Glaukos's Record Quarter: iDose Momentum and Epioxa's Debut Reshape the Future

A Quarter of Rare Magnitude

Glaukos entered the summer with a statement. “Today, Glaukos reported record second quarter consolidated net sales of $185.6 million, up 50% on a reported basis and 49% on a constant currency basis versus the year ago quarter.” — Thomas Burns, Chairman and Chief Executive Officer (CEO) · 2026-07-29 The company immediately raised full-year 2026 guidance to $680–700 million, a $60–65 million jump from the prior range. The beat was broad-based, but two product stories dominate: iDose TR's continued ramp and the first full quarter of Epioxa, the new epi-on cross-linking therapy for keratoconus.

iDose: Momentum Without the Pull-Forward

U.S. glaucoma net sales grew 64% to $118.5 million, with iDose TR contributing roughly $74 million. The surge came even as the reimbursement landscape remains unsettled—5 of 7 Medicare administrative contractors (MACs) issued proposed local coverage determinations (LCDs) during the quarter. Management pushed back on the idea that customers were accelerating purchases ahead of a potential adverse final LCD. “There was no that I'm aware of LCD-related pull-forward dynamics in iDose.” — Joseph Gilliam, President and Chief Operating Officer (COO) · 2026-07-29 Instead, they pointed to a broader mix: commercial and Medicare Advantage volumes tick up as more MACs establish professional fees. The company remains cautious, noting seasonality in Q3, but the cross linking analogy for iDose is the treatment paradigm shift it has pioneered in interventional glaucoma. The debate over LCDs is far from over, but the company's confidence is documented:

I just remind investors that there are 500,000 to 600,000 SLTs done a year… there's a pretty large market there of patients.

Epioxa: Building the Rare-Disease Playbook

The Corneal Health franchise grew 48% to $30.4 million, with Epioxa contributing ~$11 million in its first full commercial quarter. The launch is still crawling before it walks, as management navigates a permanent J-code (J2789, effective July 1) and the transition away from Photrexa. “We were very encouraged by the contribution of Epioxa in its first full quarter…” — Joseph Gilliam, President and Chief Operating Officer (COO) · 2026-07-29 But they also flagged near-term volatility: “you end of the third quarter having sunset largely Photrexa, while launching, if you will, Epioxa in the permanent J-code setting.” — Joseph Gilliam, President and Chief Operating Officer (COO) · 2026-07-29 The ground game is already extensive—data shows O2N systems covering ~85% of the U.S. population, access pathways for 125 million covered lives, and a growing permanent J code infrastructure. Management is leaning on site of care expansion and a pipeline progressing toward 95% reach. The company also emphasized the importance of 340B institution pricing dynamics, which are factored into a gross-to-net average around $60,000 per patient.

Financial Execution: Leverage Arrives

The revenue surge is translating to the bottom line. Gross margin hit approximately 85% in Q2, up ~90 basis points sequentially, driven by mix. CFO Alex Thurman noted, “we were pleased absolutely to see the continued accretion in the gross margin during the quarter… approximately 85%.” — Alex Thurman, Chief Financial Officer (CFO) · 2026-07-29 Operating expenses for the year are expected around $600 million, but revenue growth is outpacing the expense growth, a trend visible in the fundamentals. Total Revenue rose from $97 million in 2025Q2 to $151 million in 2026Q1 (latest reported), a 56% increase year-over-year. The company still shows a negative operating margin of -13.2%, but that represents a 6.2 percentage-point improvement from the prior year. Gross margin improved to 77.9% in the latest quarter, up 0.7 points year-over-year, with further accretion expected as iDose and Epioxa scale. The stock has responded: GKOS is up 58.8% over the last 90 days, entering the earnings print already in a strong uptrend.

Why It Matters

The quarter confirms Glaukos is no longer a one-product story. iDose TR is approaching blockbuster status, and Epioxa is an early but credible second pillar. The company is also strategically investing in Phase IV study data to preempt reimbursement pushback, a lesson learned from the LCD battle. Prior calls laid the groundwork: management had warned of a slow Epioxa ramp, but the Epioxa launch is already exceeding internal expectations. As the company approaches cash flow breakeven, the market is pricing in a durable growth algorithm—the question is whether the LCD tailwinds turn into headwinds or are merely noise in a multi-year secular shift.