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Glaukos Ramps Up iDose TR, Battles Legacy and Reimbursement Risks
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Key Takeaways
GKOS posted 25% YoY revenue growth in Q1 2025 to $106.7M, led by $21M in iDose TR sales.
GKOS is advancing a rich pipeline, including Epioxa and PRESERFLO, to fuel long-term growth.
GKOS expects mid-single-digit 2025 declines in non-iDose revenues due to LCD and legacy MIGS pressure.
Glaukos Corporation (GKOS - Free Report) continues to reshape the ophthalmology landscape, backed by a record-breaking first-quarter 2025 performance. The company posted revenues of $106.7 million, reflecting a 25% year-over-year increase, driven by the robust adoption of its groundbreaking iDose TR implant. Management reaffirmed full-year revenue guidance of $475-$485 million, signaling confidence in its commercial momentum.
The first quarter also validated Glaukos’ transition into a dual-growth engine business, with strong performance in both U.S. glaucoma and interventional glaucoma (IG) franchises. As the company accelerates investments behind its expanding product pipeline, Glaukos appears well-positioned to capture long-term value. However, reimbursement complexities and headwinds in legacy businesses remain watchpoints.
iDose TR Launch Gaining Traction: iDose TR, Glaukos’ first-of-its-kind intracameral sustained-release drug implant, is rapidly emerging as the key growth driver. U.S. glaucoma sales in the first quarter surged 41% year over year, fueled by iDose contributions of nearly $21 million, reflecting an $85 million annualized run rate. Physician feedback remains highly positive, and the company is expanding its base of trained surgeons and active accounts. Growing Medicare coverage across MACs — Noridian, Novitas, and First Coast in particular — is accelerating uptake. Management expects continued sequential growth as payer adjudication improves and utilization deepens.
Momentum in International Glaucoma and Interventional Platforms: Outside the United States, Glaukos delivered $29 million in interventional glaucoma sales, up 15% year over year. The company continues to scale international infrastructure and sees growing acceptance of MIGS (minimally invasive glaucoma surgery) as the global standard of care. While regional market access headwinds may emerge, early adoption of Glaukos technologies and potential new approvals support sustained double-digit growth in key markets.
Long-Term Growth Catalysts
Rich Pipeline With Multiple Shots on Goal: Glaukos has a robust and expanding R&D pipeline. Key programs include Epioxa, iDose Trex, PRESERFLO MicroShunt and GLK-401. Epioxa is a next-gen corneal cross-linking therapy for keratoconus, with an FDA PDUFA date set for October 2025. iDose TREX is a follow-up to iDose TR, targeting extended drug delivery windows and currently in pivotal trials. PRESERFLO MicroShunt is a surgical solution for refractory glaucoma, also in pivotal trials. GLK-401 is a multi-kinase inhibitor for wet AMD. It is in early clinical development.
Management sees these as potential category-defining innovations that could significantly broaden Glaukos’ addressable market in the next three to five years.
Standalone Market Expansion: The company is actively cultivating standalone use of MIGS devices like iStent infinite, positioning for longer-term tailwinds as more surgeons adopt interventional glaucoma practices. Management believes that standalone MIGS and procedural pharmaceuticals, such as iDose, will not cannibalize each other but grow in tandem as physician comfort with dual-modality therapy improves.
Challenges and Watchpoints
Reimbursement Complexities and LCD Headwinds: LCD restrictions issued by MACs in late 2024 are suppressing cataract + MIGS procedures, impacting legacy stent sales, which declined mid-single digits in the first quarter. Management expects these headwinds to persist through 2025, with full-year non-iDose revenues projected to decline mid-single digits.
Execution Risk in iDose Ramp: While iDose TR adoption has exceeded internal expectations, the path to widespread coverage and consistent reimbursement across all MACs is ongoing. Commercial coverage and Medicare Advantage access are improving but still evolving, requiring methodical rollout and patient support strategies, including $0 copay programs.
Corneal Health Weakness: Sales of Photrexa remain muted due to the Medicaid Drug Rebate Program impacts. Though 2026 may bring a rebound with Epioxa’s launch, near-term growth in this segment is guided to be flat to low-single digits.
Competitive Landscape
The iDose TR launch positions Glaukos ahead of peers in procedural glaucoma drug delivery, but competition remains fierce. Alcon (ALC - Free Report) continues to deepen its presence in MIGS through the Hydrus Microstent. Johnson & Johnson (JNJ - Free Report) leverages its global commercial muscle via the Xen Gel Stent. Meanwhile, Sight Sciences (SGHT - Free Report) is actively defending its share in standalone MIGS procedures with Omni. ALC, JNJ and SGHT offer meaningful alternatives in the glaucoma treatment continuum, and their responses to iDose’s adoption curve will be a key factor in the competition.
Meanwhile, GKOS has underperformed its rivals — ALC, JNJ & SGHT — in the MIGS space so far this year. Glaukos shares have declined 31.7% year to date, underperforming the industry’s decline of 9.2%. In the same period, Alcon and J&J have risen 2.6% and 7.8%, respectively, and Sight Sciences has declined 2.6%.
Image Source: Zacks Investment Research
Hold GKOS
Glaukos' first-quarter 2025 results underscore a business in the process of strategic transformation. The company is no longer just a MIGS pioneer; it is evolving into a diversified, interventional eye care platform with meaningful pipeline depth. With accelerating iDose TR adoption, expanding international presence and a well-capitalized balance sheet ($303 million in cash, $69 million in debt), GKOS is poised to deliver durable revenue growth. Still, reimbursement variability, regulatory timelines and execution in emerging franchises remain critical to track. For investors seeking exposure to innovation in ophthalmology, GKOS presents a compelling, albeit high-expectation, growth story.
Image: Bigstock
Glaukos Ramps Up iDose TR, Battles Legacy and Reimbursement Risks
Key Takeaways
Glaukos Corporation (GKOS - Free Report) continues to reshape the ophthalmology landscape, backed by a record-breaking first-quarter 2025 performance. The company posted revenues of $106.7 million, reflecting a 25% year-over-year increase, driven by the robust adoption of its groundbreaking iDose TR implant. Management reaffirmed full-year revenue guidance of $475-$485 million, signaling confidence in its commercial momentum.
The first quarter also validated Glaukos’ transition into a dual-growth engine business, with strong performance in both U.S. glaucoma and interventional glaucoma (IG) franchises. As the company accelerates investments behind its expanding product pipeline, Glaukos appears well-positioned to capture long-term value. However, reimbursement complexities and headwinds in legacy businesses remain watchpoints.
Glaukos Corporation Price
Glaukos Corporation price | Glaukos Corporation Quote
Near-Term Growth Drivers
iDose TR Launch Gaining Traction: iDose TR, Glaukos’ first-of-its-kind intracameral sustained-release drug implant, is rapidly emerging as the key growth driver. U.S. glaucoma sales in the first quarter surged 41% year over year, fueled by iDose contributions of nearly $21 million, reflecting an $85 million annualized run rate. Physician feedback remains highly positive, and the company is expanding its base of trained surgeons and active accounts. Growing Medicare coverage across MACs — Noridian, Novitas, and First Coast in particular — is accelerating uptake. Management expects continued sequential growth as payer adjudication improves and utilization deepens.
Momentum in International Glaucoma and Interventional Platforms: Outside the United States, Glaukos delivered $29 million in interventional glaucoma sales, up 15% year over year. The company continues to scale international infrastructure and sees growing acceptance of MIGS (minimally invasive glaucoma surgery) as the global standard of care. While regional market access headwinds may emerge, early adoption of Glaukos technologies and potential new approvals support sustained double-digit growth in key markets.
Long-Term Growth Catalysts
Rich Pipeline With Multiple Shots on Goal: Glaukos has a robust and expanding R&D pipeline. Key programs include Epioxa, iDose Trex, PRESERFLO MicroShunt and GLK-401. Epioxa is a next-gen corneal cross-linking therapy for keratoconus, with an FDA PDUFA date set for October 2025. iDose TREX is a follow-up to iDose TR, targeting extended drug delivery windows and currently in pivotal trials. PRESERFLO MicroShunt is a surgical solution for refractory glaucoma, also in pivotal trials. GLK-401 is a multi-kinase inhibitor for wet AMD. It is in early clinical development.
Management sees these as potential category-defining innovations that could significantly broaden Glaukos’ addressable market in the next three to five years.
Standalone Market Expansion: The company is actively cultivating standalone use of MIGS devices like iStent infinite, positioning for longer-term tailwinds as more surgeons adopt interventional glaucoma practices. Management believes that standalone MIGS and procedural pharmaceuticals, such as iDose, will not cannibalize each other but grow in tandem as physician comfort with dual-modality therapy improves.
Challenges and Watchpoints
Reimbursement Complexities and LCD Headwinds: LCD restrictions issued by MACs in late 2024 are suppressing cataract + MIGS procedures, impacting legacy stent sales, which declined mid-single digits in the first quarter. Management expects these headwinds to persist through 2025, with full-year non-iDose revenues projected to decline mid-single digits.
Execution Risk in iDose Ramp: While iDose TR adoption has exceeded internal expectations, the path to widespread coverage and consistent reimbursement across all MACs is ongoing. Commercial coverage and Medicare Advantage access are improving but still evolving, requiring methodical rollout and patient support strategies, including $0 copay programs.
Corneal Health Weakness: Sales of Photrexa remain muted due to the Medicaid Drug Rebate Program impacts. Though 2026 may bring a rebound with Epioxa’s launch, near-term growth in this segment is guided to be flat to low-single digits.
Competitive Landscape
The iDose TR launch positions Glaukos ahead of peers in procedural glaucoma drug delivery, but competition remains fierce. Alcon (ALC - Free Report) continues to deepen its presence in MIGS through the Hydrus Microstent. Johnson & Johnson (JNJ - Free Report) leverages its global commercial muscle via the Xen Gel Stent. Meanwhile, Sight Sciences (SGHT - Free Report) is actively defending its share in standalone MIGS procedures with Omni. ALC, JNJ and SGHT offer meaningful alternatives in the glaucoma treatment continuum, and their responses to iDose’s adoption curve will be a key factor in the competition.
Meanwhile, GKOS has underperformed its rivals — ALC, JNJ & SGHT — in the MIGS space so far this year. Glaukos shares have declined 31.7% year to date, underperforming the industry’s decline of 9.2%. In the same period, Alcon and J&J have risen 2.6% and 7.8%, respectively, and Sight Sciences has declined 2.6%.
Image Source: Zacks Investment Research
Hold GKOS
Glaukos' first-quarter 2025 results underscore a business in the process of strategic transformation. The company is no longer just a MIGS pioneer; it is evolving into a diversified, interventional eye care platform with meaningful pipeline depth. With accelerating iDose TR adoption, expanding international presence and a well-capitalized balance sheet ($303 million in cash, $69 million in debt), GKOS is poised to deliver durable revenue growth. Still, reimbursement variability, regulatory timelines and execution in emerging franchises remain critical to track. For investors seeking exposure to innovation in ophthalmology, GKOS presents a compelling, albeit high-expectation, growth story.
The company currently carries a Zacks Rank #3 (Hold). You can see the complete list of today’s Zacks #1 Rank (Strong Buy) stocks here.