GLAUKOS Corp Q4 FY2025 Earnings Call

Hello, and thank you for being here. My name is Tiffany, and I will be your conference operator today. I would like to welcome everyone to Glaukos' Fourth Quarter and Full Year 2025 Financial Results Conference Call. I will now turn the call over to Chris Lewis, Vice President of Investor Relations and Corporate Affairs. Chris, please go ahead.

Thank you, and good afternoon. Today, I'm joined by Glaukos Chairman and CEO, Tom Burns; President and COO, Joe Gilliam; and CFO, Alex Thurman. As in previous quarters, the company has posted a document on its Investor Relations website under the Financials and Filings Quarterly Results section titled Quarterly Summary. This document is intended for investors to review prior to the scheduled quarterly conference call. Please be aware that all statements made during this call, other than historical facts, about future activities, events, or developments we expect or believe will occur, are forward-looking statements. These include our plans, objectives, strategies, and prospects regarding sales, products, pipeline technologies and clinical trials, U.S. and international commercialization, market development efforts, product approvals, the effectiveness of our current and future products, our competitive position, regulatory strategies, reimbursement, financial condition, and results of operations, as well as the expected impact of broader economic conditions, including foreign currency fluctuations on our business. These statements are based on current expectations and are subject to risks, uncertainties, and factors related to our operations and environment, which are often unpredictable and outside our control. Thus, actual results may differ materially from those expressed or implied. Please review today's press release and our recent SEC filings for more information regarding these risk factors, available in the Investors section of our website at www.glaukos.com. Additionally, during this call, we will discuss certain non-GAAP financial measures, including adjusted results. We think these measures provide a more complete analysis and transparency into Glaukos' ongoing operations, especially when comparing results across periods. Please see the tables in our earnings press release for a reconciliation of these measures to the most comparable GAAP financial measure. Now, I will turn the call over to Glaukos Chairman and CEO, Tom Burns.

Okay. Thanks, Chris. Good afternoon, and thank you all for joining us. Today, Glaukos reported record fourth quarter consolidated net sales of $143.1 million, consistent with our pre-announcement last month, and up 36% on a reported basis and 34% on a constant currency basis versus the year-ago quarter. For the full year 2025, consolidated record net sales of $507.4 million grew 32% versus 2024. We are also reaffirming our full year 2026 net sales guidance range of $600 million to $620 million, which implies continued strong year-over-year growth of more than 20% at the midpoint. Our record fourth quarter and full year results reflect a highly successful year of global execution across our key commercial and development initiatives, and underscore the dedication of our global teams, strength of our differentiated technology platforms, and our evolution into a more diversified ophthalmic leader. From a corporate perspective, 2025 was a milestone year. In addition to surpassing $0.5 billion in annual sales, we celebrated our tenth anniversary of our 2015 IPO, surpassed 1,000 employees worldwide and broke ground on a new facility in Huntsville, Alabama. As we enter into 2026, we are well positioned to sustain our strong growth momentum, led by two transformational growth drivers, including the continued advancement of the interventional glaucoma treatment paradigm with iDose TR, along with the launch of Epioxa, opening up a new paradigm in interventional keratoconus and rare diseases. These two highly differentiated and durable market opportunities underpin our confidence to deliver a best-in-class growth profile extending well into the next decade as we continue to invest in and advance a robust industry-leading pipeline while remaining disciplined in capital allocation, focusing on ROI-driven investments and cash flow. Our record fourth quarter results are a testament to the progress we continue to make in advancing our mission to transform vision therapies for the benefits of patients worldwide. Within our U.S. glaucoma franchise, we delivered record fourth quarter net sales of $86.4 million on strong year-over-year growth of 53%, driven by growing contributions from iDose TR, which generated sales of approximately $45 million in the fourth quarter. iDose TR's positive clinical outcomes continue to generate momentum with sales of approximately $136 million in 2025, reflecting strong physician adoption, reaffirming the compelling patient impact of this game-changing therapy. Operationally, our teams continue to execute well on all of our plans focused on growing training surgeons and accounts, increasing utilization, broadening market access, expanding the clinical evidence and accelerating targeted marketing investments. We believe iDose TR remains early in its overall adoption curve with significant value yet to be unlocked as we expand market access and build on the progress in 2026 and beyond. Last month, we were pleased to announce that the U.S. FDA approved our NDA labeling supplement allowing for unlimited re-administration of iDose TR in patients who maintain a healthy cornea. We welcome this important labeling enhancement and believe it should help expand access for patients who may benefit from a repeat treatment and provide physicians with greater flexibility in managing their glaucoma patients over time. With iDose TR as the foundation, our goal to advance and improve glaucoma treatment by driving earlier intervention continues to gain steam as we educate surgeons and thought leaders globally to organically drive this broader evolution in the standard of care for the benefits of patients. While we remain in the early stages of these interventional glaucoma efforts, we are encouraged with the increasing levels of clinical interest for this paradigm-changing evolution. Moving on, our international glaucoma franchise delivered net sales of $32.8 million on year-over-year growth of 18% on a reported basis and 13% on a constant currency basis. This strong growth was once again broad-based as we continue to scale our international infrastructure and execute our plans to drive MIGS forward as the standard of care in each region and major market in the world. As previously discussed, we continue to expect new competitive product trialing headwinds in some of our major international markets as we progress through 2026, partially offset by growing contributions from iStent infinite, following its EU MDR certification and associated European commercial launch late last year. And finally, our corneal health franchise delivered net sales of $24 million on year-over-year growth of 12%, including Photrexa net sales of $21.4 million. As you know, during the fourth quarter, we were delighted to announce the FDA approval of Epioxa, a novel groundbreaking advancement in corneal cross-linking for the treatment of keratoconus, a rare sight-threatening disease that is currently far too often undiagnosed and untreated. Interest from the physician community following approval has been very encouraging and reinforces our view that with Epioxa, we are ushering in a new standard of care for keratoconus patients and practitioners with the first and only FDA-approved topical drug therapy that does not require removal of the corneal epithelium, the outermost layer of the front of the eye. As a reminder, Epioxa utilizes a proprietary combination of an oxygen-enriched novel therapeutic that is bioactivated by UV light in an incision-free procedure. It is the result of more than a decade of research focused on slowing or halting the progression of keratoconus while significantly improving patient comfort and minimizing recovery time to provide a new way forward for patients afflicted with this sight-threatening rare disease. As we've discussed, the FDA approval of Epioxa has allowed us to reset and redefine our go-to-market approach to better address this sight-threatening disease and truly expand patient care and access. Immediately following approval, our cross-functional teams commenced execution of our detailed methodical initial commercial launch plans ahead of Epioxa drug availability expected later this quarter. Importantly, with this launch, we plan to substantially increase our investments in patient awareness, education, and access while addressing the long-standing challenges of under-diagnosis and under-treatment that have affected this rare disease community. Our efforts are designed to support patients and families at every stage from awareness and diagnosis through ongoing treatment, taking the entire journey as seamless, efficient, and patient-friendly as possible over time. As with all pharmaceutical launches, initial patient access will be gated by our site of care network deployment and typical payer adoption headwinds and hurdles, but we're investing in the infrastructure, teams, and processes necessary to get Epioxa to as many patients as soon as possible in 2026 and beyond. We've been encouraged by the progress we've made in short order following approval. First, I'm proud to report we are ahead of schedule in establishing our Epioxa sites of care network. Our early efforts are yielding results with acquired O2n Systems already actively deployed in locations covering nearly 50% of the U.S. population and a broader pipeline of systems moving through the approval processes that would expand our treatment center of reach closer to 90%. Looking ahead, we will continue evolving this network to bring treatment access closer to patients as reimbursement and drug acquisition pathways become further established and streamlined. Next, on the market access front, we have completed our initial payer communications and updated key payer databases with the details associated with the Epioxa launch. Our payer team is already actively engaged today with insurers, representing approximately 50% of commercially covered lives in the United States, including four of the top five commercial payers. As a result, we have seen several early positive coverage determinations spanning across the Medicaid and commercial payer landscape. We successfully submitted for the permanent J-code and expect it to become effective in July of 2026. Based on the CMS' cycle for J-codes, until then, we anticipate Epioxa will be commercially available under a new technology miscellaneous J-code and anticipate measured adoption over this initial period until the permanent J-code is in place. In addition, we’ve also rolled out various new patient services and support programs led by our patient access liaison teams designed to streamline care coordination, demystify the insurance approval process and advance coverage decisions where possible. Our teams are also deploying new marketing and DTC campaigns designed to significantly enhance awareness, education, and detection, driven by increased engagement with the optometric community, the development of a handheld KC screening device and expanded advocacy partnerships alongside new patient education efforts to identify and reach patients earlier. Finally, as we've discussed with the launch of Epioxa, a critical focus of ours is to improve patient access to the sight-saving keratoconus treatment. On that front, we have successfully deployed a new financial co-pay assistance program for eligible patients and operationalize a comprehensive specialty pharma option available for our customers at launch. As you can see, we are very excited by the significant potential Epioxa offers to patients living with keratoconus and believe it will deliver exceptional value to patients, providers in the health care system. This enthusiasm was on full display during our recent national sales meeting, where anticipation for Epioxa's availability later this quarter was palpable. We're probably once again forging a new path to drive expanded patient access and enhanced treatment standards. Beyond Epioxa, we continue to advance a broad and differentiated clinical pipeline across our five novel therapeutic platforms with several noble milestones. Within our iStent surgical glaucoma platform, we completed patient enrollment in a PMA pivotal trial for iStent infinite in mild to moderate glaucoma patients during the fourth quarter and continue to advance a 510(k) pivotal study for the PRESERFLO MicroShunt. Within our iDose platform, patient enrollment is well underway in the Phase IIb/III clinical program for iDose TREX, our next-generation iDose therapy, with initial results of our Phase IIa clinical trial demonstrating substantial IOP reductions of 8.6 to 10.8 millimeters of mercury through three months. In addition, we recently commenced a Phase IIIb study for iDose TRIO and continue to advance several Phase IV studies. Within our iLink platform, we plan to bring a KC screening tool to market later this year and initiate a Phase III program for our third-gen iLink therapy next year. Within our ILution platform, we commenced a Phase II study for ILution Demodex blepharitis in the fourth quarter. And finally, within our retinal platform, we recently completed enrollment in a first-in-human clinical development program for GLK-401, our intravitreal multi-kinase inhibitor retinal program in patients with wet AMD. Despite being a relatively young company, Glaukos has invested over $1 billion in R&D since inception to develop a robust pipeline focused on chronic and rare ophthalmic diseases. Our continued investment in R&D remains best-in-class, underscoring our commitment to growing first and advancing the standard of care for ophthalmic patients worldwide into the future. In conclusion, at Glaukos, we're in the business of pioneering entirely new marketplaces within ophthalmology. Innovation is at the core of everything we do as we advance our mission to transform vision therapies that can meaningfully advance the standard of care and improve outcomes for patients suffering from sight-threatening chronic eye diseases. Our mantra of 'We'll Go First' embodies our commitment and determination to take chances, push the limits of science, and disrupt the legacy of treatment paradigms in glaucoma, rare diseases, and retinal diseases through our pursuit of game-changing innovation. Our record fourth quarter and full year 2025 highlights the strength of our strategy and execution as we continue evolving into a diversified ophthalmic leader with multiple transformational growth drivers in iDose TR and Epioxa and advance our mission to transform vision therapies for the benefit of patients worldwide. So with that, I'll open the call for questions.

Your first question comes from the line of Tom Stephan with Stifel.

First one on Epioxa. Tom, you mentioned early positive coverage determinations from commercials and Medicaid, I believe you said. Can you elaborate on kind of the key highlights here a bit? And then just broadly, to what extent has there been any payer pushback on pricing of Epioxa and/or the Photrexa discontinuation?

Tom, it's Joe. I'll start off there. If Tom wants to add comments, he certainly can. So from a payer standpoint, it's important to remember that really you start to get a lot more of the coverage policies in place once you've got drug in channel and you're actually adjudicating the claims. In the early days, it's all about the clinical education associated with the product, making sure those payers understand what Epioxa is, what it means for patients, and how that's differentiated from Photrexa that they've obviously known for several years now. So when he said that there's a positive development in terms of early policies, it's really because it's even a bit surprising in the context of a normal drug launch here in this case in pre-drug and channel, you're getting positive outcomes with a handful of Medicaid societies as well as with one of the larger blue plans out there. And so all of the conversations so far have been much more clinical in nature. We've not heard any formal or informal pushback from payers on the pricing dynamics associated with Epioxa. And so we continue to move forward and look forward to obviously getting the drug officially launched, if you will, and engaging on a claim-by-claim basis with these payers and ultimately getting into a place where many more have the positive coverage determinations that we expect.

Got it. That's great. And then my second question on iDose. Joe, maybe to stick with you. Can you talk a bit about kind of the key factors that drove the sequential deceleration in revenue in 4Q now that there's been some time to digest? And maybe more importantly, what's your level of confidence in continued sequential growth year in the first quarter, maybe you can speak about how to think about, I guess, iDose growth directionally in 1Q as well as throughout '26?

Yes. Sure, Tom. I think from an iDose perspective in the fourth quarter, and we talked a little bit on this in a recent conference. We did see a couple of factors. Obviously, we did continue to grow sequentially and grow nicely. I think it was north of 10% sequentially. But underlying that were a couple of dynamics we're calling out. The first is that in the fourth quarter, and this is learning a little bit for us in the context of iDose, the mix shifts a little bit towards Medicare Advantage. There's a lot more volume done in the fourth quarter typically than ophthalmology. But because a lot of those benefits and I'll call it the patient out-of-pocket dynamics and related, you tend to see a little bit more on the Medicare Advantage side relative to the fee-for-service patient population. And then second was just some specific things to Glaukos and I'll call it our rep incentive that in looking back, we saw probably a little bit of pull into Q3 and a little bit of pullout into Q4, but on the margin, I think, also impacted that. If you think about translating that moving forward, I think what I would say is, we do expect continued progress sequentially into the first quarter with iDose despite it being a seasonally low quarter from procedure volumes. And as the overall year, which we can talk more about throughout your matter, we expect there are going to be continued sequential improvements each quarter throughout the 2026 time period.

Your next question comes from the line of Adam Maeder with Piper Sandler.

Congrats on all the progress. Maybe picking up, Joe, a little bit where we just left off. I wanted to ask about top line guidance for FY '26, the $600 million to $620 million. And really just hoping you can kind of pull apart some of the different components, whether it's iDose contribution, how you're thinking about the U.S. stent business and corneal health with Epioxa. Any quantitative color would be fantastic, but even just broad qualitative strokes such as we expect this business to grow or not grow would be really helpful. And then I had a follow-up.

Yes. Happy to do that, Adam, and maybe I'll start off. And obviously, if you have follow-up questions or others, we can dive a little bit deeper. But if you think about the guidance that we've set and kind of affirmed here today, which is normally the time when we set it for the first time, as many of you know. There's no question 2026 is another pivotal year for us as our efforts, as you heard Tom say, to transform the standard of care and interventional glaucoma with iDose and iStent infinite are kind of now finally joined by what I'll call a complete reset and expansion of our investments, the launch of Epioxa. And so we were pleased to be able to establish an initial guidance range of $600 million to $620 million, which at the midpoint represents more than $100 million of growth this year. If you think about it by franchise, I think it's probably the easiest way to start. On the international glaucoma side, we expect high single-digit growth internationally for the year as competitive launch headwinds really play themselves out in several of the key markets as we talked about for a couple of quarters now and they're somewhat offset by the iStent infinite launches and the broader individual glaucoma and market access initiatives that we have going on worldwide. I think in the early part of the year, that will be a little bit higher than that. And then as some of the currency tailwinds wear off, we would certainly expect that to come in a little bit in the back half of the year. On the U.S. glaucoma side, we expect embedded in the guidance is growth in the 30% range year-over-year, driven entirely by iDose TR. I think as we've said in prior calls, I think it's safe to start off this 2026, assuming that the non-iDose business is flat on a year-over-year basis. And so the entirety of that growth, I'm talking about is really being driven by iDose. And that leaves corneal health. And while there are a fair number of, I'll call it, moving parts associated with the launch of Epioxa and the transition from Photrexa, I think we can confidently say we continue to expect that the franchise will grow modestly year-over-year, but with a fair amount of volatility, particularly in Q2 and as we enter into Q3 as Epioxa becomes available and that permanent J-code is established, you'll see the warehousing effect that we've been thinking about and the sort of delays as those patients are working their way through the approval process and ultimately getting approval and treatment as we kind of make our way through Q3 and certainly into Q4, where we think that the strongest results will be for that business.

That's really helpful, Joe. I appreciate all the color. And maybe just for the follow-up. I guess another modeling question, and I just wanted to ask for a little bit more color on cadence quarterly realizing you just gave a little bit there. But for Q1, I had the Street modeling, I think, $132 million, $133 million of revenue, which is down sequentially quarter-over-quarter. Just curious if you have any reaction to that figure. And obviously, Epioxa transition versus Photrexa is a little bit, I think, tough to pin down. So any more color you can kind of give us on how you're thinking about sequencing would be appreciated.

Yes, Adam, it is indeed somewhat complex on the cornea side. However, looking ahead to 2026, we anticipate some deviation from historical trends. As you're aware, ophthalmic procedures typically exhibit seasonality, showing 22% to 23% in the first quarter, 24% to 25% in the second and third quarters, and around 28% in the fourth quarter. The two main factors driving our expectations are the iDose launch and corneal health considerations. We expect consistent quarterly growth through 2026, contributing to a more back-weighted impact of iDose on U.S. glaucoma numbers. Regarding corneal health, we foresee modest growth in the first quarter due to ongoing Photrexa procedures before the availability of Epioxa. We anticipate a notable decline in Q2 as we transition from Photrexa to Epioxa, with patients being prepared for approvals but not yet receiving treatment at the expected rate with the upcoming J-code. Q3 is expected to be relatively stable year-over-year as the J-code is introduced, facilitating the movement of patients into treatment by the end of the quarter. We expect a strong finish in Q4 as the J-code becomes fully operational, leading to more normalized treatment patterns as we close out the year and move into the next. For the first quarter, the U.S. glaucoma business is likely to remain flat compared to Q4, as any non-iDose seasonal challenges are balanced out by iDose growth. As mentioned, cornea will likely see modest year-over-year growth, while international glaucoma is expected to show more typical high single-digit to low double-digit growth annually.

Your next question comes from the line of Ryan Zimmerman with BTIG.

I'm going to try to do a quick round of questions and see if I can get a few in that should be straightforward. The first one is about how you view the relationship between the re-administration of existing iDose and TREX, and whether there's a cannibalistic effect there. Additionally, you mentioned 50% coverage on Epioxa, but I want to clarify that this doesn't mean you have 50% covered lives; you're currently in discussions with those payers. I'll stop there for now.

I'll start by addressing the second part of your question, and Tom can follow up on re-administration. Regarding Epioxa coverage, it's important to note that in rare diseases and unmanaged categories, formal coverage policies may not exist. We are tracking prior authorizations and approvals over time to ensure access for patients. This access can come from formal policies or informal adjudication patterns, providing confidence that qualifying patients can receive therapy. We're ahead of this timeline. Tom mentioned in his prepared remarks that we've established meaningful clinical discussions with payers who cover over 50% of the lives in question, leading to some early positive policy outcomes. It’s crucial to recognize that cross-linking as the standard of care is not new; we have been involved with Photrexa and the Epioxa procedure for some time. Moving forward, we expect continued recognition and access for patients to this clearly superior therapy, Epioxa. Regarding re-administration and its relationship with TREX, if you're considering this from a long-term modeling perspective, our goal remains to provide patients and surgeons with a variety of options. Depending on disease severity and clinical circumstances, different surgeons may follow different protocols for re-administering a patient with iDose TR or TREX based on the clinical profile associated with TREX once it receives FDA approval. In terms of modeling, we need to consider potential trade-offs in treatment duration. We must prove this through clinical trials and account for pricing considerations related to a longer-acting therapy. Ultimately, with the anticipated approval of TREX, we aim to offer multiple options to patients who require sustained pharmaceutical therapies throughout their lives. The average patient will likely be under the care of a glaucoma surgeon for over 20 years from diagnosis until they no longer need therapy, allowing us multiple opportunities to treat these patients with either TREX or TR.

And Joe, just a follow-up. Are you going to let Alex just spend uncontrollably for this Epioxa launch? And I'm wondering if that's a subtle way of asking, Alex, kind of what your thoughts are on operating expense spend in '26 as you prepare for this Epioxa launch. Certainly, it's going to, I think, be a question around margins and operating profit and so forth, which, frankly, I do have you start to show some profitability in late '26 despite your ability to kind of spend aggressively here?

Well, let me step in before Joe speaks for me, Ryan, and address the three questions you asked. So let's talk about OpEx first and foremost. Our philosophy as a corporation still hasn't changed from what we experienced in 2025, which is we're going to continue to balance our capital investments against our revenues such that we're driving towards cash flow breakeven and potentially some cash flow generation over the course of 2026. And with that in mind, you would expect to see our operating expenses have growth next in 2026. If you think about what does that growth look like? What I would tell you today or what I would guide you to is somewhere in kind of a mid-teens year-over-year growth percentage off our base of 42 in 2025. That should put you in the neighborhood of operating expenses around 555 to 560 in 2026. Now that is still going to show operating leverage in 2026, which is another of our goals as we continue to march forward within the business and what we're trying to achieve. So that's kind of where we're thinking. And again, those are the key things that even though we're doing this, we have these two really key growth drivers that we're investing in, in Joe's organization between the iDose launch and the Epioxa launch in that. And then we have what we believe is a best-in-class R&D pipeline that we have to invest in well. And all those things are driving our decisions around our capital allocation.

And I think there's no question for all of us, Ryan, that with the Epioxa launch in the recent month when it comes to significant investment in patient access and whether that's on the hub with the specialty pharmacy, with the DTC investments or all the various things are designed to drive awareness, diagnosis, detection, and ultimately, the pull-through of these patients in as fast a time as possible, we're prepared to make those investments, obviously, within the framework that Alex alluded to.

Your next question comes from the line of Larry Biegelsen with Wells Fargo.

I have two questions, one regarding iDose and the other about Epioxa. Regarding iDose and the repeat label, can you share your thoughts on the percentage of new patients who might receive a second iDose? Additionally, what are your views on how the repeat dosing label might influence new iDose starts? I also have a follow-up question.

Well, I think, Larry, from a re-administration, we're going to have to watch that, right, in terms of those patients. I mean certainly, we've been actually already seen our first re-administration happen in the OR and it's driven by the things that you would hope to hear, which is that the patients themselves were seeking that an early patient who was getting into the area where they would potentially benefit from an incremental administration, and they were seeking it because they didn't want to go back on drops. They appreciate the value, if you will, of having the iDose working for them. And so I think over time, we'll have to continue to monitor that. But clearly, if you go back to what I said earlier, if the average patient is in the care of a glaucoma specialist or a comprehensive doctor for a little over 20 years with the disease, we expect there to be considerable opportunity for multiple re-administrations within the same patients over time. And I think that can certainly be a significant part of, I'll call it, the overall mix, if you will, relative to first-time therapy, certainly, as we get further and further out into the planning period. And I do think that there's an incremental halo effect because at a baseline, surgeons can confidently have the conversation with patients about interventional glaucoma knowing that they've got tools and solutions, including the repeat administration of iDose with those patients to manage their disease that way for hopefully their lifetime.

That's helpful. Joe, on Epioxa, can you talk a little bit about how quickly you expect to upgrade accounts to the new capital equipment? And can you put a finer point on when Photrexa is expected to be completely phased out?

Yes. As you heard in the prepared remarks, we're already well down that path of at least installing the capital equipment required to administer Epioxa and we would expect that journey to continue. I think as Tom mentioned in the remarks, we've already installed or are installing capital equipment at locations that would cover over 50% of the lives in the United States. And we've got various levels of approval at various systems and providers where we'll be north of 90% as we make our way through here into the launch. So I think we feel really good about where we're at in terms of establishing that foundation, if you will, as we move forward. As it relates to Photrexa and the transition, it makes sense, Larry, without getting too specific on dates that with a July 1 J-code, we want to make sure that Photrexa certainly remains available to physicians through that period. And then as we make our way into and through the third quarter, we'd expect to transition that more fulsomely over to Epioxa.

Your next question comes from the line of Allen Gong with JPMorgan.

I want to start with a quick question about iDose. We are about halfway through the quarter, and you've mentioned sequential growth throughout the year starting in the first quarter. However, it seems that the fourth quarter had some one-time factors that made it slightly weaker than anticipated. So, when considering sequential growth, what would be the appropriate baseline from the fourth quarter to build on for the first quarter? Or is that not the best way to approach it?

Well, I think, Allen, I certainly understand the question. I think that may be getting a little too precise for what we'll cover on a call like this. I think from our standpoint, overall, we gave the guidance that we gave, I gave the color on the first quarter dynamics and that expectation around iDose. I think we've been really pleased with the trending that we've seen so far in the quarter with iDose and the continued expansion thereof. And as you may know and may recall, March tends to be a pretty important month in the first quarter. And so we've still got that in front of us, but very pleased with what we've seen so far as it relates to iDose.

Got it. Your installed base of Epioxa in the second half is progressing faster than anticipated. There's considerable excitement and greater durability in Photrexa than we on the Street had expected. Why wouldn't you be able to transition cases over quickly, moving the cases you're handling with Photrexa to Epioxa efficiently once you receive that J-code?

Yes, that's a great question, Allen. I can confirm that our team has done an excellent job of getting ahead of our initial plans regarding the installation and procurement process related to the O2n System, effectively laying the groundwork for success. To understand our guidance for Q2 and Q3, it's important to take a step back. In the first half, we will face challenges associated with a miscellaneous code affecting patient access and approval processes, which can be lengthy. Once we establish the J-code, there will be additional tasks like payer notifications. These factors, combined with the complexities of the approval process in any rare disease, particularly with Epioxa, mean we will likely see a significant amount of patient discussions leading to what could be described as warehousing. This isn't true warehousing, but as patients navigate the approval process, we expect those processes to take longer due to the use of a miscellaneous code, the transition to a J-code, and potential initial denials that require appeals and peer reviews. As a result, there may be a gap between initial patient conversations and when we start seeing a more regular patient follow-through with treated Epioxa cases.