Glaukos Ramps Up iDose TR, Battles Legacy and Reimbursement Risks

Core Insights - Glaukos Corporation (GKOS) reported a record-breaking first-quarter 2025 performance with revenues of $106.7 million, a 25% year-over-year increase, primarily driven by the adoption of the iDose TR implant [1][8] - The company reaffirmed its full-year revenue guidance of $475-$485 million, indicating confidence in its commercial momentum [1] Near-Term Growth Drivers - The iDose TR launch is gaining traction, with U.S. glaucoma sales increasing by 41% year-over-year, contributing nearly $21 million in the first quarter, reflecting an $85 million annualized run rate [3] - Internationally, Glaukos achieved $29 million in interventional glaucoma sales, a 15% year-over-year increase, supported by the growing acceptance of minimally invasive glaucoma surgery (MIGS) [4] Long-Term Growth Catalysts - Glaukos has a robust R&D pipeline with key programs including Epioxa, iDose Trex, PRESERFLO MicroShunt, and GLK-401, which are expected to broaden the company's addressable market in the next three to five years [5][6] - The company is cultivating standalone use of MIGS devices like iStent infinite, anticipating long-term growth as more surgeons adopt interventional glaucoma practices [7] Challenges and Watchpoints - Reimbursement complexities and LCD restrictions are impacting legacy stent sales, which declined mid-single digits in the first quarter, with expectations of continued pressure through 2025 [8][9] - Sales of Photrexa remain muted due to the Medicaid Drug Rebate Program, with near-term growth in this segment expected to be flat to low-single digits [10] Competitive Landscape - The iDose TR launch positions Glaukos ahead in procedural glaucoma drug delivery, but competition from Alcon, Johnson & Johnson, and Sight Sciences remains significant [11] - Year-to-date, Glaukos shares have declined by 31.7%, underperforming its rivals in the MIGS space, while Alcon and J&J have seen increases [12]