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Record Q1 performance was driven by the rapid commercial scaling of iDose TR, which generated approximately $54 million in its first full quarter of launch.

The U.S. glaucoma franchise grew 58% year-over-year, reflecting a broader shift toward an interventional treatment paradigm and strong physician interest in durable, long-acting therapies.

International growth of 23% was broad-based across regions, though management expects competitive trialing headwinds and abating currency tailwinds to be partially offset by growing contributions from iStent Infinite through the remainder of 2026.

The Corneal Health franchise is undergoing a strategic pivot with the commercial availability of Epioxa, an incision-free alternative designed to expand the treated patient population in the rare disease keratoconus market.

Management is redefining the go-to-market approach for corneal health by significantly increasing investments in patient awareness and education to address historical underdiagnosis.

Operational focus remains on achieving cash flow breakeven and driving operating leverage while selectively reinvesting outperformance into high-ROI commercial initiatives.

Full-year 2026 net sales guidance was raised to $620 million to $635 million, reflecting increased confidence in the adoption curves for iDose TR and Epioxa.

International glaucoma growth is expected to moderate to high single digits for the remainder of the year as currency benefits wane and new competitors enter major markets.

Corneal Health guidance assumes quarterly volatility during the transition from Photrexa to Epioxa, with a projected dip in Q2 followed by a strong exit velocity in Q4.

The company plans to initiate more 'offensive' commercial investments, including potential direct-to-consumer (DTC) marketing, as reimbursement foundations for new products solidify.

Clinical milestones include a planned market introduction of a new keratoconus screening device late this year and a regulatory filing for iDose Trio by year-end, with targeted approval expected in the fourth quarter of 2027.

A permanent J-code (J2789) for Epioxa has been assigned by CMS and is scheduled to take effect on July 1, 2026, which is expected to streamline reimbursement.

Initial Epioxa access will be gated by typical payer adoption hurdles; the drug is currently being processed under a miscellaneous J-code, which results in slower adjudication.

Management noted that while no Local Coverage Determinations (LCDs) for iDose have been issued and the regulatory environment remains unpredictable, they believe an LCD would be premature at this stage of the clinical adoption curve and is currently less probable.

Supply chain disruptions affecting competitors provided a non-material benefit to the core U.S. glaucoma business during the first quarter.

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Management reported encouraging patient flow into their hub, though they noted that the current use of a miscellaneous J-code makes the process slower than it will be post-July.

Pathways are already established for more than 100 million covered commercial lives, including 4 of the 5 largest U.S. payers.

Adoption is becoming more broad-based; while early-adopting MACs like Noridian and Novitas represented 78% of new region volumes in Q4, they dropped to 7% of that mix in Q1 as other regions like NGS and Palmetto 'turned on'.

Approximately 99% of patients now have an access pathway in the commercial and Medicare Advantage arena.

Management believes the true addressable market is 50,000 to 100,000 eyes per year, significantly higher than the historical 18,000 to 20,000 eyes treated with legacy 'Epi-off' procedures.

The company views this as a potential $1 billion-plus franchise as they transition the condition from a 'rare disease' to a 'rarely diagnosed' disease through DTC efforts.

Ongoing studies are specifically designed to provide data for commercial payers and Medicare Advantage plans regarding the incremental value of iDose in combination with cataract surgery.

Management emphasized that these studies validate what surgeons are already doing in practice rather than being required to drive initial clinical adoption.

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