined by Paul Boudouille, CEO, and Ali Bauerlein, CFO.

I’ll dive right into things if that’s okay, and I’ll start with surgical glaucoma. Some near term related questions. But to begin with the first quarter, Ali, you initially guided to one q surgical glaucoma down roughly ten to fifteen percent year over year. You beat that nicely, down only, I think, six percent year over year. So, Ali or Paul, maybe if you can start by talking about observations in the quarter specific to surgical glaucoma in Omni, and maybe dynamics that trended a bit better than your expectations in the first quarter.

Ali Bauerlein, CFO, Site Sciences: Yeah. I I can take that, Tom, to start. And, you know, obviously, we’re in a pretty dynamic MIGS environment with the new MIGS restrictions in place that limit the combination of, multiple MIGS at the same time as cataract surgery. So when we put guidance in place, we assume the industry and site sciences would experience that overall decline in MIGS devices used even while you still have the similar or same number of overall MIGS visits happening. There’s just less claims, occurring.

And so that was, you know, kind of consistent with our expectations. We’ve now seen the the q one claims data and, you know, consistent themes there. We did obviously, you know, when we set guidance, we wanted to be prudent with it given the the fact that it was still early in that transition, and we didn’t know exactly how many of those multiple MIGS we would win. But we do think that both Omni and Scion are performing very well in this new environment, and both are performing slightly above the levels that we had expected. And, you know, Omni with its strong clinical efficacy, surgeon preference, you know, long term customer relationships, and then, of course, now with the launch of OmniEdge, I think all of those are really helping it, you know, take slightly more than its fair share in this conversion down to one mgs, world.

Tom Steffen, Analyst, Stifel: Got it. That’s really helpful. So so you said you’ve seen maybe some claims data and that Omni may be taking a bit more of its its fair share. Maybe if you can just elaborate a bit further on, you know, kind of the trends you’re seeing or the tendencies that you’re observing from a share standpoint. Talk about just kind of surge in behavior and maybe if there’s any any data around the claims that you can back that with, that would be, very helpful.

Paul Boudouille, CEO, Site Sciences: I I would just start off clinically, Tom, and procedurally with Omni and and what we’re seeing in the market. Omni was designed to be multimodal in nature, offering the surgeon more functionality with a single device, a more comprehensive procedure indicated for canaloplasty followed by trabeculotomy. So Omni by itself stands alone in that regard that it can it can address all three points of resistance in the conventional outflow pathway. So in a one mgs world, while while, you know, the transition is underway and devices use, the market is contracting for a period of time from a relative competitive positioning, Omni is strong. Some surgeons were using part of Omni’s functionality and combining it with, for example, a stent to address the disease trabecular meshwork, and now we can go to those surgeons and say, in a one MIGs world, you can use more of Omni’s functionality.

So you can use the canaloplasty in addition to the trabeculotomy and address address all three points of resistance as you were doing with these combination MIGs in the past. So we’ve we’ve felt good about our competitive position entering the year, recognizing that we would all of us in MIGs would have a a headwind until these restrictions are lapped in the fourth quarter of this year. So we’re gonna continue to execute with excellence commercially. As Ali mentioned, we have long term relationships with our customers and proven technology where, you know, Omni is a very mature product, and we’re we’re continuing to innovate on it. As she mentioned, we’ve released OmniEdge, which I think is getting very good reception from the market.

And we continue to innovate on the Omni platform, and we’ll be releasing additional innovations on that platform in due course.

Tom Steffen, Analyst, Stifel: Got it. And it seems like from a share standpoint, Omni and Scion doing well, Omni primarily Canaloplasty, Scion, Goniotomy. So is it Stents who who who may be kinda losing more than their fair share, from from a market share standpoint? Or talk to what you’re seeing, across the different types of MIGS procedures within the claims data year to date in this new kind of MIGS environment.

Ali Bauerlein, CFO, Site Sciences: Yeah. I think that’s that’s right, Tom, that maybe stents are are losing a little bit, and and goniotomy is losing a little bit as well. I I think that those are trends that we’ll have to watch over more than just a quarter or two because, you know, these will take some time to fully play out. We do think that we’re well positioned in this environment. Omni also can bill under goniotomy, so it’s it’s not Omni doesn’t have a unique code.

And so because of that, we can’t say specifically how Omni is trending in terms of share gains or losses more than, you know, kind of how we see the competitive players play. We do see that when we look at, visits that include these multiple MIGS, as we said, prior to these LCDs going into effect, it peaked at about 15% of the volume. That’s now in q one down to about 5% of the volume. Now, obviously, that’s still allowed in a couple max and then commercial plans as well. So, that that big shift from 15 to five has occurred in that that first quarter, and you see the mass majority of the volume coming out as expected.

Tom Steffen, Analyst, Stifel: Great. And and that’s a great segue into my my next question, which was, you know, as we think about these LCDs more broadly in the context of mixed volume to to to your point, Ali, upon implementation, they were somewhat disruptive in in 04/2024. Again, in 01/2025, there was a full quarter impact, but, you guys at least seem to manage it effectively. So talk about how the LCD impact is trending just in terms of the magnitude of this impact. Are we seeing improvements?

Is it worsening of late? Is it is it getting better? How is it sort of trending of late in terms of the impact more broadly on Mig’s volume? It seems like kind of the the the stacking headwind has has already come from 15% all the way down to five. So maybe maybe it’s, digesting a little quicker than anticipated.

Maybe if you can talk about that.

Ali Bauerlein, CFO, Site Sciences: Yeah. Happy to. So, you know, first of all, what I would say is, you know, it it kinda has to happen quickly because there is no payment associated with the the stacked procedures anymore. So that happening quickly is not a surprise to us, and this is consistent with kind of what we had expected in terms of of net impact here. Of course, the headwind will continue until we get all the way through the fourth quarter where we’ll have the smallest headwind, and then the first quarter twenty twenty six is when we’ll have the first, you know, kind of clean year over year comp.

I think what’s important is that we still are seeing, you know, in the trailing twelve month growth in total, MIGS visits, so in that, you know, mid to high single digit level. And, you know, we didn’t see a falloff in visits associated with, you know, these changes in coverage, which, you know, previously, a few years ago when the stent, reimbursement was cut, there also was a pullback in procedure volume initially. We didn’t see that here, and that’s that’s a good indication that the market is healthy. They sees a value and a place for MIGS in the treatment paradigm for these patients, and those patients are still getting care even without these stacked procedures. So I think all of that has been, you know, relatively consistent with what what we had expected really since the start of the first quarter, and we’re just continuing to, you know, progress through this process.

Tom Steffen, Analyst, Stifel: Got it. That’s great.

Paul Boudouille, CEO, Site Sciences: And, Tom,

Tom Steffen, Analyst, Stifel: I I think I think

Paul Boudouille, CEO, Site Sciences: stepping back a bit, just it’s worth the reminder glaucoma is world’s leading cause of irreversible blindness. Minimally invasive glaucoma surgery is a proven treatment, whether it’s canaloplasty or goniotomy or stents. The market is not fully penetrated. Combination cataract market is the majority of MIG’s revenue today. There’s still plenty of runway and market expansion available in combo cataract.

There are hundreds of thousands of patients per year that have glaucoma and are undergoing cataract surgery that today are not getting a MIGS. There’s an opportunity there, and we’re working on that to expand the combo cataract segment. Obviously, we’ve discussed the stand alone market opportunity at length, and there’s, you know, millions of patients that can benefit from a minimally invasive procedural intervention sooner. So it’s it’s a space that’s here to stay. I think the bar has been elevated and raised in terms of clinical requirements, and I think Omni’s got a terrific product market fit in that regard.

So we feel we feel good about the space over over the long term.

Tom Steffen, Analyst, Stifel: Got it. That’s great. And and, Ali, you mentioned that patient visits really haven’t deteriorated at all, which, at least we view very encouraging in the context of as we lap these LCD headwinds to device unit volume, maybe we can return to at least some level of normal volume growth. Maybe if you can just talk to The US migs market longer term as we lap these headwinds kinda exiting this year. It sounds like, just based on this, kinda call it, MIGS I growth, maybe we can get back to a normal level of market growth.

Maybe if you can touch on that.

Ali Bauerlein, CFO, Site Sciences: Yeah. Happy to. And, you know, as you said, like, we we really start lapping the headwinds in the fourth quarter, fully lap it first quarter of twenty twenty six. And, you know, we’re really focused on how do we make sure patients are getting treated at the right time for, you know, these very serious, you know, needs. And, one of our focuses is really on how do we make sure that unmet need of pseudophakic patients continues to see increased penetration.

We also are focused on the combination cataract market. When we think about engagement, with cataract surgeons, it’s still a significant portion of patients that have glaucoma and have a cataract procedure in a given year, and, you know, almost half of them still don’t get a MIGS procedure at the time of cataract surgery. And that’s really a a large potential, and we need to get to those surgeons to really understand why they aren’t also trying to make an improvement on the glaucoma outside of the cataract procedure. So we do think that we can see a return to growth here in the MIG segment both in the combination cataract kind of core market as well as really addressing the stand alone pseudophakic patient population that is highly underpenetrated at this point. Obviously, that will, have to include a continued shift in mindset of surgeons of their willingness to intervene, procedurally to improve outcomes.

So I I do think that we have confidence that this market can return to higher growth rates as we lap those MIG stacking, but we as an industry also have to do work educating surgeons on why MIGs is an important part of the treatment paradigm.

Tom Steffen, Analyst, Stifel: Got it. That’s great. And a couple more on glaucoma. I’ll shift back a little more near term. For 02/2025, Ali, surgical glaucoma, you guided to revenue down high single digit to low double digit percent year over year growth.

Revenue declined by only 6% in one q. And in this quarter, in February, you’re facing an easier comp. So are there any factors we should be cognizant of that would drive a deceleration in year over year growth as well as the two year stacks? Is it competition? Is it the LCD headwinds worsening, or is it maybe just simple conservatism?

If you can touch on the the the two q guide, that’d be great.

Ali Bauerlein, CFO, Site Sciences: Yeah. So, I mean, I think that’s in the range of outcomes of what we saw in the first quarter. What I would say is that, you know, obviously, the second quarter tends to be the the highest quarter seasonally. Sometimes that can be impacted by summer vacations. I do think we wanted to be a little bit more conservative given competitive factors as well, timing of launches, and making sure that we didn’t get out ahead of the market.

Mhmm. I think it is important to set appropriate revenue guidance and, you know, making sure that we don’t get get, get caught there. The other thing I would note that I don’t think is is necessarily understood very well is that the headwind as we we talked about the stacked procedures, as we were running up to the deadline there, we saw an increase in stacked procedures in q one and q two and q three of twenty twenty five. So the headwind of stacking procedures on a year over year comp basis actually peaks in q three of twenty twenty five, in terms of headwind. And so q two does see more stacked procedures than q one did, in that comparative comp.

So that that, I think, is another factor that when we thought about guidance is part

Paul Boudouille, CEO, Site Sciences: of it.

Tom Steffen, Analyst, Stifel: Okay. That’s helpful. That makes sense. And and you mentioned new launches. Maybe just to finish here on on glaucoma, a v s Via three sixty from New World, kind of a new fairly direct competitor to Omni.

You have talked in the past about potential trialing and, that some some of that had been contemplated in your in your outlook. Maybe if you can just briefly briefly touch on how Via three sixty trialing has tracked relative to your expectations. And then I’ll have one more follow-up on Glaucoma.

Paul Boudouille, CEO, Site Sciences: Well, I’ll I’ll I’ll jump in there on on just a reminder that we we too have launched OmniEdge into the market, and our surgeon customers are very pleased. We’ve been listening to the market as the pioneers of the category, and we’ve been innovating on behalf of our surgeon customers and patients for a decade now. So OmniEdge is the latest. It’s being very well received. We’re proud of that, and we continue to innovate on the Omni platform, as I mentioned.

And OmniEdge will not be the the last elegant ab internal canaloplasty or trabeculotomy device from SITE Sciences, so stay tuned for more. As it relates to competitive products, yeah, we’ve seen them, Tom, before. Every yeah. The the ophthalmic community likes to try new things. I think that’s, you know, consistent with most specialties.

New products are released. Let me try it. There’s trial and disruption for sure. I think with any product, We’ve seen it in the past. In this case, I think there have been prior ab internal canaloplasty attempts here.

None of those have really broken through into the mainstream, so time will tell. But, yeah, there’s there’s trialing disruption. We had expected it. We we knew that this product would be coming likely coming to market this year and have prepared accordingly. Again Okay.

We’re doing we feel very good about OmniEdge, and we are in ORs, across the country today, delivering great clinical outcomes.

Tom Steffen, Analyst, Stifel: Got it. Got it. That’s helpful. And then last one on surgical glaucoma, and then I wanna leave some time for dry eye. But, saw you commenced, I believe, it was a pilot study on the Helix MicroStent.

Paul, maybe if you can talk about that product, its differentiating factors, and then any rough sense for timelines, milestones, etcetera, that’d be very helpful.

Paul Boudouille, CEO, Site Sciences: Sure. Yeah. So Sight Science is actually we we started off as a canolecular scaffold company many, many years ago. Shifted to non implantable solutions, which ultimately resulted in Omni. Think of, to make a cardiovascular analogy, angioplasty and stent.

Angioplasty came first in the seventies, and then stents bare metal stents came later in the eighties and nineties, and then drug eluting stents. So we shifted to Omni. I think that was a great decision. Omni has been transformative to the MIGS category, and now we are working to bring a elegant cannellicular scaffold to market. As you mentioned, the Helix, I think the differentiating qualities, I think it we’re trying to ace both procedural ease and usability coupled with efficacy.

And we’ve seen from the various stent products on the market, you know, some have better attributes on the procedural side, some have, you know, claimed to have better efficacy from the circumferential approach. So we’re trying to marry the procedural ease of your favorite microstent with the circumferential efficacy that comes with treating more of the diseased outflow pathway versus less. And so that’s what you have in the Helix microstent. It’s a very elegant helical design, can be delivered into the canal in a very efficient and straightforward manner. Props open the canal effectively while minimizing contact with the with the walls of the canal to ideally optimize outflow.

Tom Steffen, Analyst, Stifel: Got it. That’s great. Super helpful. And, shifting to dry eye, I’ll dive right in. And and, Paul, maybe if you can start by talking about how payer discussions are going, any payers maybe in the later stages of discussions.

And you reiterated, on the one q call expectations for 2025 payer wins. Do you still expect, some to begin coming through this year? Maybe if we can start there.

Paul Boudouille, CEO, Site Sciences: Yeah. We, we remain very excited about the tear care opportunity and the the opportunity to pioneer a significant new category of interventional or procedural dry eye. There are no reimbursed treatments. Patients do not have reimbursed access to procedures that address the root underlying cause of the vast majority of their dry eye disease, which are obstructed meibomian glands. We are many years into a a a long term strategy and a significant investment we’ve made primarily with the Sahara RCT, two year RCT in dry eye, which is concluded now.

We we are having very productive conversations with payers, Tom, as we’ve discussed in the past. Those conversations are progressing. This includes small commercial payers, large national commercial payers, as well as a handful of MACs. We have stage one and stage two of Sahara published. We have a budget impact model published.

We’ve completed stage three, the two year endpoint for Sahara. That is in the peer review process, and we expect publication this year along with a cost utility analysis. We have shared the high level clinical outcomes of the two year data at the recent ASCRS conference. The the results were as we had expected and as we’ve seen over the years in the cash pay market and the 65,000 plus cash pay cases that we’ve seen. So tier care is proven to be efficacious, consistently efficacious on all signs and all symptoms, not just immediately, but also over the long term.

Mhmm. And with that foundation of clinical data and the health economics that come with that, and the superiority to the leading prescription eye drop, we’ve really made a strong case for payers to wanna cover this. Better clinical outcomes for patients, better value to the system, better value for payers, value for patients, value for eye care providers, obviously value for Sight Sciences and shareholders as well. Because of that value that’s readily apparent, our conversations have progressed nicely. We continue to state that we believe we will have coverage policies and or payment decisions this year in 2025.

Hopefully, that’s more than one. It will take several years to get, you know, complete coverage of, you know, all of the potential covered lives. But we think that that first coverage policy and or payment decision will be a very significant milestone in our journey to pioneer this new very significant category. I would say it’s probably one of the biggest categories in all of medicine where the prevalence is already significant. It’s growing.

Our obsession with screens and smartphones and Zoom, just like we’re all on Zoom right now, it’s exacerbating the problem. A publication out of Europe from some cornea professors in Europe called it a lifestyle epidemic, and we have a very proven treatment with rigorous RCT data behind it to suggest intervening earlier with tier care is good for patients immediately and over the long term. And, again, stay tuned for some progress this year. We do believe we’ll we’ll put up some coverage decision successful coverage decisions or payment decisions this year.

Tom Steffen, Analyst, Stifel: That’s great. No. Super compelling, super comprehensive. Appreciate that, Paul. And so, you have talked about customers upon kinda coverage and or payment decisions ramping quickly.

You have smart hubs in the field today, but where does remind us where the dry eye Salesforce stands today, and how important is that to the ramp up as reimbursement starts to come through, hopefully, sometime this year?

Paul Boudouille, CEO, Site Sciences: Yeah. We we have a we have a lean infrastructure, commercial infrastructure with TiareCare, but they’ve they’re very tenured, and that’s important. So we are we are not starting a you know, this will not be a launch cold into the market. We’ve been in this space for years carefully, paying close attention to it, learning a ton, understanding the market, understanding the customer, understanding office throughput, having long term relationships with those customers. And so this team of 10 to 15, you know, maybe ten ten reps, maybe 15 all in with with marketing resources.

While it’s smaller, it’s a highly effective lean team because of the tenure in the market and their expertise. I I would say we’ve been more focused on procedural dry eye or interventional MGD than any other company out there over a long period of time. And so when we get coverage and or payment decisions, we have that installed base, as you mentioned, of 1,500 plus smart hubs trained. These folks have been trained on the TIER care procedure. We have reps that are ready to go.

We have those established relationships. We have customers that are waiting, frankly, for the reimbursement determinations. And so we are excited about the kind of acceleration we can see. We will we will make investments as we go. We’ll feel it out.

We’ll see how how it’s performing and the rate of acceleration and the opportunity to invest and grow better faster. But but, again, we will not be starting from a standstill when we get the reimbursement.

Tom Steffen, Analyst, Stifel: Okay. Got it. So so potential investments, I e, maybe Salesforce expansion as you kind of feel out payment decisions coming through, but there is an openness to kind of scaling that that Salesforce footprint.

Paul Boudouille, CEO, Site Sciences: There is, but think it most importantly, I think we’re gonna have market performance in hand before we have to make those decisions because we have that existing Right. Customer base and those that existing commercial infrastructure. So it’s a lot easier to make informed Yep. Investment decisions when you’re already seeing you really like what you see.

Tom Steffen, Analyst, Stifel: Got it. That that makes perfect sense. And, I think we’re out of time, but I’ll I’ll squeeze one more in if that’s okay. Maybe just to wrap up here on on dry eye. You know, we look back in at peak, your customers were performing roughly 20,000 total tier care procedures annually.

But cash pay likely had limitations just given cost constraints since the procedure out of pocket wasn’t, inexpensive. So have you quantified how the TAM may expand with coverage and reimbursement? Maybe if you can just talk to us about, you know, where volumes could, escalate to, as you start to you know, as these coverage and and payer decisions, start to come through.

Ali Bauerlein, CFO, Site Sciences: Yeah. I’m happy to take that. So we did peak at over 20,000 procedures in 2023, and in total, as we said, done about 65,000 procedures. And we estimate there’s over 19,000,000 diagnosed patients in The United States with dry eye disease. Up to eighty six percent of those have some form of MGD.

So that’s, you know, up to, almost seventeen million patients, and about half of those are moderate to severe. So that’s, you know, call it seven to eight million patients, and, you know, that is a significant patient opportunity. We estimate one procedure per year for moderate patients, two procedures per year for severe patients. Now, obviously, actual TAM will depend on what the reimbursement rate is, and that’s still TBD. But this is a very large market opportunity.

There’s poor compliance with prescriptions and over the eye drops. And not only is this a better solution for patients, much easier from a compliance perspective to go once or twice a year. It’s a lower cost for payers as we’ve shown in the budget impact analysis, and the providers can participate in the procedural economics. So we think this is really a win win win in a huge, and as Paul said, growing market, where patients are really looking for a better option.

Tom Steffen, Analyst, Stifel: Got it. Well, that’s a great note to end on. Paul, Ali, thank you guys so much for participating, and, hope you both have a great summer. Thanks.

Paul Boudouille, CEO, Site Sciences: Tom, thanks a lot. Appreciate it.

Tom Steffen, Analyst, Stifel: Take care.

Ali Bauerlein, CFO, Site Sciences: Thanks, Tom.

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