Glaukos (GKOS) Q2 2026 earnings call transcript

Thank you, and good afternoon. Similar to prior quarters, the company has posted a document on its Investor Relations website under the financials and filings quarterly results section, head of quarterly summary. This document is designed to be read by investors before the regularly scheduled quarterly conference call. To ensure ample time and opportunity to address everyone's questions, we request that you limit yourself to only one question. Please note this as a change versus our previous calls. If you still have additional questions, you make it back into the queue.

Please note that all statements, other than statements of historical facts, made on this call, that address activities, events, or developments we expect, believe, or anticipate will or may occur in the future for looking statements. These include statements about our plans, objectives, strategies, and prospects regarding among other things, our sales, products, pipeline technologies, and clinical trials, US and international commercialization, market development efforts, product approvals, the advocacy of our current and future products, competitive market position, regulatory strategies, and reimbursement for our products, financial condition, and results of operations, as well as the expected impact of general macroeconomic conditions, including foreign currency fluctuations on our business and operations.

These statements are based on current expectations about future events affecting us, and are subject to risks, uncertainties, and factors relating to our operations and business environment, all of which are difficult to predict, and many of which are beyond our control. Therefore, they may cause our actual results to differ materially from those expressed or implied by forward-licking statements.

Please review today's press release at our recent SEC filings for more information about these risk factors. You'll find these documents in the investor section of our website at www. globcoast. com.

Finally, please note that during today's call, we will also discuss certain non-GAP financial measures, including results on an adjusted basis. We believe these financial measures can facilitate a more complete analysis and greater transparency into Globcoast's ongoing results of operations, particularly when comparing underlying results from period to period. Please refer to the tables on earnings press release available in the investor releases section of our website for reconciliation of these measures to their most directly comparable GAP financial measures.

With that, I will turn the call over to Globcoast Chairman and CEO Tom Burles.

Okay. Thank you, Chris. Good afternoon. And thank you all for joining us today. Today, Globcoast reported record second quarter consolidated net sales of 185.6 million, 50% on a reported basis, and 49% on a constant currency basis versus the year ago quarter. As a result of our second quarter out performance, we are raising our full year 2026 net sales guidance to 680 to 700 million in increase of 60 to 65 million over a prior guidance of 620 to 635 million.

Our second quarter results reflect strong performance across our global commercial and development priorities, underscoring the successful execution of our teams, the strength of our differentiated technology platforms, and our continued evolution as an increasingly diversified leader in ophthalmology.

Looking ahead, we believe we are well positioned to sustain this momentum, driven by two transformational growth drivers, including the further advancement of the intervention of glaucoma treatment paradigm with IDOS TR, and the launch of EPIOCSA, establishing a new standard in the interventional care reconnaissance and rare diseases. Together, these compelling and durable market opportunities reinforce our confidence and our ability to deliver our best in class growth and margin profile along to the next decade. At the same time, we continue to invest strategically across our industry-leading pipeline and commercial infrastructure while maintaining a focus on disciplined capital allocation to support sustained operating leverage and cash flow.

While our priority remains to maximize near long-term growth, we were pleased with our progress across our P&L in the second quarter. Now, let's discuss our second quarter results in more detail.

Within our U. S. glaucoma franchise, we delivered record second quarter net sales of 118.5 million on strong year-over-year growth of 64 percent, driven by growing contributions from IDOS TR, which generated sales of approximately 74 million in the second quarter. IDOS TR continues to deliver strong clinical outcomes that immediately improve patient's lives, resulting in strong position, interest, and adoption while helping to accelerate a broader treatment paradigm shift towards earlier intervention of glaucoma care.

From an execution standpoint, we remain focused on our key initiatives, including expanding our base of training surgeons and active accounts, increasing utilization, broadening market access, scaling targeted commercial investments, and expanding the robust and growing body of clinical evidence, which now includes 24 peer-reviewed publications complemented by a broad portfolio of active phase four studies across diverse real-world clinical settings, further enforcing and reinforcing its consistent performance in real-world practice.

Earlier this month, CMS issued its proposed rules for 2027, which, as drafted, largely maintained the 2026 EPC assignments, associated facility payments, and relative physician fee rates associated with our procedures across both the hospital, outpatient, and ASC settings. Additionally, as many of you know, during the quarter, five of the seven Medicare administrative contractors issued proposed local coverage determinations for IDOS-TR.

We were encouraged by the overwhelming support from physicians, medical societies, and other stakeholders throughout the open meetings and public comment period, validating the meaningful clinical value that IDOS-TR is delivering to patients. We continue to believe the strength of IDOS-TR's clinical evidence, real-world outcomes, and broad stakeholder advocacy support, appropriate Medicare coverage, and preserves physician decision-making and patient access.

Moving on, an international block home of franchise delivered record net sales of 36.6 million on year-over-year growth of 17% on a reported basis and 16% on a constant currency basis. The strong growth was once again broad-based as we continue to scale our international infrastructure and execute our plans to drive NAICS forward as a standard of care in each region and major market in the world.

As previously discussed, we continue to expect new competitive product troweling headwinds in some of our major international markets as we progress through 2026, partially offset by growing contributions from ICE 10 Infinite, following its EU MDR certification, and associated European commercial launches late last year. We also expect the currency tailwinds to abate going forward based on the current rate environment.

Finally, our corneal health franchise delivered net sales of 30.4 million on year-over-year growth of 48%, including epioxet net sales of approximately 11 million. Turning to epioxet, we remain very encouraged by the early progress of our commercial launch as the first and only FDA-approved epithelium on corneal cross-linking therapy for carotecones. Epioxet has been met with strong interests from surgeons and the broader ophthalmic community, reinforcing our confidence in its potential to redefine the treatment paradigm for this rare site-threatening disease that is currently far too often undiagnosed and untreated. Our launch priorities remain centered on expanding patient access, building awareness, optimizing referral networks, and driving earlier diagnoses.

We continue to make meaningful progress across each of these areas, including the ongoing expansion of our site-of-care network, establishing broad market access, and the implementation of our specialty pharma infrastructure and robust patient support programs.

First, a proud report that we've successfully established and continue to selectively expand a broad-reaching site-of-care network. Our acquired O2N systems are already actively deployed across locations, serving roughly 85% of the U. S. population. With a pipeline progressing through various approval processes that we expect will expand our treatment center reach to approximately 95%.

Next, we continue to make considerable progress with payers to secure access pathways for policy coverage for Epioxet, where the access pathways now established for more than $125 million to cover commercial lives in the United States, including with the five largest payers reflecting encouraging initial receptivity of Epioxet's clinical value.

While we expect the pace of policy adoptions to build over time, we remain focused on driving broader coverage across both commercial payers and Medicaid programs to support more streamlined access pathways over time.

As anticipated, Epioxet's new product-specific JCode, J279, became effective on July 1st 2026. While we expect it will take some time for this to be solidified operationally by providers and our specialty final partner, we believe this now effective code will help streamline the reporting and reimbursement processes for Epioxet among U. S. payers over time.

The on-market access we're proud to lead the way, once again, and forge in a new path for interventional care economists by advancing targeted marketing and DTC initiatives to drive awareness, education, and earlier detection supported by greater optometric engagement and strengthen advocacy partnerships.

Finally, we've launched a co-pay assistance program for eligible patients. While we remain nearly stages of the launch, we're encouraged by the solid progress we're making against our core launch priorities and remain very excited by the significant potential at the axle offers to patients living with care economists.

Beyond Epioxet, we continue to advance abroad and differentiate clinical pipeline across our five novel therapeutic platforms encompassing 13 publicly disclosed programs and additional undisclosed assets supported by robust portfolio of active clinical and phase four studies.

Within our IDOs platform, we are advancing a phase 2B3 clinical program for IDOs T-Rex, our next generation IDOs therapy, and patients follow up in a phase 3B study for IDOs trio with a targeted FDA approval by the end of 2027. We also continue to advance various additional phase 4 studies. Within our I-Link platform, we remain on track for our planned commercial introduction of our KC screen device later this year, and are preparing to commence a phase 3 clinical program for our third generation customized topographically guided I-Link therapy in 2027.

Within our I-Stent surgical glaucoma platform, we are advancing a PMA pivotal trial for I-Stent Infinite and mild to moderate glaucoma patients, and recently completed patient enrollment in our 510K pivotal study for the Preciplo Microsoft.

Within our I-Lution platform, we recently completed patient enrollment in a phase 2 study for Demodex Pliferitis and expect to have top line results in hand by the end of this year.

Finally, within our retinal platform, we are advancing a first in human clinical development program for GLK 401, our intravitral multi-kinase inhibitor retinal program, and wet A&D patients.

We believe that each of these novel differentiated platforms have the potential to generate transformative therapies that significantly improve the existing treatment paradigms for patients suffering from chronic eye diseases.

So in conclusion, at GLK posts, we're in the business of pioneering new marketplaces within ophthalmology. Our record second quarter performance highlights the strength of our strategy and execution as we continue evolving into an increasingly diversified ophthalmic leader with multiple transformational growth drivers in the Idaho's TR and FDOCSA as we advance our mission to transform vision therapies for the benefits of patients worldwide.

So with that, I'll open the call open for questions, operator.

Thanks, Tom. I'm happy to jump in there. Obviously, we were very encouraged by the contribution of epioxin. It's for all quarter really of commercial availability, particularly when you consider the unavoidable challenge that go along with the miscellaneous J code period that's there. And as you heard, Tom mentioned, obviously, our primary focus today remains on those building blocks that we think really set up epioxin for long-term success. And I can certainly talk more about that as we make our way through the call here. But as I think about the translation of how this plays out for the remainder of this year, and again, orienting you back to where our focus is at is making sure that we get the right puzzle piece of the place to drive optimization in 2027 beyond.

We know that the third quarter will come with some transition that it relates to the permanent J code. We've talked about that for some time. So you enter the third quarter having sunset and largely Botrexa while launching, if you will, epioxa in this permanent J code setting. And so there will be some volatility around that. It makes it much more difficult than usual for us to forecast during that stretch. And so there's a wider variety of scenarios, I guess, the way I would say it, around the potential outcomes of epioxet as we transition that way, you know, throughout the third quarter and certainly in the fourth.

I think as we get into the fourth quarter, we have a lot more conviction that some of those J code, you know, translation or transition really issues should start to get behind us and we should start to see that uptick as we think our way, you know, making our way through the fourth quarter and into the beginning of the next year. So I think we're going to have some transition here while we make our way through.

And we may, you know, ultimately deliver terrific results, but I think we want to make sure that we're saying somewhat conservative here as we navigate really what is a unique transition for us.

And then for the full year as it relates to epioxet, you know, really our overall Corial Health franchise, if we start off with you're saying we were confident we would still grow and then we ultimately, I think, you know, upgraded that to high single digits. Now, I think we're confident saying that for the overall year, Corial Health should now be able to grow, you know, call it 20% plus or minus on a year of year basis, just again based on that strong Q2 performance and then the growing epios to contribute your contributions as we make our way through the remainder of the year.

Got it. Congrats again. Thanks, Tom.

Yeah. Adam, I'm happy to do that, you know, as both you and Tom, we obviously very pleased with the strong second quarter and, you know, really each of our franchise has exceeded expectations and so as a result, we were happy to be able to raise guidance in the line of what you heard Tom mentioned earlier to the 687 billion mark.

If you think about your kind of models by franchise, and I think it requires adjustments across all the franchise, given that, that outperformance. First on international glaucoma, I always think we've increased our expectations there, there now where we expect to achieve low to mid teens, year over year growth for the overall year. If you think about the second half dynamics within that, you do have the FX tailwinds abating.

We've called that out before and we certainly expect that and we're kind of half the, I'll call it the FX benefit now on a year over year basis. So that will be a relative headwind as we would make our way into the second half. And we'll continue to advocate competitive dynamics in those international markets and some reimbursement headwinds that have emerged in Germany and Switzerland.

But offset that by continued growth of press or flow and incident and really our overall, you know, interventional glaucoma market developments abroad. So I think we're pleased to be able to increase our expectations there to low to mid teens for the overall year. You heard me reference the corneal health side of things before, so I won't spend as much time there. But just again, reiterating that the 20% growth year over year plus or minus attempts to factor in, you know, especially in the third quarter, the impact from sunsetting fotrexa and shifting to the permanent Jacob for epioxa, it's possible we'll have a bit of an air pocket there as we make our way through this quarter, but we remain confident that air pocket will be behind us by the time we get into the fourth and moving out of the out of the full year.

And then finally on the on the U. S. glaucoma side, you know, we now expect full year growth of right around 50% plus or minus for for that business. And that's really driven by by two things, obviously, I think we now can say that we would expect the year at least low single digit growth of our broader portfolio and then the continued expansion of, of IDOS TR, which, you know, I think when you, when you do all the math, you're going to land somewhere in that, I'll go with 275 to 280 range for varidos in, in 2026.

Yeah. Thanks, Larry. I mean, to your point, clearly a lot transpired on this front, you know, between the draft LCDs that came out in May, you know, open meetings in June and the formal submissions in early July. And, and really I think the way we always said conviction is you can imagine around the evidence associated with IDOS in a multitude of settings and use cases that, and certainly perhaps most importantly, the study that supported the approval of IDOS and all the evidence that generate a wide open label in that regard. So we were encouraged, as I think many of you were, by the overwhelming support from physicians and the medical societies and even patients throughout the country, the objective and high quality evidence that was presented really just validated, you know, our belief in the clinical value of IDOS.

So at this point, you know, we certainly believe that the max are digesting all that evidence that was presented and submitted and while there's no statutory next step or even timing in that regard, we do believe that ultimately it should come out in a more favorable position to the extent that it is proposed as a final LCD, you know, as I think about in the context of, you know, moving forward what, what may or may not shift, I think it would be a recap of what you heard during those meetings. I think there was a pretty strong opposition to the underlying criteria associated with each of the provisions, there certainly was a lot of opposition to the idea of having multiple components to the, I'll call it the step at it, associated with those drops and SLT.

You heard a significant pushback around glaucoma as a disease and the right way of treating it and thinking about it clinically and really not reducing the optionality for physicians to utilize multiple tools that are complimentary in the case of IDOS and other MIGs and so I think all of those things had compelling evidence presented and certainly are in play as it relates to the overall.

As I think about the final part of your question which is, you know, how does this impact, you know, the years of the comments that we're finalized as it is, while I think it's highly unlikely that that would be the outcome of any process here, I think it's important to remind folks some things that we talked about when investors were on the road, I think the continued strength of the business that you see in IDOS today, I think shortens the expectations that existed previously around 2027 and beyond and maybe more importantly, even in an SLT world, I just remind investors that there are 500 to 600,000 SLTs done a year and that's been being done for quite some time, meaning that there's a pretty large market there of patients both in terms of annual incentives as well as the overall prevalence pool for IDOS to continue making meaningful contribution and clearly if something came forward that was not aligned with what we believe is appropriate clinically, not only would we object strenuously to that alongside the society, but we would also continue to provide the evidence that we have already generated or will generate to make sure that for the long term of IDOS and international just do part or into one question just to keep to Chris's rules, but when you think about the O2 placement and the 85% of the user base, what do you see?

Of course. I'll pretend it was one question, Ryan, so that I'll get in trouble with Chris. First, it relates to the Epioxia kind of growth to net dynamics. Obviously, that's something that we'll be watching. Alex will be watching alongside of us here as we get a bit more maturity in the market launch of Epioxia, but what I think generally we've said to investors is I think a safe place out of the gate is to think about it in that kind of net $60,000 range. That's really meant primarily to include the impact of Medicaid pricing and the various other required discounts as a part of the launch.

We're not necessarily doing much beyond that at the stage of the launch, so it comes down to that mix that happens with Medicaid and place like the Department of Defense and things like that. As we make our way through, we'll hone that in a bit more from there, but I think $60,000 is a good place. On the O2N system side, we made a lot more progress during the quarter and we were already well ahead of our expectations.

I think at this stage, to be able to say you've got systems deployed at 85% of the US population and that pipeline progressing towards 95% of the country. When you actually think about the country from a geographic perspective, that's about as good as it gets in terms of the way you think about an installed base, certainly at this stage of the launch and as the J-code came online, we've seen even though some of those folks who were a little bit slower in their process and approvals picking up the pace of getting that in line going forward.

I would say it's not so much about any particular cohort of patients or sites. We've got private sites, we've got parts of large groups that have sites in their network. We've got hospitals and 340 institutions that are there. There certainly are some new, but I would say it's been much more about taking a look at our prior base of customers and leaning into those folks that historically have both geographically and from a patient focused standpoint, provided the optimum care in terms of their treatment times, their commitment to it, the education with the optometrists in their community and all the things you want to see to make sure that you're optimizing your network, especially these early days, where you can't afford to have a massive number of centers.

We've really leaned into what I would call the tier one and tier two sites and our conversion of those have been extremely high and so we're pleased with what that looks like. In terms of that early utilization, I think it's really been pretty profound in terms of the number of patients that almost all of these sites have started to put into our hub and seeking to get approval for epioxa, given the clear benefits of that therapy over the legacy of an FBOF solution-like buttress.

Hey, Alan, it's Alex. I'll take that question. And you're right. We were pleased with the progress that we saw in the second quarter across the entire P&L, from the margin to operating expenses to the bottom line as well, including, you know, cash generation in the quarter that we saw. And again, you know, like we've said to investors in the past, and given our company's close margin profile, there's certainly a clear line of sight that we have today towards govivoting profitability at some point in the future.

And it's increasingly more and more towards the near term as we see the increased revenues from these two transformative drivers. But that said, you know, we would remind investors, you know, our management focus continues to be on prioritizing and currently investing back into the commercial business to support these two transformative launches, as well as, you know, supporting the R&D pipeline and things that you saw in the quarter as we stepped up, especially in clinical, as we've grown our clinical trial programs that Tom was referencing in the prepared remarks.

And that is just really, again, driven to maximize both our near term and long term top line growth profile of the company.

Yeah. Thanks, Richard. First on the IDOS front, I think there was no, that I'm aware of, you know, LCD related, you know, pull forward dynamics in IDOS. I mean, most of the surgeons you talk to, their schedules are pushed out well beyond even that timeframe from when this came on. So if you're going to see that, I think it would be something that was on the heels of actually a pro's final rule, if it were ever to come out. So I don't think that was really the case. What we really saw in the quarter was the first time where you had, obviously we've had meaningful growth in the beginning. But in this quarter, we really saw both an acceleration across the various mags, I would say, with the most recent additions of the professional fees and NGS and Palmetto, you saw that contribution pick up.

And then maybe even more importantly or equally important, we saw a knife up tick in activity around the commercial and Medicare Advantage patient populations, as well as more of our customers started to expand utilization of IDOS into those patient populations. So I would say it was a diversified performance in the quarter. You know, the strength of it does give us a little bit of pause, I'll call it in terms of conservatism around how we think about that into the third quarter and through the remainder of the year. We're still early in that launch as well. So when you have quarters of this magnitude, you want to make sure you still stay somewhat cautious about how that will translate, certainly into a seasonal down quarter in terms of ophthalmology procedures in the third here.

As it relates to Epiocca and 340B pricing, that's really factored in as a part of the prior question that I think Ryan asked. So when we think about the grossed net and what that kind of realized average ASP, and we've sort of consistently said around 60K is our starting point, that really factors in the impact of the 340B institution related volume and the discounts associated with selling product into those institutions.

Hey, Joanne, it's Alex. Thanks for the question. And yeah, we were pleased absolutely to see the continued accretion in the gross margin during the quarter. And as you mentioned, it landed approximately 85%, which was up roughly, you know, call it, you know, 90 base points from last quarter. And you know, that accretion was driven, as you might expect, from the growing contributions of IDOS, net deoxy, and the overall revenue mix. And you were asking about looking ahead, you know, we would continue to expect modest gross margin accretion over the remainder of the year. And particularly in the fourth quarter, as the IDOS and Epiaxis sales, you know, continue to become a greater share of our revenue mix.

Now, that all said, you know, we'll continue to stick with our targeted guidance range for the year of a gross margin of 84 to 86%, and we're holding that steady as we move forward at this point.

And our margins? Yep. And operating expenses? Yep. Nope. That's exactly right. We, you know, we were obviously, we're encouraged to see the operating leverage in the quarter. And our philosophy remains the same. We're going to continue to push our operating expenses such that we realize the leverage in the model, while still investing in these, you know, priorities around commercial and R&D. And that will be our philosophy growing forward. And again, you know, you coupled out with the cash and what we're trying to do there, and we're just trying to manage the business toward a cash flow break even stance. And those all kind of fold together and try and go away.

And I guess, Joanne, I'll just end, you know, just to get it out there on the record that for operating expenses for the year now, given the, you know, the outperformance on the top line, you can expect our operating expenses to land somewhere around 600 million for the year.

Thank you again.

Yeah, Mason, there's something I would call out in particular around it. But I think I sort of answered that before by saying that whenever you have this level of outperformance in a quarter and it's really the first, you know, we certainly continue to see sequential growth and progress throughout our launch and strong growth on a year-of-year basis. But the second quarter was so strong, I think we'd like to see another quarter or two of that before we call it a trend. And so I think we just want to be cautious about how you translate that Q2 number into Q3 in particular.

And just knowing that volume seasonally tend to be down in the third quarter and given that outperformance in the second, I just would be a little bit conservative around the third quarter IDOS number and give us a little bit of time to determine whether this is a trend or a bit of an outlier in the context of the strength of that print in the second quarter.

David, I think so let me start with the second quarter and in the cadence there as you might expect the majority or certainly a significant portion of the 11 million of revenue that we talked about was realized for the latter part of the quarter and that stands the reason with an FDA approval that was as we exited the first.

It took time for some of those claims to make their way through the prior authorizations, the contracting around them and ultimately to get those approved and shipped and those treatments to happen. So I think we're now thankfully through that part of that process. But having said that, you know, you kind of get there in June and then on July 1, a very important milestone but one that does shift years for us a bit is the permanent J code being established. So it made that progress. You got those patients treated and you did that in the miscellaneous code environment and on July 1, obviously you have, it's not a full reset if you will, but there's a partial reset there around making sure those patients are getting access in the contracts and the prior authorization as well as the payment approvals are happening with that permanent J code now in place.

And so you got to start back over a little bit in that context and make it through and that's why we called out here on this call the potential for volatility around the IVXA and Corial Health results in the third quarter in particular as we reset that. But I'll finish this by addressing I think part of your question around the backlog. And you know, that along with the things that you heard Tom mention earlier in terms of the payer network, the progress we've had there, the site of care network and so on and so forth in terms of the foundations of our launch, we've been extremely encouraged by the sheer number of patients that are being put in to seek approval for IVXA.

It makes us, I'll call it very bullish around what this product can mean for us in the intermediate term. And the question becomes more about how do you, how quickly can you get from where we stand today to seeing these patients get approvals and access to treatment on a more rapid basis? Certainly, we make our way into 2027, that'll be our focus here. But the leading indicators are strong in terms of the number of patients that our providers are seeking access to, Epioxys and therapy for.

Yeah, absolutely. So that answer that question has very much to do with which side of care you're talking about. So there are clearly those institutions and groups who have the experience that are much more comfortable out of the gate with the buy and bill pathway. And you see them pretty much even in these early days bypassing the specialty pharmacy option.

I think as you get more into the broader community based practices, you can imagine that they lean a little bit more heavily, if not entirely on the specialty pharmacy option. Certainly again, in these early days, that does not mean that we don't believe over time. They won't shift some of their thinking around that versus the buy and bill pathway.

But it's a little early, you know, again, thinking about we just got the permanent J code here less than a month ago. And so from that standpoint, I think for them to have that confidence, they've got to start seeing consistent and recurring approvals, even through the SP pathway with individual payers before they're going to start thinking about whether they should buy and build that. So I think that'll be a part of the journey here over the next several years, but one we're prepared to support.

Well, I think first, it's important to remind ourselves that we're at the beginning of a pretty transformational product launch and it may be even more importantly a seismic shift to the standard of care. And when you think about what that means in terms of driving awareness and detection and access to treatment at a different level, that's obviously a large opportunity for cloud coasts and for our customers and most importantly their patients.

Whenever you build a market like that, you do so expecting competition. And you hope that that incremental competition comes in the form of responsible market participants who are going to invest in and hopefully help accelerate that shift in overall market growth. I think when we look at it sitting here today, we should be many, many years away from market share dynamics outweigh expansion and market growth as a key consideration.

The reality is that when you think about things like square lens, that's really not a competitive solution. These patients often will have square lens. Even after therapy, the point is that you've stabilized and arrested the progression of a site threatening disease. And so from that standpoint, I think the fact that you've got a solution that doesn't require removing the epithelium lowers the bar for patients or for providers to act more prophylactically in the treatment of the disease and put square lens where it should be, which is postoperatively a part of continuing that vision as you move forward after a cross-linking procedure. So I think that Epioxa helps us in that broader initiative in terms of solidifying cross-linking as a therapy of choice.

And I think ultimately we provide the investment to meaningfully change, you know, we've talked before about the difference between eating to 20,000 eyes where we ultimately believe the market could be as high as 50 or 100,000 annual eyes at any given year that's potentially addressable. But we've got to go do the work to build that market the hard way and prove that to ourselves and to you all.

And I'll add on to what Joe's saying, this is Tom, and we spend lots of time and effort building new marketplaces. So you can imagine we spend considerable time figuring out how to protect our market share and how to grow these marketplaces over time. And so it's important to point out not only how much progress we'll make with Epioxa in the near term, but we already have a second or we call it how a third generation customize topographically guided island therapy that's going to begin clinical trials in 2027. And if that product performs as well as I think it will and can, we could have a product that has demonstrably greater reductions in K-Max that even what we're seeing with the current methodologies and a preferential treatment of the peaks to allow us to create the ultimate kind of sphere in refractive indices that may be able to throw off even better best corrected visual cues.

So you can imagine not only would any competitor have to deal with a really formidable commercial team that Joe has put together, but we'll have to then have to deal with a demonstrably possibly far better approach that we will have just in the near term. So you can imagine in our contemplation, if we spent the time and effort to build this marketplace, we will spend that time and effort to protect it as well.

I'll start if Tom wants to ask me, and I think it's really the re-administration work changes to be successful. Procedures get done. Obviously, it's still somewhat limited because these are really for some of our earliest commercial patients that are now getting the window where you see that, but where they're eligible, we're seeing them get done and get done successfully.

I don't see anything there in the context of cannibalization. I see that as additive in terms of the physicians and those patients determining that they want to stay on the therapy as the initial idose wears off. And if you think about in the context of idose rex, you know, in the future and the approvals there, I think that's only added in the context of that overall algorithm for getting those patients there because initially as well as during an administration procedure.

Okay, I want to thank all of you for your time and attention today. And thank you for your continued interest and support of glucose. Goodbye.