Core Insights - Sight Sciences reported strong third-quarter results, raising its revenue guidance for 2025 to $76 million to $78 million, driven by growth in its surgical glaucoma segment and advancements in its dry eye business [4][9][30] - The company is focusing on expanding its Tiered Care franchise, which aims to establish a new category of reimbursed interventional dry eye treatments, following the establishment of fee schedules by First Coast Service Options and Novitas Solutions [8][10][22] Financial Performance - Total revenue for Q3 2025 was $19.9 million, a 1% decrease year-over-year, while surgical glaucoma revenue increased by 6% to $19.7 million [27][28] - Dry eye revenue fell to $200,000 from $1.5 million, aligning with expectations as the company prioritized achieving reimbursed market access for Tiered Care procedures [28] - Gross margin improved to 86%, up from 84%, with surgical glaucoma gross margin remaining stable at 87% [28][29] Market Opportunities - The company estimates approximately 10.4 million Medicare-covered lives in regions where new fee schedules for Tiered Care have been established, indicating a significant market opportunity [10][12] - There are around 6,500 eye care providers identified as potential adopters of Tiered Care procedures, with an existing customer base of about 200 providers who have previously purchased related products [12][13] Strategic Initiatives - The management team is focused on securing additional reimbursement coverage and payment decisions for Tiered Care, accelerating commercial momentum in both surgical glaucoma and dry eye segments, and deepening customer engagement through education initiatives [25][66] - The company has made significant progress in reengaging dormant accounts and expanding its customer base, particularly in the context of the new reimbursement environment for Tiered Care [58][66] Management Changes - Recent management changes include the promotion of Ali Bauerlein to Chief Operating Officer and Jim Rodberg to Chief Financial Officer, aimed at enhancing operational execution and strategic focus [21][23][24]

Financial Data and Key Metrics Changes - Total revenue for the second quarter of 2025 was $19,600,000, an 8% decrease compared to the same period in the prior year [19] - Surgical glaucoma revenue was $19,200,000, a decrease of 5%, primarily due to an 11% decrease in account utilization [19] - Dry eye revenue was $300,000, down from $1,100,000 in 2024, attributed to fewer SmartLid sales [19] - Gross margin was 85%, down from 86%, with surgical glaucoma gross margin at 86% compared to 88% [20] - Net loss was $11,900,000 or $0.23 per share, compared to a net loss of $12,300,000 or $0.25 per share in the prior year [21] Business Line Data and Key Metrics Changes - Surgical glaucoma segment showed a sequential growth in ordering accounts, up 6% sequentially and 4% year-over-year [11] - Surgical glaucoma utilization increased by 4% sequentially, contributing to strong quarterly performance [11] - Dry eye segment revenue decreased significantly due to a focus on achieving reimbursed market access for tear care procedures [13][20] Market Data and Key Metrics Changes - The company is experiencing a stable market environment despite headwinds from Medicare coverage restrictions [32] - The demand for minimally invasive glaucoma treatments is expected to grow, representing a significant long-term market opportunity [8] Company Strategy and Development Direction - The company is focused on securing equitable reimbursement for tier care and driving commercial momentum in MIGS through the rollout of OmniEdge [18] - Strategic initiatives include enhancing competitive positioning, investing in commercial resources, and expanding the pseudophakic standalone omni market [10] - The company aims to build on early traction with OmniEdge and improve surgeon education on standalone procedures [12][17] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the ability to drive adoption of the Omni procedure, citing a shift in surgeon mindset towards interventional glaucoma [9] - The company remains optimistic about achieving reimbursement coverage for tier care, despite delays [38][40] - Future growth is anticipated in the surgical glaucoma segment, with expectations of mid-single-digit declines in the near term [25] Other Important Information - The company has not yet received monetary damages from a patent infringement case against Alcon, and ongoing legal proceedings may impact future revenue [23][24] - The company is exploring additional third-party manufacturing locations to enhance production capabilities starting in 2026 [26] Q&A Session Summary Question: What is driving the strength in the surgical glaucoma business? - Management noted stability in the market and effective execution by the sales team, contributing to better-than-expected performance [32][34] Question: When can reimbursement wins for tier care be expected? - Management indicated that while they are working towards reimbursement wins in 2025, the timing is uncertain [38][40] Question: How is the competitive landscape evolving? - Management acknowledged ongoing competition but emphasized their strong performance and market position, particularly with the Omni product line [46][48] Question: What is the outlook for the second half of the year? - Management expects a mid-single-digit decline in surgical glaucoma revenue for Q3, with potential for growth in Q4 as they lap previous restrictions [52][53] Question: What are the obstacles to standalone MIGS adoption? - Management highlighted the need for a prescriptive approach to identify and treat specific patient populations, emphasizing the importance of education and workflow integration [92][96]

Summary of the Conference Call Company and Industry Overview - The conference call involved **Site Sciences**, focusing on the **surgical glaucoma** and **dry eye** treatment markets, particularly the **minimally invasive glaucoma surgery (MIGS)** segment and the **TearCare** product for dry eye treatment [1][2][18]. Key Points on Surgical Glaucoma - **First Quarter Performance**: Surgical glaucoma revenue was initially guided to decline by 10-15% year-over-year but only decreased by 6%, indicating better-than-expected performance [2][26]. - **MIGS Environment**: The company is navigating a dynamic MIGS environment due to new restrictions limiting the combination of multiple MIGS procedures during cataract surgery, which has led to a decline in claims for these devices [3][4]. - **Product Performance**: Both **Omni** and **Scion** devices are performing slightly better than expected, with Omni's strong clinical efficacy and surgeon preference contributing to its market share [4][10]. - **Market Dynamics**: The transition to a one MIGS world is ongoing, with Omni positioned well due to its comprehensive functionality, allowing it to address multiple points of resistance in the outflow pathway [6][7]. - **Claims Data**: The volume of visits involving multiple MIGS procedures has dropped from 15% to 5%, indicating a significant shift in the market [11][12]. - **Long-term Growth Potential**: The market for MIGS is not fully penetrated, with significant opportunities in the combination cataract segment, as many patients undergoing cataract surgery are not receiving MIGS [18][19]. Key Points on Dry Eye Treatment - **TearCare Opportunity**: The company is focused on pioneering a new category of interventional dry eye treatment, addressing the underlying causes of dry eye disease, particularly obstructed meibomian glands [42][45]. - **Payer Discussions**: Productive conversations with payers are ongoing, with expectations for coverage policies and payment decisions to begin in 2025 [45][46]. - **Market Size**: There are over 19 million diagnosed patients with dry eye disease in the U.S., with a significant portion suffering from moderate to severe conditions, representing a large market opportunity [55][57]. - **Procedure Volume Potential**: The company estimates a potential for 7-8 million patients to undergo one or two procedures annually, depending on reimbursement rates [56][57]. - **Existing Infrastructure**: Site Sciences has a lean but experienced sales team ready to ramp up once reimbursement decisions are made, with over 1,500 trained smart hubs in place [49][50]. Additional Insights - **Competitive Landscape**: The introduction of new competitors, such as the Via 360 device, is acknowledged, but the company remains confident in the Omni product line and its ongoing innovations [31][34]. - **Market Education**: There is a need for continued education among surgeons regarding the importance of MIGS in the treatment paradigm to increase adoption rates [25][24]. - **Long-term Confidence**: The company expresses confidence in the long-term growth of both the MIGS and dry eye markets, emphasizing the importance of addressing unmet patient needs [20][21].

Financial Data and Key Metrics Changes - Total revenue for the first quarter of 2025 was $17,500,000, reflecting a 9% decrease compared to the same period in the prior year [19][21] - Surgical glaucoma revenue was $17,100,000, a decrease of 6% year-over-year, primarily due to a 10% decrease in account utilization [20][21] - Dry eye revenue was $400,000, down from $1,000,000 in the same period last year, attributed to fewer SmartLids sales following a price increase [21][16] - Gross margin for the first quarter was 86%, unchanged from the prior year [21] - Net loss for the quarter was $14,200,000, or $0.28 per share, compared to a net loss of $16,300,000, or $0.33 per share, in the prior year [22] Business Line Data and Key Metrics Changes - Surgical glaucoma segment showed a slight decline in sequential ordering accounts, with a 3% increase year-over-year despite new Medicare restrictions [20][10] - The dry eye segment's revenue reflects ongoing efforts in market access and new pricing strategies [16][21] Market Data and Key Metrics Changes - The MIGS market is experiencing changes due to new Medicare coverage restrictions, limiting the number of MIGS procedures performed during cataract surgery [9][10] - The company is actively engaging with surgeons to adapt to the new environment and optimize commercial strategies [10][31] Company Strategy and Development Direction - The company is focused on addressing unmet medical needs in glaucoma and dry eye markets through innovative interventional technologies [7][15] - Strategic initiatives include building commercial momentum in MIGS, establishing equitable reimbursement for tier care, and advancing the product pipeline [7][15] - Plans to expand manufacturing operations outside of China to mitigate tariff impacts are underway [8][25] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the continued demand for glaucoma treatments and the company's ability to adapt to the new MIGS environment [10][9] - The company reaffirmed its revenue guidance for 2025, expecting total revenue of approximately $70,000,000 to $75,000,000 [23][24] - Management highlighted the importance of ongoing conversations with payers regarding reimbursement for tier care procedures [45][46] Other Important Information - The company has not yet received any monetary damages from a patent infringement case against Alcon, awaiting final rulings [22] - Adjusted operating expenses for the first quarter were $24,700,000, a decrease of 7% compared to the prior year [22][26] Q&A Session Summary Question: Can you discuss trends in surgical glaucoma and share dynamics? - Management noted a decline in actual utilization but emphasized the continued growth in patient encounters and the effectiveness of the Omni product [30][31] Question: Are there efforts to reverse the stacking component of the LCDs? - Management acknowledged multiple efforts to collect clinical data supporting the need for multiple MIGS procedures [36] Question: What are the reimbursement dynamics for Omni versus competitive MIGS devices? - The reimbursement dynamics remain largely unchanged, with most procedures historically performed as single MIGS [43] Question: Any updates on tier care reimbursement? - No coverage determinations have been made yet, but management is optimistic about future decisions [45][46] Question: Can you provide insights on the Scion product? - Scion is a complementary product with modest revenue contribution, primarily serving surgeons looking for simpler procedures [49][50] Question: What is the outlook for device intensive qualification? - Management expressed strong conviction that the device should qualify for device intensive but refrained from speculation [58] Question: How is the company addressing competitive launches? - Management remains confident in Omni's market position and is actively monitoring competitive dynamics [88]

Financial Data and Key Metrics Changes - Total revenue for the first quarter of 2025 was $17.5 million, reflecting a 9% decrease compared to the same period in the prior year [20] - Surgical glaucoma revenue was $17.1 million, a decrease of 6% year-over-year, primarily due to a 10% decline in account utilization [20] - Dry eye revenue was $400,000, down from $1 million in the same period last year, attributed to fewer SmartLids sales following a price increase [21] - Gross margin for the first quarter was 86%, unchanged from the prior year [21] - Net loss for the quarter was $14.2 million, or $0.28 per share, compared to a net loss of $16.3 million, or $0.33 per share, in the first quarter of 2024 [22] Business Line Data and Key Metrics Changes - Surgical glaucoma segment showed a revenue of $17.1 million, with a slight decline in sequential ordering accounts despite new Medicare restrictions [11][20] - Dry eye segment revenue was $400,000, reflecting a focus on market access and new pricing strategies [17][21] Market Data and Key Metrics Changes - The MIGS market is experiencing changes due to new Medicare coverage restrictions, limiting the number of MIGS procedures performed during cataract surgery [10][20] - The company is actively working to establish third-party manufacturing lines outside of China to mitigate tariff impacts [9][25] Company Strategy and Development Direction - The company aims to build commercial momentum in the MIGS market through customer education, equitable reimbursement, and new clinical data [8][16] - Focus on advancing the product pipeline, including the recent launch of the next-generation OmniEdge [13][15] - The long-term strategy includes pioneering interventional procedures for moderate to severe meibomian gland disease (MGD) in the dry eye market [16] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the demand for glaucoma treatment and the ability to adapt to the new MIGS environment [11][20] - The company reaffirmed its revenue guidance for 2025, expecting total revenue of approximately $70 million to $75 million [23][24] - Management is optimistic about the potential for reimbursement coverage decisions for tier care procedures in 2025 [44][68] Other Important Information - The company is awaiting a final ruling on a patent infringement case against Alcon, which could impact future financials [22] - Adjusted operating expenses for 2025 are expected to be between $101 million and $105 million, reflecting a focus on fiscal discipline [26] Q&A Session Summary Question: Trends in surgical glaucoma and share dynamics - Management noted a decline in actual utilization due to new Medicare restrictions but emphasized the continued reliance on the Omni product for its comprehensive efficacy [30][31] Question: Efforts to reverse the stacking component of LCDs and competition - Management acknowledged ongoing efforts to collect clinical data supporting multiple MIGS procedures and discussed competitive dynamics in the MIGS market [34][35][39] Question: Reimbursement mechanics for Omni versus competitors - Management indicated that reimbursement dynamics remain largely unchanged, with the majority of procedures still performed as single MIGS [42] Question: Update on tier care reimbursement - Management confirmed no coverage determinations have been made yet but expressed optimism about ongoing discussions with payers [44][45][68] Question: Scion product performance and revenue contribution - Management stated that Scion is a modest portion of total revenue, primarily serving as a complementary product to Omni [48][49] Question: Tariff impact and mitigation strategies - Management expects minor impacts to gross margin in 2026 as new manufacturing locations are phased in [52][53] Question: Outlook for device intensive qualification - Management refrained from speculating on device intensive qualification but expressed strong conviction that the device should qualify based on procedure costs [57] Question: Revenue cadence and pricing strategy - Management expects sequential revenue growth in the second quarter, with a typical seasonal pattern throughout the year [60][80]