Glaukos Corp. Earnings Call Signals Growth Momentum

Glaukos Corp. ((GKOS)) has held its Q1 earnings call. Read on for the main highlights of the call.

Glaukos Corp. struck an upbeat tone on its latest earnings call, pairing record first‑quarter revenue growth with a sizable guidance raise and expanding margins. Management acknowledged some near‑term access and reimbursement friction, particularly around new corneal therapy Epioxa, but stressed that strong glaucoma momentum and a deep pipeline more than offset these operational headwinds.

Record Sales Surge and Upgraded Outlook

Glaukos posted Q1 consolidated net sales of $150.6 million, up 41% year over year on a reported basis and 39% in constant currency, marking a new high for the company. On the back of this performance, management lifted 2026 net sales guidance to a range of $620 million to $635 million, up from prior expectations of $600 million to $620 million.

U.S. Glaucoma Powered by iDose TR

The U.S. glaucoma franchise remained the star performer, with net sales of $93.5 million, rising 58% versus last year as physicians continue to embrace interventional treatments. iDose TR, the company’s sustained‑release glaucoma implant, contributed around $54 million in Q1 and is emerging as the key growth engine in domestic glaucoma.

International Glaucoma Expansion

Outside the United States, glaucoma revenue reached a record $35.8 million, increasing 23% on a reported basis and 16% in constant currency as Glaukos broadened its global footprint. Management highlighted contributions from iStent Infinite, which is now benefiting from EU MDR certification and launch, although it cautioned that competitive trialing could temper growth in some markets.

Corneal Health and Early Epioxa Momentum

Corneal Health delivered net sales of $21.3 million, up 15% year over year, supported by $17.7 million in combined revenue from legacy Photrexa (Fetrexan) and initial Epioxa sales. Surgeons are giving encouraging early feedback on Epioxa as it becomes commercially available, laying the groundwork for a broader transition to the epi‑on cross‑linking platform.

Epioxa Access Wins and Coverage Build‑Out

Glaukos reported important market‑access wins for Epioxa, including a CMS product‑specific J‑code (J2789) that will take effect July 1, 2026, which should streamline billing and reimbursement. The company has already established coverage pathways for more than 100 million commercially insured lives and built a site‑of‑care network that reaches roughly 65% of the U.S. population, with plans to extend to about 95%.

iDose Clinical Strength and Reimbursement Tailwinds

Management underscored the growing clinical and real‑world evidence base for iDose, now supported by 22 peer‑reviewed publications and multiple Phase IV studies. On the reimbursement front, roughly 99% of commercial and Medicare Advantage patients have an access pathway and about half are in plans with specific policy language, and early readministration procedures signal physician comfort with ongoing use.

Margin Expansion and Cost Discipline

Glaukos delivered a strong group gross margin of 84% in Q1, improving by about 120 basis points year over year, and reaffirmed its full‑year gross margin outlook of 84% to 86%. Management emphasized ongoing focus on operating leverage and cash‑flow breakeven, even as it steps up spending behind new launches.

Deep Pipeline and Clear Product Timelines

The company’s pipeline spans five therapeutic platforms and 13 disclosed programs, underscoring its multi‑franchise ambitions beyond today’s products. Key milestones include completion of the iDose Trio clinical study with a planned regulatory filing by the end of 2026 targeting approval in late 2027, ongoing pivotal trials for iDose TREX, iStent Infinite and PreserFlo MicroShunt, and a planned late‑2026 introduction of a keratoconus screening device.

Epioxa Adoption Challenges and Workflow Friction

Despite early enthusiasm, Epioxa’s initial uptake is constrained by payer adoption curves and prior‑authorization processes that lengthen the treatment journey. For now, the product is reimbursed under a miscellaneous J‑code, requiring case‑by‑case claim adjudication, so Glaukos is guiding investors to expect measured near‑term adoption and some elongated patient access cycles.

Corneal Health Volatility During Transition

Management signaled that Corneal Health revenue will likely be choppy as the portfolio shifts from Photrexa to epi‑on Epioxa, particularly during the temporary J‑code period. Executives even flagged an anticipated year‑over‑year dip in Q2, framing it as a transition‑related air pocket rather than a change in long‑term demand.

International and Currency Headwinds Loom

Looking abroad, Glaukos warned that competitive trialing of rival products in certain major markets could weigh on international growth in 2026. In addition, management expects the currency tailwinds that benefited recent results to fade, potentially dampening reported growth rates even if underlying demand remains solid.

Regulatory Policy and LCD Overhang

On the policy front, management said it currently sees no signs of a local coverage determination targeting iDose and views such a move as premature given the therapy’s profile and evidence base. Even so, the company acknowledged that potential future LCD activity remains a structural industry risk that investors should monitor.

Higher Operating Spend and Channel Complexity

Operating expenses are set to grow in the high‑teens percent range year over year, modestly above prior plans, as Glaukos invests to support the Epioxa rollout and broader commercialization. At the same time, the transition from traditional buy‑and‑bill for Photrexa toward specialty pharmacy and mixed channels for Epioxa is adding workflow complexity, which is compounded by the current miscellaneous J‑code environment.

Guidance and Outlook Emphasize Growth with Investment

Glaukos’ updated 2026 guidance calls for net sales of $620 million to $635 million, supported by Q1 momentum and robust glaucoma demand, with management expecting high‑single‑digit international glaucoma growth for the remainder of the year and low‑double‑digit growth for the full year. Corneal Health is projected to grow at a high‑single‑digit rate for 2026, albeit with quarter‑to‑quarter volatility including a Q2 dip, while gross margin should remain in the 84% to 86% band and operating expenses rise modestly as the company balances investment with a push toward cash‑flow breakeven.

Glaukos’ earnings call painted a picture of a company leaning into its growth opportunity, capitalizing on strong iDose momentum and a promising Epioxa launch while accepting some short‑term noise in access and corneal revenue. For investors, the combination of a meaningful guidance raise, expanding margins and a visible pipeline suggests a favorable long‑term setup, even as reimbursement and competitive dynamics keep risk on the radar.