Glaukos (NYSE:GKOS) reported record fourth-quarter and full-year 2025 results and reaffirmed its 2026 revenue outlook, with management pointing to continued momentum in iDose TR for glaucoma and the initial launch steps for newly approved Epioxa in keratoconus.
Financial results and 2026 revenue outlook
Chairman and CEO Tom Burns said Glaukos delivered fourth-quarter consolidated net sales of $143.1 million, consistent with a pre-announcement, representing 36% growth on a reported basis and 34% on a constant-currency basis versus the year-ago quarter. For full-year 2025, the company posted consolidated record net sales of $507.4 million, up 32% versus 2024.
In response to analyst questions, President and COO Joe Gilliam provided additional framing for the 2026 guide by franchise:
- International glaucoma: expected high single-digit growth for the year, with competitive trialing headwinds in key markets partially offset by iStent infinite contributions following EU MDR certification and a European launch late last year.
- U.S. glaucoma: embedded guidance implies growth in the 30% range year-over-year, which Gilliam said is driven entirely by iDose TR; management suggested modeling the non-iDose U.S. business as flat year-over-year.
- Corneal health: expected to grow modestly year-over-year, but with volatility during the transition from Photrexa to Epioxa and reimbursement mechanics that management expects will influence timing of treatments.
iDose TR performance and key developments
Burns said U.S. glaucoma franchise net sales were $86.4 million in the fourth quarter, up 53% year-over-year, driven by iDose TR. iDose TR generated approximately $45 million of sales in the quarter and approximately $136 million in 2025.
Management highlighted the FDA’s approval of an iDose TR labeling supplement allowing for unlimited re-administration in patients who maintain a healthy cornea. On the call, executives said they believe the labeling change should expand physician flexibility and potentially broaden access for repeat treatment.
Gilliam addressed questions about iDose revenue cadence, noting that fourth-quarter performance included some mix and timing dynamics. He cited a seasonal shift toward Medicare Advantage utilization in the fourth quarter and a rep-incentive-related timing effect that he described as “a little bit of pull into Q3 and a little bit of pull out into Q4.” He said the company still expects continued sequential improvement each quarter throughout 2026, including sequential progress into the seasonally lower first quarter.
On re-administration, management said it was not a material assumption in 2026 guidance and that it is expected to become a more meaningful contributor in 2027 and beyond. Gilliam also said Glaukos has already seen its first re-administration procedure in the operating room, describing it as driven by a patient seeking to avoid returning to eye drops.
Management also discussed reimbursement and utilization dynamics, including progress in establishing professional fees with Medicare Administrative Contractors (MACs) and efforts to expand utilization in commercially covered and Medicare Advantage populations. Gilliam said the company was “closest” with Palmetto and also cited progress with WPS and CGS. Regarding broader policy risk, he said the company had not seen signs of a Local Coverage Determination (LCD) emerging from the CAC process, though he acknowledged the process can be “unpredictable and sometimes opaque.”
Epioxa launch preparation, access, and Photrexa transition
Burns highlighted FDA approval of Epioxa as a “groundbreaking advancement” in corneal cross-linking for keratoconus, describing it as the first and only FDA-approved topical drug therapy that does not require removal of the corneal epithelium. He said Glaukos expects Epioxa drug availability late in the current quarter and that the company is increasing investments in awareness, education, and access to address underdiagnosis and undertreatment.
Management emphasized that early access will be influenced by site-of-care deployment and payer adoption hurdles typical of pharmaceutical launches. Burns said Glaukos is ahead of schedule in building its Epioxa Sites of Care network, with O2N systems deployed at locations covering nearly 50% of the U.S. population and a broader pipeline that could extend reach closer to 90%, pending approvals. Executives declined to provide a specific number of sites on the call, explaining that early efforts focus on committed providers and geographic reach, with expansion over time.
On payer engagement, Burns said the company is actively engaged with insurers representing approximately 50% of commercially covered lives, including four of the top five commercial payers. Gilliam clarified that this refers to dialogue and clinical engagement rather than established broad coverage policies, noting that coverage in rare disease settings may develop through a mix of formal policies and observed adjudication patterns once claims begin. He said the company had not heard pushback from payers on Epioxa pricing in early discussions and pointed to early positive policy outcomes with “a handful” of Medicaid plans and one large Blue plan.
Glaukos said it has submitted for a permanent J-code and expects it to become effective in July 2026 based on the CMS cycle. Until then, the company expects Epioxa to be commercially available under a new technology miscellaneous J-code and anticipated “measured adoption” during that period.
Gilliam discussed expected quarterly cadence tied to the Photrexa-to-Epioxa transition, saying the company expects modest growth in corneal health in the first quarter, a “fairly material dip” in the second quarter, a more “flattish” year-over-year third quarter as the permanent J-code comes online, and a stronger fourth quarter as treatment patterns normalize and approvals convert into procedures. He also said Glaukos intends to keep Photrexa available through the period leading up to the July J-code, with a fuller transition into Epioxa as the company moves through the third quarter.
Pipeline updates and 2026 spending plans
Beyond commercialization, management reviewed development milestones across multiple platforms. Burns said the company completed enrollment in a PMA pivotal trial for iStent infinite in mild-to-moderate glaucoma patients and continues a 510(k) pivotal study for PRESERFLO. He also said enrollment is underway in the phase IIB/III program for iDose TREX, with phase IIA results showing intraocular pressure reductions of 8.6 to 10.8 mmHg through three months. Glaukos also started a phase IIIB study for iDose Trio, commenced a phase II study for iLution Demodex blepharitis, and completed enrollment in a first-in-human program for GLK-401 in wet AMD.
On expenses, CFO Alex Thurman said Glaukos expects operating expense growth in the mid-teens year-over-year from a 2025 base, implying operating expenses of approximately $555 million to $560 million in 2026. He said the company plans to balance investments against revenues while driving toward cash flow break-even and potentially cash flow generation over the course of 2026, and that the expense outlook still implies operating leverage.
About Glaukos (NYSE:GKOS)
Glaukos Corporation is a medical technology company specializing in the development, manufacturing and commercialization of innovative therapies for patients with glaucoma and other chronic eye diseases. The company’s core offerings focus on micro-invasive glaucoma surgery (MIGS), designed to reduce intraocular pressure and manage glaucoma more safely and effectively than traditional surgical approaches. Glaukos’s flagship products include the iStent, iStent inject and iStent infinite trabecular micro-bypass stents, which are implanted during cataract surgery to improve aqueous outflow and help control eye pressure.
Beyond its MIGS portfolio, Glaukos has expanded into sustained drug-delivery solutions.
