Glaukos (GKOS) Q2 2025: iDose TR Drives 45% U.S. Glaucoma Growth, Reshaping Ophthalmology Playbook

July 30, 2025 | By EarningsIQ Research

iDose TR adoption is accelerating Glaukos’ shift toward interventional glaucoma, driving record U.S. growth and a guidance raise despite reimbursement headwinds and corneal transition risks. The company’s disciplined capital deployment and pipeline momentum set up a multi-year transformation, but execution on payer coverage, facility economics, and product transitions will define the next leg of value creation.

Summary

• iDose TR Momentum: Standalone glaucoma therapy is rapidly changing physician behavior and expanding Glaukos’ addressable market.
• Margin Accretion: High-margin iDose sales are lifting overall profitability, offsetting legacy segment headwinds and royalty expirations.
• Corneal Health Transition: EpiOXA launch will disrupt near-term sales but positions the business for future category leadership.

Performance Analysis

Glaukos delivered record consolidated net sales, with the U.S. glaucoma franchise up 45% year-over-year, driven by iDose TR, a first-in-class intracameral drug delivery system. iDose TR contributed roughly $31 million in the quarter, accounting for a significant share of U.S. glaucoma sales and validating management’s thesis that a new therapeutic category is taking hold. International glaucoma sales also hit a record, up 20% reported and 15% constant currency, reflecting broad-based adoption and regional execution, though competitive trialing is emerging as a headwind abroad.

Corneal health showed only modest growth, constrained by the anticipated transition from Photrexa to EpiOXA, Glaukos’ next-generation cross-linking therapy. The company’s margin profile improved, with gross margin reaching 83%, as iDose TR’s high contribution began to offset royalty expirations and legacy product declines. Operating expenses grew at a mid-teens rate, in line with pipeline investment and launch activity, but were impacted by a one-time stock comp expense.

• U.S. Glaucoma Franchise Expansion: iDose TR now represents a foundational therapy, with accelerating surgeon adoption and utilization in regions with established reimbursement.
• International Growth and Risks: European regulatory wins and new launches are driving growth, but competitive pressure and currency benefits are moderating the outlook.
• Corneal Health Disruption: EpiOXA’s pending approval is leading to patient warehousing, with a material Q4 headwind expected as the market transitions.

Cash and equivalents grew by $4 million, excluding one-time investments, reflecting underlying operational leverage as iDose scales. Management’s capital discipline is visible in both R&D cadence and targeted M&A.

Executive Commentary

Strategic Positioning

1. iDose TR as a Foundational Therapy

iDose TR, a continuous drug delivery implant, is fundamentally shifting glaucoma management from adjunctive to interventional care. Physician adoption is strongest in Medicare regions with established professional fees, where 50% of Medicare lives accounted for over 80% of iDose TR volumes. This demonstrates the power of reimbursement clarity in accelerating procedural adoption and signals a durable shift toward procedural pharmaceuticals, a category defined by in-eye drug delivery devices that replace chronic topical therapy.

2. Diversification Beyond Legacy MIGS

Glaukos is intentionally reducing reliance on legacy micro-invasive glaucoma surgery (MIGS) devices, which face reimbursement compression and competitive saturation. The company’s focus on standalone therapies—such as iDose TR and iStent Infinite—positions it to benefit from CMS’ evolving payment models and growing demand for less invasive, repeatable interventions. Category 3 codes, currently unaffected by proposed physician fee cuts, are a strategic buffer against broader industry reimbursement volatility.

3. Pipeline and Platform Leverage

The pipeline spans five platforms, including next-gen iDose therapies (T-REX and TRIO), corneal cross-linking (EpiOXA), and retinal disease programs. The EpiOXA launch is expected to reset the corneal health segment, offering a non-invasive, surgery-free alternative that could become the new standard. The company’s disciplined investment cadence and targeted acquisitions, such as Mobius Therapeutics, are designed to solidify supply chain and extend reach into tertiary glaucoma care.

4. Commercial Execution and Payer Access

Market access and payer coverage remain key execution levers. Over 50% of commercial and Medicare Advantage lives now have positive iDose policies, typically as second or third-line therapy. The company is methodically working to move iDose closer to first-line status over time, but near-term growth is driven by expanding coverage and procedural reimbursement in lagging MAC regions.

5. Operational Discipline and Cash Flow

Glaukos’ capital allocation is tightly managed, balancing pipeline investment with operational cash generation. Cash flow is expected to improve as iDose TR scales and legacy headwinds moderate, with the company targeting near-term cash flow break-even while funding launches and clinical trials.

Key Considerations

The quarter marks a strategic inflection as Glaukos pivots from legacy device dependence to a platform-driven, high-margin procedural pharmaceutical model. The company’s ability to convert clinical innovation into commercial execution, especially in the face of reimbursement and competitive challenges, will determine the sustainability of its growth trajectory.

Key Considerations:

• Reimbursement Clarity Drives Adoption: iDose TR utilization is highly correlated with regions where MACs have established professional fees, underscoring the need for payer engagement and advocacy.
• Pipeline Execution Is Multi-Year: EpiOXA, next-gen iDose, and in-office procedural innovations are staggered launches, each with unique regulatory and market access hurdles.
• Corneal Health Disruption Is Inevitable: EpiOXA’s approval will cause a near-term revenue dip as patients defer Photrexa, but positions Glaukos for long-term category leadership.
• Competitive Pressures Abroad: International glaucoma growth is moderating as new entrants trial products, requiring continued investment in market development and evidence generation.
• Margin Expansion Hinges on iDose Mix: Sustaining gross margin accretion depends on the pace of iDose TR adoption and the ability to offset legacy segment erosion.

Risks

Key risks include ongoing reimbursement volatility, particularly as CMS revises facility and physician fee schedules, which could impact both procedure adoption and profitability. Corneal health faces near-term disruption as the market transitions to EpiOXA, with patient warehousing and access ramp risks. International competition is intensifying, and pipeline execution remains exposed to regulatory and clinical trial uncertainties. Payer policy evolution and managed care adoption will be critical for sustaining U.S. growth.

Forward Outlook

For Q3 2025, Glaukos expects:

• U.S. glaucoma growth to be modestly up sequentially, led by iDose TR, with seasonal procedure volume softness offset by adoption gains.
• International glaucoma to step down a few million due to typical Q3 seasonality and emerging competitive headwinds.

For full-year 2025, management raised net sales guidance to $480 to $486 million, reflecting iDose TR momentum and a cautious corneal health outlook:

• iDose TR sales are expected to continue sequential expansion in Q3 and Q4.
• Corneal health faces a flat Q3 and a material Q4 headwind as EpiOXA launches and patients defer procedures.

Management highlighted:

• Continued investment in pipeline and launch preparation, with operating expenses guided to mid-teens growth.
• Disciplined capital deployment with a focus on maintaining a strong balance sheet and funding growth initiatives.

Takeaways

Glaukos is rapidly evolving into a procedural pharmaceutical leader, with iDose TR catalyzing a new standard in glaucoma care and driving margin expansion. The business is less exposed to legacy device and royalty pressures, but must execute on payer engagement, pipeline launches, and international competition to sustain its multi-year growth runway.

• iDose TR Adoption Is the Growth Engine: Physician uptake in reimbursed regions is accelerating, with evidence of a durable shift in practice patterns and margin mix.
• Corneal Health Faces Near-Term Headwinds: EpiOXA’s launch will cause a temporary sales dip, but is a strategic reset for long-term leadership in non-invasive corneal therapy.
• Payer Access and Pipeline Execution Are Critical: Success depends on converting clinical innovation into commercial coverage, and on managing transitions across multiple product platforms and geographies.

Conclusion

Glaukos’ Q2 results affirm its transformation from a device-centric to a platform-driven ophthalmic innovator, with iDose TR’s momentum providing both a growth and margin catalyst. The company’s ability to navigate reimbursement dynamics, competitive pressures, and corneal health transitions will determine whether it can sustain leadership in the evolving ophthalmology landscape.

Industry Read-Through

Glaukos’ performance signals a broader industry pivot toward procedural pharmaceuticals in ophthalmology, as chronic disease management shifts from daily topical therapy to in-eye, long-acting interventions. Reimbursement clarity and payer engagement are becoming decisive competitive advantages, not just for Glaukos but for all medtech innovators seeking to redefine standards of care. Legacy device segments face mounting pressure from both policy and innovation, underscoring the need for diversified, evidence-backed platforms. The corneal health transition also highlights the disruptive impact of next-gen therapies on established categories, with implications for patient access, procedure volumes, and revenue recognition timing across the sector.

GKOS Healthcare Medical Devices Procedural Pharmaceuticals Ophthalmology Reimbursement Pipeline Innovation