Sight Sciences, Inc. (SGHT) September 2026 Conference Transcript

Great. Thank you, everybody, for joining. First, importantly, there's a disclaimer on the Morgan Stanley website that I encourage everybody to go to. With that, I'd like to welcome the Sight Sciences team. We have Paul, Allie, and Jim here today to give a little bit of a deeper dive on the story and an update on how the company is doing. And I know there's been a lot of exciting updates, so looking forward to unpacking those. Maybe to start us off, I'll turn it over to Paul to introduce Sight Sciences and give folks a level setting on the business.

Sure. Thanks. Good to be here. Sight Sciences, we're an ophthalmic medical device company in growth stage. We are focused on two of the major problems in eye care, glaucoma and dry eye disease. Glaucoma is the world's leading cause of irreversible blindness. And dry eye disease is one of the top reasons for a visit to an eye care provider, for a patient to visit an eye care provider. We're an interventional company, so we believe strongly that patient care needs to move out of the hands of the patient and into the hands of the eye care provider. So we've developed over many years two compelling, clinically proven, and now commercial stage and growing interventional technologies, Omni in the microinvasive glaucoma surgery space and TearCare in the interventional dry eye space. Excited both businesses are growing. MIGS is back in growth and Omni is back in growth mode and TearCare on the dry eye side is also growing very nicely commercially as we're working to secure additional payer wins and market access in parallel.

Okay, great. I mean, look, the story has evolved significantly over the last 12 months, and so for investors who are newer to it, how would you kind of characterize the differences of the company today versus a year ago?

Yeah, I think we're quite different today. Several years ago, we were primarily an Omni-MIGS company. That product was in growth mode. Tier care, lots of work was getting done, great work getting done in the field with our team, development work, perfecting the technology, running multiple RCTs to prove it out and to ultimately secure reimbursement. But the headline of the company, the headline story was Omni and MIGS, and for several years there was a challenge with Medicare around what they would cover, what they wouldn't cover, and it kind of took us sideways as a public company with a single product. But now, fast forward 12 months, and as I mentioned in my opening remarks, we are very excited to be back in growth mode with both businesses. So Omni is back in growth. The MIGS market is back in growth. Our team is as laser focused on MIGS and making Omni a standard of care. It's the leading implant-free MIGS technology. So that's very different. I'd say on the interventional dry eye side of our business, it's night and day. So if you go back a year, we didn't have any market access a year ago. It was less than a year ago we secured our first two successful kind of payer coverage in First Coast and Novitas. And so with that reimbursement, we have been hiring great people who are locked in and focused on the opportunity and training eye care providers on the tier care procedure, and we're growing a very nice business. You know, we've been almost doubling every quarter since we got reimbursement. So growing that business is very encouraging. And in parallel, again, we're working on both driving more depth of coverage in the First Coast and Novitas regions, the 13 states that are covered by those two MACs, as well as broadening access beyond First Coast and Novitas.

It's nice to see the story truly turn into a platform opportunity and with businesses humming. And, Jim, maybe I'll turn to you. You know, the performance in Q2 was a strong 20% growth following a Q1 performance of 13% growth. What gives you confidence in the durable change in the company's trajectory versus this being an episodic set of quarters?

Yeah, thanks. That's a great question. And, as Paul said, excited to be back in growth mode. And I think for us it's really the underlying metrics of both businesses. So 13% growth in Q1, 20% growth in Q2, as you said. Excited to be back in that double-digit growth mode. And on each business in Glaucoma, we exit Q2 at record number of accounts, strong utilization, strong pricing. So the health of that business and the momentum there, we expect to continue. And then on DryEye, Paul mentioned revenue has been doubling. The underlying metrics in that business are also really compelling and performing really well, number of accounts, utilization, all those patterns. So the strength of those underlying metrics, and you also saw during the Q2 call our raise and guidance. So our confidence in the trajectory of the business and the rest of the year is really based on those underlying fundamentals and the growth of the markets and our ability to go execute.

Great. Right. Well, maybe we'll spend a little bit of time on the interventional glaucoma part of the story, because in particular that grew quite strongly in Q2. How should investors think about the sustainability of that business in particular across combination cataract procedures, market share gains, utilization, pricing, and standalone procedures? Maybe, Paul, you can help unpack that a little bit.

Yeah, we're obviously very excited about the growth of the overall market and the strength of each of those segments, combo cataract and standalone. We're focused on both. Look, again, stepping back from all of it, glaucoma is a very tough problem. MIGS is a very important part of the treatment algorithm. We continue to advance the field. Other players continue to advance the field. This interventional mindset is here. It's growing, and we're moving beyond a mindset into greater and greater activation. We have folks on the psych team that are doing a great job specifically targeting, kind of activating the interventional mindset, moving from, yeah, this makes sense, intervening earlier makes good sense, to actually helping the practices schedule those patients for intervention and getting those interventions done. So combo cataract is back in growth. Standalone is back in growth. I think we're driving a lot of that growth in standalone in particular, while it has taken longer to kind of, you know, hit those growth levels that we've been seeking for many years. I think it is starting to accelerate. We're starting to see it's becoming a more meaningful contributor to our overall growth profile. So we're going to continue to invest in that. And we expect over the coming years for standalone to become a bigger and bigger percentage of our revenue mix. You know, I think historically MIGS has been around 90%, 10% combo cataract for standalone. I think our mix historically was 85-15 approximately. You can't measure it exactly. I think we're higher than that now. I think we're probably at 80-20, maybe 75-25, somewhere in between there. So standalone is becoming a more and more important part of our revenue mix. And ultimately, we're here to help improve care for patients and improve visual outcomes over a longer period of time. Standalone interventions have to get done more frequently.

Okay. And with that, you're also launching the next generation Omni Ultra. What can you tell us about the new device and how you expect that to impact the business?

Yeah, we've been innovating in this category. As the category creators for many years, OmniUltra is the latest of our kind of circumferential glaucoma surgery technologies. We are trialing it right now with our surgeons, so 20 to 30 surgeons across the country. We've been in operating rooms all over the U.S. just in the last few weeks. It's going very well. We're excited about it. Our surgeons are excited about it. We're going to do a broader launch of Omni-Ultra at the American Academy of Ophthalmology meeting in mid-October in about a month. So it's good to get these cases under our belt right now to prove it's delivering on what we worked with our surgeon customer base to improve upon, and it is. So we have single-pass canaloplasty, so it's a more efficient procedure. We have, we've introduced TruSync Plus technology into Omni Ultra, which is a gel that we deliver, viscoelastic gel, to deliver it on advancement of a microcatheter and on retraction. So we're performing canaloplasty on the way in and on the way out. That's a very nice feature. the ergonomics of the device. You know, I was in the operating room with one of our KOLs I think just last week in Arizona and the ergonomics, you know, she shared with us. She liked everything about it. So we're excited about it. Our surgeon customers are excited about it and you'll be hearing more at the launch at AAO in about a month. Perfect.

Sounds very exciting and very promising. You know, maybe you've described a standalone glaucoma as a significant long-term opportunity for the company. I think investors understand Omni well in combination cataract procedures, but standalone glaucoma is less developed. What is the opportunity that you see, and how are you helping develop the market itself, and what do you see as kind of the potential for site down the road?

Yeah, it's still a very significant market opportunity and need, frankly. There's a very real clinical need for glaucoma patients to receive standalone glaucoma interventions. The reality is, look, MIGS has come to market associated with cataract surgery, but the reality is the majority of glaucoma patients don't need cataract surgery. It's either prior to them needing cataract surgery or they've already had cataract surgery, but they have glaucoma. So there is a way bigger patient population with glaucoma that just needs glaucoma surgery. We know the data says that if you intervene earlier on these patients, they're going to be better off than waiting until its end stage. So I think the medical community understands that now, and the name of the game is activating that, moving from an understanding to those patients getting to the operating room and getting these procedures. And so where did that activation happen? It happens in the office. And so we are mastering, as we speak, kind of how to improve that office flow, identify helping our customers and staff identify these patients, help bring them back for a glaucoma consultation, much like they would with a cataract consultation. They would bring the cataract patient back for a cataract consultation day, and they'd walk through all of the options, and then they would set a surgical plan in place, and then take that patient to the operating room. We're mirroring that, and it's working. And we're having our customers bring patients back for glaucoma consults. They're putting a surgical plan in place, and then they're getting an interventional glaucoma procedure. It's not always omni. We're doing the work. It needs to be done. It's often omni, but it's not always omni, and that's okay. And I think as more and more industry also starts driving this, driving the activation, patients will be better off, and obviously it's one of those scenarios where industry will benefit overall.

Yeah, okay, great. I mean, it really is about improving patient access to care that they need and getting to that underserved patient population, so that's great. And maybe switching gears to tier care, which has grown rapidly over the last several quarters, what's driving the progression? And, you know, what must happen for this to be a repeatable, scalable, predictable procedural market rather than simply an early adoption opportunity. Maybe, Ali, I'll have you unpack that a little bit for us.

Yeah, sure. And we're really excited about the tear care opportunity. There are 19 million people in the United States who suffer from dry eye disease and about 7 to 8 million that have moderate to severe MGD-associated dry eye disease. And so there are a lot of patients that are seeking alternatives to drops and looking for interventional solutions. And with our progress that we've seen so far in the First Coast Novotov jurisdictions where we have appropriate fee schedules established, we've been able to treat patients and help them improve their dry eye symptoms and signs. And so we're really proud of the impact that we've had in those markets. They cover about 13 states here in the U.S. And right now that's traditional Medicare fee-for-service patients, and then we have some Medicare Advantage plans in those areas that have also followed suit. We're really focused in about five states right now, though. That's where we have sales, commercial team coverage. And so those are the areas that we're focused on. And as you said, we have shown great traction. We sold over 3,000 lids this last quarter, $2.7 million of total revenue, and that was almost doubling from the first quarter, and the first quarter was almost doubling from our fourth quarter. So we have seen good traction because this is an important part of the treatment paradigm and people are figuring out the workflow. What we really need to have this become more of a standard of care is we need to have, first of all, expanded market access, more access to this important treatment for our patients. We also need practices to create the workflow around this. How are they going to identify patients and put them into a tier care specific workflow and decide to treat them? But we've seen really great early traction. We're really proud of the results that we've achieved and and we'll continue to make progress as we move forward here.

Okay, great. And maybe you could give us a little bit of a status update on expanding care care's market access. You know, how important is the Medicare versus commercial patient population of the market, and how do you see that kind of evolving over time?

So when we look at the patients that have dry eye disease, about 70% of them are covered under commercial plans and about 30% are under Medicare or Medicare Advantage plans. And so over time, it is very important for us to get commercial payer coverage because that is where the majority of the market is. And we are continuing to talk with the medical directors at those policies and make sure that we have claims submitted. We have great clinical data to support the necessity of the procedure, and we're continuing to have those conversations. For now, though, with Medicare establishing fee schedules and at least about a third of the Medicare-covered lives, we are focused on activating in those. And because of our glaucoma business, we actually see some great synergies there where there are a lot of patients that are being treated with omni or glaucoma or cataracts or in those same types of practices, but also experience dry eye. And so that synergy has been a good leverage point for us in these early days. But long term, we do need to establish broader market access. And we are very actively working on that, both with expanding MAC fee schedules across the rest of the states and then also with commercial payers and Medicare Advantage as well. It's hard to predict exactly.

Right. Of course. Of course. I mean, you know, the last tailwind I want to cover on the tier care system is you guys just received expanded label on it.

Can you talk about the label and why it's so important as you think about the trajectory of tier care? Absolutely. You know, we're really proud of the fact that we were able to get an expanded label for tier care to really showcase what tier care does, which is treats MGD versus just a local application of heat and a tool label. So we are really proud of the fact that we were able to get that expanded label, and it's just a testament to the value of the tear care procedure. It already resonated with customers. Customers could clearly see intuitively the value and the benefits It's based on the Sahara data and Olympia data that we had already published. But it is a great validation on the treatment and also important for payers over time to see that we have a label that actually reflects treatment of MGD versus just the prior label. Yeah.

Okay. Perfect. Well, that's very exciting. Paul, maybe I'll turn it back to you. So you've increasingly described glaucoma and dry eyes as intersection of intervention. Where are you seeing the tangible commercial benefits of that overlap today, and how meaningful can that advantage become over time?

Yeah. So if you think about the primary interventions that are available in the anterior segment and the most prevalent diseases of the anterior segment, You think about things like cataract surgery, that's an intervention, minimally invasive intervention. You think about glaucoma surgery in MIGS, that's a minimally invasive intervention on a very large patient population. And now we're introducing another procedural intervention on another significant patient population that needs better care, better treatment. So you have this mix of cataract interventions, glaucoma interventions, and dry eye interventions. So when we, and Allie mentioned it, we have thousands of relationships through our glaucoma, microinvasive glaucoma surgery business, with surgeons, with staff, in offices. and those are often the same customers that we will be targeting with tear care. First of all, these doctors, ophthalmologists, we also sell tear care to optometrists, but in the case of the ophthalmologist, that ophthalmologist probably does cataract surgery. That ophthalmologist probably does glaucoma surgery. And that ophthalmologist probably will want to adopt tear care as a procedure. So they're capable of adopting all of these things. They want to adopt these things. They make good clinical and business sense. And they have all of these patients. That same ophthalmologist has patients who have cataracts. He or she has patients who have glaucoma. He or she has patients who have dry eye disease. Sometimes that same patient might have all three comorbidities. So you can start to see the synergy. So when we talked earlier about building up our skill set and omnipresence in offices around the country to drive standalone omni activation, a lot of the work is similar to activating tier care in that practice and integrating tier care into the workflow, just like integrating omni standalone into the office workflow to generate standalone OR visits. So as we develop this muscle, this in-office workflow muscle, the benefits are going to accrue both to our omni-market development work and standalone, as well as our tiered care market creation work. And so it's super exciting. I think it's a unique synergy. I think we're one of the few companies that has two leading interventional technologies in two of these big categories that has this kind of synergy. So what is the long-term impact? I think it makes us far more commercially effective, commercially more efficient, and capable. So we'll see the dividends over the coming years.

That's great. And look, I do think, again, the platform story becomes more and more true as you have these synergies also come to fruition. I think the last few quarters have really highlighted the strength of having these businesses come online. We've seen that in the revenue growth. And, you know, Jim, I guess for you, there's always a question from investors when it comes to high-growth stories around the balance of growth versus proving profitability. The last quarter in particular, revenue grew significantly, but operating expenses also declined. So, you know, you're kind of structurally making those moves on the leverage side and getting that benefit of the pull-through. How should investors think about the balance, though, of improving cash flow versus continuing to invest behind growth and powering the platform to really achieve its full potential from a top-line perspective?

Yeah, it's a great question. And I think the simple answer is we plan to do both. So you saw it in the first half with revenue back in growth mode, double-digit revenue growth, adjusted OpEx down year over year. And in our updated guide for the full year, revenue growing mid to high teens, and adjusted OPEX only growing mid-single digits. So part of this was a restructuring we did a year ago intentionally to really focus on our strategic objectives and make sure we go deploy the capital in the most efficient and high-value opportunities that we can. So fast forward to this year, we're starting to see that operating leverage and a reduction in cash burn each of the first two quarters. So we expect to continue driving that leverage, and as we go invest for growth, really be disciplined about that scale-up and make sure that we continue to drive leverage.

Okay, great. And if you could give investors two to three KPIs that you in particular are focused on that you think that they should also look to, what would they be?

Revenue is obviously very, very important to us, but also those underlying metrics like I talked about in each of the businesses, active accounts, utilization, those are very important to us. And most importantly, some of the P&L metrics and balance sheets, so cash burn and our efficiency through the P&L in deploying that capital.

Okay, great. Well, Paul, maybe, you know, to wrap, what do you think investors should be focused on over the next 12 to 18 months? Talk a little bit about the upcoming milestones that you'd like folks to make sure that they look out for and you think about kind of key developments to structurally helping site achieve its long-term goals.

Sure, yeah. Well, we're obviously super excited about where we are today. We love being back in high-growth mode. We love the fact that both of our interventional businesses are growing, so executing very well across our fundamentals, like we discussed, continuing to grow Omni in the combo cataract, MIG space, continuing to grow Omni in the standalone space, launching Omni Ultra with excellence, and having that scale up throughout 2027. on tier care, on the interventional dry eye side, continuing the commercial excellence in Novitas and First Coast and demonstrating that we have a wonderful business, recurring revenue, high-margin recurring revenue business in the existing covered states, and, of course, securing additional market access. So if we're back here a year from now, we'd expect to have additional payers, commercial as well as Macs covering. So with all of that, lots to do, lots to execute with excellence, but also maintaining that OPEX discipline and continuing to show that operating leverage. So I think we're going to execute well on all of those things. And then lastly, if we're here a year from now, we're also going to be excited to talk more about our interventional pipeline. Beyond Omni-Ultra, we've got a really elegant model of tier care coming out next year, tier care MGX, so we'll be excited to share with everybody. And then behind that, we have a platform, a sustained release medication delivery platform that we think is going to be disruptive. We've shared it with a handful of ophthalmologists. They share our views that this could be disruptive in first line. And as we get close to human clinical trials, which I would expect, will be ready to talk about it if we're here 12 months from now.

Well, look, that's a lot of things that you've listed off, so a lot of execution, and I know you guys are keen to do so and have been building up a nice track record around that. So congratulations on all the success to date, particularly the performance in the first half of the year, and we're going to be looking out for those milestones over the next 12 months.

Please do. Thank you.

Thanks for joining us.

Appreciate it.