Glaukos Builds Dual Growth Engines Amid Market Headwinds

Glaukos Corporation GKOS continues to reshape the ophthalmology landscape, backed by a record-breaking first-half 2025 performance. The company posted revenues of $230.8 million, reflecting a 27.3% year-over-year increase, driven by the robust adoption of its groundbreaking iDose TR implant. Management also raised full-year revenue guidance from $475-$485 million to $480-$486 million, signaling confidence in its commercial momentum.The first half also validated Glaukos’ transition into a dual-growth engine business, with strong performance in both U.S. glaucoma and interventional glaucoma (IG) franchises. As the company accelerates investments behind its expanding product pipeline, Glaukos appears well-positioned to capture long-term value. However, reimbursement complexities and headwinds in legacy businesses remain watchpoints.Near-Term Growth DriversiDose TR Launch Gaining Traction: iDose TR generated ~$31 million in second-quarter sales, reflecting strong momentum since its U.S. launch. Surgeon adoption and utilization continue to expand, supported by positive clinical outcomes and growing reimbursement coverage across several Medicare Administrative Contractors (MACs). Over 80% of iDose volume in the quarter came from regions with established professional fee schedules, demonstrating how reimbursement progress accelerates uptake. Glaukos is scaling physician training, expanding market access, and investing in awareness, establishing iDose TR as a foundational therapy in glaucoma care and a major driver of revenue growth.Momentum in International Glaucoma and Interventional Platforms: International glaucoma revenues grew 20% year over year to $31.3 million, aided by scaling infrastructure and wider adoption of MIGS. The EU MDR clearance for iStent Infinite, covering all stages of open-angle glaucoma for both combo and stand-alone procedures, strengthens Glaukos’ interventional glaucoma (IG) strategy. The company plans a European launch at the ESCRS meeting in September. Globally, interventional glaucoma adoption continues to build momentum as physicians increasingly embrace proactive therapies like iDose TR and iStent Infinite, positioning Glaukos as a leader in driving the paradigm shift toward stand-alone glaucoma interventions.GKOS Sales & EPS Growth EstimateImage Source: Zacks Investment ResearchLong-Term Growth CatalystsRich Pipeline With Multiple Shots on Goal: Glaukos is advancing a diversified pipeline across five therapeutic platforms. Within glaucoma, pivotal trials are underway for iStent Infinite and PRESERFLO MicroShunt, while iDose TREX (next-generation) is in Phase IIb/III. In corneal health, Epioxa awaits FDA approval by October 2025, with Phase II trials ongoing for third-generation iLink. Retinal pipeline progress includes GLK-401 for wet AMD, now in first-in-human studies. The company is also developing an iLution therapy for Demodex blepharitis. This broad pipeline, coupled with the Mobius Therapeutics acquisition, offers Glaukos multiple opportunities to sustain long-term growth.Standalone Market Expansion: Glaukos is shaping a new stand-alone interventional glaucoma market, with iDose TR and iStent Infinite at the forefront. Physician adoption is increasingly shifting toward these therapies as long-term treatment strategies for “forever patients.” Management compares this opportunity to cataract surgery, envisioning millions of procedures annually over the next decade.Early evidence suggests that iDose TR is becoming the foundational therapy, complemented by iStent for progression management. As comprehensive ophthalmologists face declining cataract surgery reimbursement, stand-alone glaucoma therapies present both clinical value and economic sustainability, supporting Glaukos’ market-expansion thesis.Glaukos Corporation Price Glaukos Corporation price | Glaukos Corporation QuoteChallenges and WatchpointsReimbursement Complexities and LCD Headwinds: Glaukos continues to navigate reimbursement hurdles. The 5 MAC LCD restrictions, limiting the use of two MIGS devices in a procedure, remain a headwind through 2025. While iDose TR reimbursement is expanding, progress varies by region, with Novitas, Noridian and First Coast leading adoption. Proposed 2026 CMS rules would modestly raise facility fees but cut physician fees across ophthalmology, pressuring legacy MIGS economics. However, Category III stand-alone therapies like iDose TR and iStent Infinite remain unaffected. Glaukos is actively engaged in advocacy to mitigate reimbursement challenges and protect access to its innovations.Execution Risk in iDose Ramp: Despite strong adoption, scaling iDose TR carries execution risk. Utilization remains most robust in MAC regions with established professional fee schedules, leaving slower uptake in other geographies.While all MACs now pay J-codes, progress on professional fees at lagging MACs like Palmetto, WPS, and CGS remains uneven. Glaukos is methodically expanding surgeon training and patient access but must balance physician onboarding, payer education, and reimbursement variability to ensure a smooth national rollout. Sustaining momentum while addressing these geographic disparities is critical to unlocking the therapy’s full growth potential.Corneal Health Weakness: Corneal health posted $20.6 million in second-quarter sales, up just 4% year over year, with Photrexa revenues pressured by Medicaid Drug Rebate Program participation. Looking ahead, Glaukos expects disruption as the market transitions from Photrexa to Epioxa, pending its FDA approval in October 2025.While Epioxa offers a breakthrough, non-invasive option for keratoconus patients, management anticipates revenue softness during the switch as patients defer treatment in anticipation of the new therapy. This transition highlights both the near-term drag and long-term potential of Glaukos’ corneal health franchise.Competitive LandscapeThe iDose TR launch positions Glaukos ahead of peers in procedural glaucoma drug delivery, but competition remains fierce. Alcon ALC continues to deepen its presence in MIGS through the Hydrus Microstent. Johnson & Johnson JNJ leverages its global commercial muscle via the Xen Gel Stent. Meanwhile, Sight Sciences SGHT is actively defending its share in standalone MIGS procedures with Omni. ALC, JNJ and SGHT offer meaningful alternatives in the glaucoma treatment continuum, and their responses to iDose’s adoption curve will be a key factor in the competition.Meanwhile, GKOS has underperformed its rivals — ALC, JNJ and SGHT — in the MIGS space so far this year. Glaukos shares have declined 36.1% year to date, underperforming the industry’s decline of 8%. In the same period, J&J and Sight Sciences have risen 22.5% and 11.6%, respectively, and Alcon has declined 6%.Image Source: Zacks Investment ResearchHold GKOSGlaukos posted record second-quarter results, driven by accelerating adoption of iDose TR and strong international performance, affirming its leadership in reshaping glaucoma care. The company’s strategy of building a stand-alone interventional market positions it well for durable growth, particularly as it advances a diversified pipeline across glaucoma, corneal, and retinal platforms. However, reimbursement complexities — including LCD restrictions and pending professional fee finalizations at MACs — pose near-term friction, while execution risk around iDose ramp-up remains a critical factor. Corneal health continues to weigh on results as the business navigates a disruptive but strategically important transition to Epioxa.Overall, Glaukos’ robust innovation engine, expanding global footprint, and disciplined execution suggest that long-term opportunity outweighs near-term headwinds, though investor focus will remain on sustaining iDose momentum and securing smoother reimbursement pathways.The company currently carries a Zacks Rank #3 (Hold). You can see the complete list of today’s Zacks #1 Rank (Strong Buy) stocks here.5 Stocks Set to DoubleEach was handpicked by a Zacks expert as the favorite stock to gain +100% or more in the months ahead. 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