Welcome to the conference call to discuss Glaukos Corporation's acquisition of Avidro Inc. And the Q2 2019 financial results that each company released this afternoon. A copy of the company's press releases can be found on the company's respective websites. All lines have been placed on mute to prevent any background noise. After the speakers' remarks, there will be a question and answer session.
This call is being recorded and an archived replay will be available online in the Investor Relations section at www dotglaukos.comandwww.davidra.com. I would now like to turn the call over to Chris Lewis, Glaukos' Director of Investor Relations and Corporate Strategy and Development. Please go ahead.
Thank you, and good afternoon. Joining me today from Glaukos are President and CEO, Tom Burns CFO, Joe Gilliam and COO, Chris Calcutera and from Avidro, our President and CEO, Rosa Zadno and CFO, Tom Griffin. Following our prepared remarks, we'll open the call to questions. To ensure ample time and opportunity to address everyone's questions, we request that you limit yourself to one question and one follow-up. If you still have additional questions, you may get 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 are forward looking statements. These include statements about our plans, objectives, strategies and prospects regarding, among other things, our sales, our products, our pipeline technologies, our U. S. And international commercialization efforts, the efficacy of our current and future products, our competitive market position, financial condition and results of operations and the proposed acquisition transaction with Avidra. 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 and the proposed transaction, 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 looking statements. Review today's press releases and our recent SEC filings for more information about these risk factors. You'll find these documents in the Investors section of the company's respective websites. Comments we make today about the proposed acquisition transaction with Avitro do not constitute an offer to sell or the solicitation of an offer to buy any securities nor a solicitation of any vote with respect to the proposed transaction. Glaukos will be filing a registration statement on Form S-four with the SEC that will include a prospectus of Glaukos and a proxy statement of Avico.
Security holders are urged to read the proxy statement, prospectus and other relevant documents filed with the SEC when they become available because they contain important information. In addition, please note that Avidro, Glaukos and their respective directors and executive officers may be deemed to be participants in the solicitation of proxies from Avidro stockholders in connection with the proposed transaction. Information about Avidro's Directors and Executive Officers is included in its Form 10 ks filed with the SEC on March 21, 2019, and in its Form S-one registration statement filed with the SEC. Information about Glaukos' directors and executive officers is included in its definitive proxy statement filed with the SEC on April 17, 2019. Additional information about the participants and the solicitation of proxies will be contained in the proxy statement, prospectus and other relevant materials to be filed with the SEC regarding the proposed transaction.
Copies of these documents can be obtained for free on the SEC's website at www.sec.gov and in the manner provided in today's press releases regarding the transaction. With that, I will turn the call over to Glaukos' President and CEO, Tom Burns.
Good afternoon, and thank you for joining us. Today is truly an exciting day for Glaukos as we report record second quarter financial results and announce a definitive agreement whereby Glaukos will acquire Veedro in an all stock transaction. Based on our closing stock price today, the deal values Avidro at approximately $26.68 per share or a total transaction value of $500,000,000 This transaction pairs 2 highly complementary high grade pharma and device organizations combining Avidro's disruptive bioactivated pharmaceutical solutions and R and D capabilities with Broadridge's global commercial scale, proven market building and shared reimbursement expertise, robust pharmaceutical and medical device R and D capabilities and extensive clinical and regulatory infrastructure. By leveraging our core strengths, we see tremendous opportunity to accelerate Avidro's growth potential and pipeline programs, while also strengthening our own R and D expertise to propel organic development programs forward. Avidro is an ideal strategic fit for Glaukos as evidenced by the striking similarities between our 2 companies.
We are both transforming ophthalmic's treatment paradigm and timing an entirely new market. Like Glaukos, Avidra was first to market with novel solutions backed by a considerable body of compelling clinical data. And like Glaukos, Avidro has secured favorable reimbursement and developed a market expanding pipeline to extend its leadership revenue feature. Importantly, a majority of Avidro's target accounts are already Glaukos customers, which will enable us to use our reaching scale to accelerate utilization of Avidro's pharmaceutical solutions. By virtually every measure, we believe Glaukos is uniquely qualified to fuel Avidro's momentum, creating a durable synergistic global health franchise that should serve as a powerful growth engine capable of delivering near and long term shareholder value and helping to transform DOCOS into a global pharma and device ophthalmic leader.
We will discuss the key factors that attracted us to Medidro as well as our future clients in more detail shortly. But first, I'll ask Reza to make a few remarks. Reza?
Thanks, Tom. I, too, would like to express my excitement about Avidio becoming part of the Glaukos organization and the significant value we believe the transaction creates for all of our stakeholders. We are proud to be pioneering new treatment options for patients with corneal disease and those seeking to improve their eyesight using a single application of bioactivated topical abdominal pharmaceuticals. Our initial commercial product offering, the Fortrexa Bioactivated Topical Solution, is the 1st and only FDA approved treatment for patients suffering from progressive keratoconus, a site threatening corneal disease characterized by progressive thinning and weakening of the cornea, ultimately resulting in vision loss if untreated. I have long admired Glaukos and the manner in which the organization forged a new path to establish Meats.
I believe their existing infrastructure, relevant customer relationships and their proven strength in pioneering viable new ophthalmic market with disruptive technology that address important unmet clinical needs of practitioners and patients make Glaukos the perfect partner to help execute on our current and future business opportunities. Our Board carefully and thoroughly reviewed the strategic and financial benefits of this opportunity and has agreed in its view that this transaction represents a compelling opportunity for shareholders, patients, providers and employees. I'm more certain than ever that Aviso's best days are ahead. With that, I'll turn the call back over to Tim.
Well, thanks so much, Reza, and we certainly look forward to welcoming you and your team to Glaukos. We've been carefully evaluating our core capabilities and long term growth strategies for some time with the fundamental strength of our base business, continued execution and the culmination of the complete glaucoma pipeline we have created to address all stages of disease severity, I'm confident that the time is right to implement this next major phase of our long term growth strategy. Consider our key accomplishments this quarter. 1, we delivered record 2nd quarter net sales of $58,600,000 up 36% versus the year ago quarter, allowing us to increase our full year 2019 revenue guidance to $226,000,000 to $231,000,000 2, we progressed on the U. S.
Commercial rollout of our generation iStent inject trabecular micro bypass device. Thanks to our team's solid execution, we have made considerable progress on the initial conversion process and our U. S. Reps are beginning to shift focus back to driving utilization and training new surgeons who have yet to adopt Menace. Surgeons' feedback and real world results remain very positive and give us high confidence in iSpent injects potential to fuel meaningful U.
S. Sales going forward. 3, we drove robust international growth of 53% year over year as we continue to see the benefits of the international investments we've made over the past several years. 4, we advanced our industry leading proprietary glaucoma pipeline that now addresses the full range of disease states and progression. 5, we continue to expand and strengthen our pharmaceutical R and D capabilities to advance more than 10 internal preclinical initiatives across glaucoma, corneal health and retina.
And 6, we executed financially, not only with continued revenue growth and outperformance, but also with strong gross margins, disciplined operating investments and positive net cash flow. With respect to our existing glaucoma Pharmaceutical and Surgical pipeline, we continue to execute according to our plan. Our iDose Travelprops Phase 3 trial is progressing on schedule, bringing us breakthrough technology closer to becoming a reality for the benefit of patients by addressing the ubiquitous problem of non compliance with topical glaucoma meds. We continue to target a filing of an FDA approval in late 2021 to 2022. We're encouraged about the early progress in our collaboration with the investor now, a potential ROCK inhibitor to further leverage our iDose platform.
On the surgical side, enrollment is on track in the standalone iStent infinite 510 clinical trial in support of filing an FDA approval in late 2020 to 2021. For iStent Supra, Supra will recently lock the full pivotal data set and will be evaluating the final data as it is received in the coming months. We'll then determine the most appropriate path forward for this product. And in addition, we are in early preparations for the potential U. S.
Commercial launch of Santen Pharmaceuticals MicroShunt AbEx terminal surgical implant device, assuming FDA approval in 2020. The MicroShunt is not only a compelling treatment alternative to late stage glaucoma management, but also marks the capstone through our glaucoma treatment algorithm. We are poised to deliver a truly comprehensive portfolio of microinvasive surgical devices and sustained pharmaceutical therapies capable of providing an optimized treatment solution at each stage of glaucoma disease state severity and the earliest manifestations to the most severe and of both cabocatternic and standalone procedures. We believe our glaucoma pipeline platforms, if approved, will create a 7 fold increase in our U. S.
Opportunity, expanding our reach to over 4,000,000 eyes during the next several years. We're delighted with the current performance of our glaucoma business and its potential to deliver long term growth. While it probably comes as no surprise to many of you that we've had long aspirations beyond glaucoma, and for the past few years, we've been shaping a broader growth strategy that would allow us to apply our core competencies to tackle some of ophthalmology's most challenging unmet clinical needs. As a result of this work, we've identified multiple opportunities in retinal disease and clinical health where chronic conditions affect large patient populations and conventional treatment options have significant shortcomings. Our strategy is to build 2 new disruptive and durable franchises, retinal disease and cornea health, following a similar blueprint that brought success with our growth hormone business.
Our focus is on supportive long term growth. Our expansion plans have been carefully conceived and are based on our seasoned ophthalmic experience across multiple disciplines. We believe this growth strategy can generate further potential risk adjusted value creation as our addressable opportunities dramatically expand from $13,000,000,000 in glaucoma to roughly $54,000,000,000 cumulatively. Over the past several months, our strategy has started to take shape as we advance promising organic programs and broaden our pipeline opportunities. First, let's talk more about iDose, one of our most important organic programs.
In addition to the Phase 2 clinical trial progress I referenced earlier, we are continuing to follow iDose Phase II treated study subjects through 3 years. Based on late breaking readout, follow-up data at 2 years, this is for the 4th cohort, continue to demonstrate favorable iDose performance and durability. For competitive agreements, we have no current plan to publicly share this data. And of course, the Phase 2 clinical results will be the principal determinant of iDose's success. However, we are extremely encouraged by the Phase 2b follow-up and what it tells us about the commercial viability of iDose.
In addition, I'm excited to announce today that we are in late stage development with finalized designs for next generation iDose extended release implants that in a similar size and form factor to the original iDose are designed to provide nearly twice the drug capacity to extend efficacy durations even longer. Next, let's talk about retina. With the recent acquisition of dose medical, we've established a foundation for our future retinal disease franchise. Our new retinal R and D program includes multiple microinvasive, bioavailable, sustained release drug delivery platforms that are designed to be used in the treatment of various retinal diseases, including age related macular degeneration and diabetic macular edema. This program's primary goal is to develop treatment options capable of a meaningfully longer duration of effect than is available with current standard of care.
We believe a longer lasting approach with the potential to not only significantly reduce the treatment burden, but also potentially improve treatment efficacy could prove disruptive within these large categories. On the Colonial Health front, we recently entered into a global licensing agreement with Intratus, giving us a global exclusive license to develop and commercialize the patented transdermal drug delivery platform designed for treatment of dry eye disease, glaucoma and other chronic disorders such as allergy, blepharitis, conjunctivitis and related conditions. Intraris' patented cream based drug formulations are applied to the outer surface of the eyelid for transdermal delivery of pharmaceously active compounds to treat eye disorders. Early human studies of this novel delivery system have demonstrated efficacy while limiting the side effects often associated with drugs delivered as topical eye drops. Entralis' lead candidate will be for the treatment of dry eye disease with potential future applications for other corneal disorders and glaucoma.
This agreement has a novel platform to several organic cornea health ongoing issues we already have in place. But of course, the centerpiece of our new corneal health franchise is intended to be Avidra, where their team has made tremendous early progress as evidenced by revenue growth of 66% through the first half of twenty nineteen compared to the same period in 2018. Since receiving FDA approval for the VITREXZA Ophthalmic Solution in April 2016 and commercially launching in September 2016, Avinja has secured more than 300 active U. S. Customer sites and its drug formulations have been used in over 25,000 treatments.
There are now more than 130 peer reviewed publications supporting the performance of Avidra solutions. On the reimbursement front, Avedra obtained a product specific J code for Protexer that became effective in January 2019 and has secured broad coverage for nearly all national commercial payers, facilitating access to approximately 95% of commercially covered lives. Moreover, like La Crosse, Cintra has shown a commitment to innovation with a robust portfolio of next generation and new pipeline products that have the potential to significantly expand its addressable opportunity. Even though kericosis is a serious site threatening disease and a leading cause of full thickness corneal transplant in the United States, it remains vastly untreated. This is due primarily to under diagnosis and underwhelming conventional treatment options such as eyeglasses or contact lenses that attempt to provide some symptom relief, but do not slow the progression of the disease.
Literature estimates that as many as 20% of Kerikomi's patients ultimately require a corneal transplant, a costly and invasive procedure with high failure rates. In fact, literature suggests that 72% of corneal grafts fail within 20 years and 98% fail within 30 years. Sadly, if the disease onset is often diagnosed in teenage years, keratoconus patients may require multiple transplants over the limb's lifetime. Avigio spiltrexa is the first ever bioactivated ophthalmic pharmaceutical therapy and unlike antiquated approaches is the 1st and only treatment option approved by the FDA to actually slow or halt the progression of the disease. While adoption remains in the early stages, we believe there are tremendous opportunities to drive meaningful penetration and realize exceptional growth in this underpenetrated opportunity.
Galco Synodino are similar hybrid organizations. And as I said at the top of the call, there are pronounced similarities that underpin the transaction strategic benefits. By virtually every measure, Glaukos is uniquely qualified to leverage its expertise establishing mix in order to build a Veedro into a durable global health franchise capable of delivering nearing long term sustainable growth. Now let's talk more about the strategic benefits this transaction will provide. 1st, Avidro fits perfectly with our commercial organization.
We plan to leverage our global commercial infrastructure and establish sales, marketing and market access teams to accelerate the market awareness, development and adoption for Avidro's novel solutions. More than 700 of Avidro's 1100 U. S. Targeted accounts are comprehensive ophthalmology practices where Broadfoot maintains strong existing relationships. This represents an immediate opportunity to leverage our relationships in these accounts to grow the awareness about cirrhiconus, capture physician mind share, drive new adoption and increase OTREXZA utilization.
The addition of more than 75 Glaukos sales professionals will dramatically expand the field presence, sales reach and coverage of Avidro's current 17 person U. S. Sales organization. Our sales professionals have established partner like relationships through years of working with physicians and their office staff in areas such as training, patient screening, new technology practice integration and consumer engagement. Following closing of this transaction, we plan to utilize our entire sales force on day 1 and over time expand a newly created Corninga Health specialty sales force to accelerate commercialization.
This will also establish a commercial foundation in corneal health for future product launches. We will also utilize our powerful customer and experienced in coverage, coding, contracting, claims processing and payment processes. We plan to deploy our extensive market access capabilities to bolster Avidro's payer and provider education and patient support initiatives to help drive more consistent and reliable commercial reimbursement for VITROS customers and patients. Internationally, Vaukos' established direct sales infrastructure in 16 international markets will be deployed with local leadership, distributor management and reimbursement. Finally, we plan to accelerate our combined investment in the optometrist referral channel.
The combined entity will have additional resources to further awareness in this important community, optimizing relationships and improving patient care. 2nd, the acquisition of Avidro can significantly accelerate our revenue growth trajectory as a synergistic cornerstone of our new In the U. S, keratoconus disease affects roughly 1,900,000 eyes, representing a large and relatively untapped opportunity of $3,000,000,000 In addition, Avidro's pipeline programs for refractive indications could expand this addressable market opportunity by over $23,000,000,000 Avidra delivered 66% revenue growth through the first half of twenty nineteen compared to the same period in 2018 and anticipates 2019 revenues of $38,000,000 to 41,000,000 dollars We believe that the addition of Avidro's fast growing product portfolio will increase Barcos' revenue growth rate in 2020. We also believe the combined organization's global sales force and reimbursement scale can potentially drive revenue synergies, further accelerating revenue growth trajectory for the combined organization beginning in 2021. 3rd, the addition of Avidro further solidifies our unique hybrid pharmaceutical phone device strategy.
Both companies have a uniquely similar hybrid pharma and device profile that should allow for a seamless integration and future organizational success. One example of this is Avidra's successful achievement of a combination prophy and J code therapy reimbursement. This will be an important area of expertise to leverage as we embark on similar reimbursement pathways for our future products, including iDose. 4th, the respective organizations will combine to strengthen our company's organic programs, initiatives and R and D capabilities. This includes what will be a highly complementary hybrid technology and pharmaceutical organization with expanded core competencies in device, optical and software engineering, analytical chemistry, applied research and drug delivery innovation.
These expanded pharmaceutical R and D capabilities will help fortify advance our promising internal preclinical clinical R and D programs. In addition, the combination will allow Glaukos to deploy its extensive clinical research infrastructure and global regulatory expertise that in total includes more than 75 professionals and over 100 active clinical investigator sites to advance Avidro's pipeline programs. We believe our track record and expertise in bringing new innovations the market can help strengthen and advance Aviso's rich pipeline of new next generation products that could accelerate adoption and significantly expand its addressable opportunity over time. 5th, we believe the transaction is attractive financially and will create meaningful shareholder value for all stakeholders. In addition to our expectation for this transaction to accelerate Glaukos' revenue growth rate in 2020, we expect this combination will generate annualized cost saving synergies of at least $15,000,000 and be accretive to operating results and cash flow by 2021.
As we look forward from here, Avitro's commitment to innovation is evident in its healthy market expanding portfolio of next generation and new pipeline products. The first of these is a next generation bioactivated pharmaceutical solution for progressive keratoconus known as Epione therapy, which is designed to shorten treatment times and improve patient comfort versus the 1st generation at the off therapy. Avigil completed the patient enrollment for its Phase II pivotal clinical trial in May of 2019 and is targeting data in the second half of twenty twenty with FDA approval expected in late 2021 to 2022 time period. Beyond the $3,000,000,000 US cured to Columbus market opportunity, Avidra is leveraging its platform solutions to develop and pioneer novel single applications of bioactivated topical ophthalmic pharmaceuticals for refractive conditions such as presbyopia, low myopia and post cataract refractive error, which combined are estimated to have an addressable opportunity of approximately $23,000,000,000 in the United States. Avijo has commenced a Phase 2a multicenter clinical trial outside the United States to investigate the use of its novel bioactivated topical pharmaceutical solution to treat patients with presbyopia, a refractive disorder due to aging that affects over 50,000,000 people in the United States alone.
The results of the Phase IIa study are expected by the end of this year and will be used to optimize the therapeutic parameters for presbyopia and determine the appropriate US clinical and regulatory pathway. Putting this all together, we could not be more enthusiastic about this announcement and believe the acquisition of AVEVA will provide a significant growth engine for our company and create meaningful shareholder value in the years to come. So with that, I'll turn the call over to Joe to discuss the financial aspects of this transaction as well as our Q2 financial results. Joe?
Thanks, Tom. I'll first walk through the transaction terms and financial benefits, followed by a summary of our Q2 financial results. Under the terms of this agreement, Avidro will merge with a subsidiary of Glaukos in an all stock transaction. For every one shareholder or share of Veedro stockholders hold, they will receive an exchange ratio equivalent of 0.365 Glaukos shares, which implies a per share value of $26.68 and a total transaction value of approximately $500,000,000 based on Glaukos' closing share price on August 7, 2019. The transaction represents a premium of approximately 42% based on both companies' 60 day volume weighted average price.
Upon closing, Glatko's shareholders are expected to own approximately 85% of the combined company with Avidro shareholders owning the remaining 15%. As Tom highlighted earlier, we believe this transaction is financially compelling for us. Through the first half of twenty nineteen, the company has generated combined sales of 131,700,000 an increase of 39% compared to the same period in 2018. As we look forward and as Tom discussed, we expect Avidro to increase our revenue growth rate in 2020 and we expect to realize revenue synergies that could further accelerate pro form a revenue growth beginning in 2021. The transaction is expected to generate annualized cost savings of at least $15,000,000 through reducing public company and administrative costs and is expected to be accretive to operating results and cash flow by 2021.
The transaction is expected to close in the Q4 of 2019, subject to the satisfaction of customary closing conditions, including Hart Scott Rodino plans and the approval of Avidro shareholders. Now let's discuss our Q2 financial results. As noted earlier, net sales for the Q2 of 2019 were $58,600,000 a year over year increase of 36%. The U. S.
Represented 82% of our sales in the quarter and international 18%. In the U. S, Q2 2019 sales were $48,100,000 up 32% from the same period a year ago. U. S.
Sales in the quarter primarily benefited from continued market growth, the launch of Istent inject and the competitive market developments that occurred late in Q3 of 2018. Outside the U. S, 2nd quarter sales were $10,500,000 an increase of 53% from the same period a year ago or 64% on a constant currency basis. Our international business continued to outperform expectations driven by broad based growth, including in the UK, where 2nd quarter performance was stronger than expected, even though we continue to expect recent reimbursement cuts there may create future headwinds. Our gross margin in the 2nd quarter was 86.6% versus 85.7% in the same quarter in 2018.
Gross margins benefited from elevated iStent inject production levels associated with the U. S. Launch and initial inventory build. We continue to expect our core gross margins to remain in the mid-80s percent range going forward. SG and A expenses in the 2nd quarter rose 31% to $37,700,000 versus $28,600,000 in the year ago quarter.
This rise reflects higher personnel and other costs related to the ongoing expansion of our domestic and global infrastructure, investments associated with the iStent inject launch, professional fees associated with legal services and approximately $3,000,000 of global enterprise systems implementation expenses. R and D expenses rose 35% in the 2nd quarter to 17,100,000 dollars versus $12,600,000 in the same year ago period. And we also incurred a $2,200,000 in process R and D charge associated with the acquisition of Dose Medical. The rise in R and D expenses reflects primarily the cost of additional personnel as we expand our pharmaceutical R and D capabilities and within clinical research where in particular the direct costs associated with the iDose trial enrollment continues to increase. We expect the transactions involving Dose and Etradis to add as much as $5,000,000 of R and D expense in the second half of twenty nineteen.
We finished the second quarter with a net loss of $6,300,000 or $0.17 per diluted share compared to a net loss of $5,400,000 or $0.15 per diluted share in the Q2 of 2018. As of June 30, 2019, we had cash, cash equivalents, short term investments and restricted cash of $159,200,000 compared to $120,100,000 at the end of the Q2 of 2018 and $149,300,000 at the end of 2018. We now expect capital expenditures for 2019 of $5,000,000 to $10,000,000 given our decision to expense the costs associated with our global enterprise systems implementation and updated timing estimates for our new headquarters development. We are updating our 2019 net sales guidance to $226,000,000 to $231,000,000 compared to $225,000,000 to $230,000,000 previously. This guidance outlook takes into account the 2019 considerations we outlined in prior calls, including our expectations for organic growth, the MIGS market landscape and competitive dynamics, the new doctor training dynamics associated with our inject launch and the expansion of our international sales, which we now expect to be in the range of $38,000,000 to $40,000,000 for the full year based on current foreign exchange rates compared to our previous range of $37,000,000 to 39,000,000 Please note, this revised guidance does not include any assumed contribution from Avidro.
And with that, I'll turn the call over to Tom Griffin for a review of Avidro's 2nd quarter financial results.
Thanks, Joe. For the second quarter of 2019, Avedro revenue grew 63 percent to $10,300,000 compared to $6,300,000 in the Q2 of 2018. Worldwide drug revenue accounted for approximately 88% of our total revenue for the Q2 of 2019, and revenue from the United States accounted for approximately 80% of the total revenue in the Q2 of 2019. A $4,200,000 increase in U. S.
Revenue drove the growth, primarily from a $4,300,000 increase in drug revenue, driven by expanding average revenue per unit and volume of drug formulations sold. The utilization rate strengthened in the Q2 of 2019 to 2.81 for TREXA treatments per account site per month compared to 2.1 in the Q2 of 2018. As of June 30, 2019, we have 332 active centers in the United States, which we estimate is a 30% penetration into our 1100 target centers. We now expect 2019 revenues to be in the range of $38,000,000 to 41,000,000 compared to our previous range of $37,000,000 to $40,000,000 Our upwardly revised outlook implies anticipated annual growth of 43% at the midpoint of the range. I'll now turn things back to Tom for a few closing remarks.
Okay. Thanks, Tom. So I'll wrap up by reminding you that our goal at Glaukos is to build durable, disruptive franchises in large and growing markets where we can leverage our core competencies in microscale surgical, sustained pharmaceutical and hybrid platforms across glaucoma, corneal health and retinal disease. The acquisition of Avidro combined with our promising organic initiatives and other strategic expansion plans create a hybrid pharma and device ophthalmic leader, which we believe is ideally positioned to deliver sustainable long term growth and create meaningful shareholder value for years to come. I could not be more enthusiastic about the future of Glaukos as we embark on our aspirational mission to transform ophthalmology.
By turning the call over for questions, I want to express my deep appreciation for Avidro's talented and dedicated employees. We look forward to working closely with them to plan the integration and ensure a seamless combination. So with that, I'll open the call to questions. Operator?
Your first question comes from Robbie Marcus with JPMorgan. Your line is open.
Hi, this is actually Alan on for Ravi. I guess one question is kind of on that 15,000,000 dollars Part of the rationale for the deal really is the cross selling opportunity, right? So I guess just when it comes to generating that $15,000,000 in 2021, where is that going to come from?
Hi, Alan, it's Joe. Thanks for the question. So with respect to the $15,000,000 you're absolutely right in the way you asked the question. I mean, this is ultimately about our ability to achieve the channel synergies and drive revenue growth, especially as we get towards 2021. On the cost savings, in particular, it really comes primarily from public company costs as well as what you'd expect on the sort of administrative side.
And given the current size of Avidro, there's a lot of things that they continue to do that rely on 3rd party consultants and expenses associated with that, that we believe ultimately we can do in house here with our existing infrastructure at Glaukos.
Got it. And then I guess when just moving on to guidance. So it looks like
you guys raised it a
little bit. But given you already raised guidance a little bit conservatively on the Q1 call, I know you said that UK was a little bit stronger this quarter. But looking into the back half, right, like what's kind of like keeping you guys a little bit, I guess, a little less a little more conservative on the guidance front? Like what still concerns you there?
Yes, sure, Alan. It's Joe again. I'll break that down between the United States and the international markets. Internationally, it quite frankly is sort of what we said on the Q1 call. While in the Q2, the U.
K. Actually performed quite well, the cuts did happen in April and we do know that over time that's going to be a headwind to that market in particular, even though it wasn't as much of a headwind in the Q2 as we anticipated. So I think as we continue to play our way through, the UK situation, we want to make sure that we're appropriately capturing that and are thinking about international guidance. In the U. S, we usually talk about a series of topics in the dynamics around the trends associated with our U.
S. Business. And what I'll say sort of simply is, all the trends that were we saw in the Q1 really continued in the 2nd quarter with very little change, if you will. But having said that, in the context of competitive trying and trialing, we continue to expect to see it and we continue to expect to see some growth in it. And so, I think as we think about the setup the second half, we want to continue to be cautious about what that could mean for our U.
S. Business, even though, to your point, thus far in the first half, we've been delighted with the results we've seen.
Got it. And then sorry, just one more. When it comes to Avidro, do you think it can help with kind of a halo effect of injecting iDose, does that give you like a better presence in the office since you have such a differentiated asset starting in Q4? Thanks.
Well, I'll answer that. This is Tom. And I think it does have an appreciable effect. And we will be entering into a paradigm changing new pharmaceutical ingredient into the offices where really as we think about it, of the current 1100 targeted accounts that AZEDRA is approaching, we are already actively addressing 700 of them. So we have intimate relationships with really the vast majority of the targeted accounts and with something that is such a paradigm changing solution that can help such an underserved marketplace.
Of course, I think it's going to add value with our representatives entering into these practices.
Your next question comes from Larry Biegelsen with Wells Fargo. Your line is open.
Thanks for taking the question. Congrats on the deal. Tom, 1 on Avigro, Joe, 1 on the guidance. So Tom, why is this the right time for this deal given your strong pipeline? I'm sure you've known Avidro for a long time.
So why is this the right time?
Yes. Thanks, Larry. Great question. So we believe that the opportunity and the timing of this transaction are a deal at this time to fortify our long term growth potential. So both companies have just come off record 2nd quarter revenues, and we're both really strongly positioned in our respective marketplaces.
And Glaukos really has just completed its treatment algorithm in glaucoma, which is designed to really give us sustained commercial growth and sustained competitive advantage well into the mid-2020s and beyond. So with the Capstone agreement with Santen, we've now capped off a full portfolio of products that treat glaucoma from its most incipient stages to late stage treatment. So it's incumbent upon me to look for long term growth potential and we believe we have the opportunity to build powerful commercial franchises within this corneal commercial class, just like we've done in glaucoma. The characteristics of the class, a vastly underserved market are very, very similar to what we did with MIGS. And Avidro is an ideal partner.
If you think about it, Avidro has a paradigm changing technology. It already has very, very strong foundational clinical data. It establishes J code and a solid reimbursement foundation. It's the first to market in this vastly underserved embryonic marketplace. And it's be able to address with really a palpable new product to address these unmet clinical needs.
And I would say that the transaction really placed our strengths in 2 major ways. 1, we believe we're very good at disrupting and creating new marketplaces. So I would argue that just what we've done in glaucoma by setting up this template in this portfolio that gives us such a sustained quality competitive advantage, it's a challenge and an opportunity for us to do this within Corning as well. And we are we have every intention to do so. And then secondly, Larry, if you think about the commercial fit within the organization, it is enviable.
We'll have 700 to 1100 accounts that are currently targeted, we already call on. So we'll have kind of a very, very modest change in bandwidth for our commercial organization. And if you think about it, what Avigil has been able to accomplish with 17 representatives now with the new math, we'll have nearly 5 times the mass and muscle and commercial sales representatives in the marketplace. And so for all these reasons, it is the right opportunity, it is the right time and it's why we're striking now.
Perfect. And then just one follow-up for Joe. Just the cadence of growth in Q3 and Q4 for standalone Galakos given that the comps get tougher in Q4. And Joe, the midpoint of the second half guidance implies growth of about 18%. Is there any read through there?
How should we think about maybe puts and takes for 2020 as we kind of update our models here? Thanks for taking the question.
Sure. Thanks, Larry. Let's think about this for 2019. Obviously, as we think about the remainder of the year, you have to remember first the seasonality that we tend to experience, right? And as we've said in the past, Q1 can be 22%, 23% of our overall business.
The Q2, Q3 tends to be about 25% of the year each and Q4 tends to be somewhere in the 27% to 28% zip code. I think that's the most important determinant when you think about the setup for the overall year. Obviously, we've had a variety of puts and takes, but as we look at it, I think it actually should land us back in a place that looks somewhat like that typical seasonality. When you think about the implied growth in the second half, obviously, you've got comparability to the second half of twenty eighteen. And as everyone on this call knows, the recall associated with CyPass happened really as we went into September.
So the tail end of the Q3 of last year and the Q4 really had a full run rate of that bypass recapture in it and that will temper the year over year growth percentage as we think about the Q4.
That's helpful, Joe. Any just color on puts and takes for 2020, given that 18% implied second half growth that I'll drop? Thank you. Yes.
No, I mean, I think, look, when we think about 2020 and we'll obviously get to that when we get to our Q4 call and the guidance there, but I think it continues to be all about execution, about the addition of new surgeons as our sales force gets back to bringing in new doctors more so than converting the existing physician base and utilizing a benefit of that. I think it's about the expansion of same store sales that we've talked about that we believe comes with the conversion to iStent inject and getting a full year benefit of that. And then of course, as Tom mentioned, depending upon the timing of the Santen product hitting, we could potentially have some benefit from Santen in 2020 as well. But we'll obviously dial that in as we know the timing or more on the timing associated with that product.
Thanks for taking the questions guys.
Thanks, Larry. Thanks, Larry.
Your next question comes from Brian Weinstein with William Blair. Your line is open.
Hey, guys. Thanks for taking the question. Going back to the revenue synergy discussion, it seems pretty obvious that there is a good strategic fit here. You talk about revenue synergy in 2021 beyond. Why would you not be able to see anything sooner than that?
It would seem that maybe plug and play isn't quite the word to use here, but pretty close to that. Thanks.
Yes. Thanks, Brian. It's Joe, and Tom or Chris can add on here. I think the way to think about it is, it takes a little bit of time to actually organizationally make all this stuff happen. So while we will be putting our full sales force behind this day 1, we know from deals like this, sometimes there can be disruption, right, that happens during that time as well.
And so, I think we want to make sure that we've got and we're setting expectations, that we think about 2020 as potentially having some puts and takes, right, as we navigate that. And that we're confident by time you turn the corner to 2021, you should start to see the benefit of this combination in the context of the ability to grow above what the expectations would be on a standalone
basis. And I would just add and say, Abidro has done a wonderful job getting the J code and putting into place commercial payer coverage to see how well defined they are and how much commercial payer coverage they have. But there's always a hangover, right, with doctors who express some skepticism that, that coverage and payment is available. So that takes some there's a little bit of a Missouri show me state that's going on, and Reza can add to this as he deems fit within the commercial organization. It takes a little while to overcome.
And can't imagine a better combined company than us in the future to be able to attack that and to make payment a routine part of the use of Votrexa in the marketplace. But it will take some time.
Yes. Dufa, I'm going to add that I agree with what Tom is saying. We definitely have now more than 95% coverage. And for Trexa, there is a J code for that. All nationals are covering it.
All most regional insurance are covering. There are few regionals left. So those are still we need to work with them. Again, that's why we still, as Tom mentioned, still need some support for accounts to for those regional insurance to pay this consistently.
Okay. And then not sure if Efresa or Tom, you guys want to which one you want to address this, but just to kind of educate those of us that are going to be coming up to speed quickly on Avedro here. Can you just talk about the pharma pipeline that Avedro has, kind of where the company is in their various processes and how you guys think that the 2 organizations together can actually help accelerate R and D in commercial? Well, we talked about commercialization, but just I guess how you guys can jointly accelerate the R and D on both sides of the house? Thank you.
Thanks, Brian. I guess I'll ask Reza, who's been so prominent in bringing this fulsome pipeline into reality to address the first part of the question. And then I'll try to address how as a combined business we can accelerate and move that forward. So Reza?
Yes. So the first product that we received FDA approval was the Fotrexa. That's the only FDA approved for the treatment of progressive keratoconus. We just, as Tom mentioned, completed the enrollment of a clinical study for the next generation treatment with a new drug, Epione. The enrollment of that is complete, and we are in the 1 year follow-up on that.
And then separately, the Phase IIa is different. For every application, we have a system, activation system and its own corresponding drug. So these are the 2 studies currently in the clinic.
And as far as the combined business, if you think about it, already, the Avidro has shown really strong prowess in creating using both optical and scanning boxes in order to bio activate these pharmaceutical compounds and transform them on the surface of the eye. It's really quite an amazing accomplishment of what they've done. But I think when we put them and combine them with now the greater than 30, scientists, engineers, biochemists that we've been able to recruit from Allergan and other major companies, I can't help but think we're going to add substantial intellectual capability to what we'll be able to create as a combined company. And then the clinical side, you can imagine as a small company, typically, you have a Spartan clinical group as you look to husband resources and get the highest returns. And I think when we combine the Avidro's clinical group with our substantial clinical and regulatory infrastructure, I'm very, very encouraged to see how quickly we can attack both clinical recruitment and maybe bring these products to fruition and to approval in a more expedited fashion.
Your next question comes from Matthew O'Brien with Piper Jaffray. Your line is open.
Good afternoon. Thanks for taking the question. Just one quick house keeping one. Joe, what kind of collar do you have on this transaction?
This transaction actually does not have a collar attached to it.
Okay. And then, Tom, forgive me for being blunt here with this question, but I think people are going to look at what's going on today with the in process R and D charge. They're talking more about iDose extended release now, which is a newer thing for you. They're doing a vidro as well on top of that, which is has a lot of products in the pipeline. So I think what people are going to assume here is that something's wrong in the pipeline with traditional iDose as you have presented it or with INFINIT or something else along those lines.
So what can you offer up to make us all confident that there's not some other issue with the pipeline that's causing you to do this Avidro deal or something with the core business that's causing you to do this Avidro deal as you're lapping tough comps in the next year, etcetera?
Well, I guess what I would say, if we're accused of anything, we'd be accused of great ambition, okay? And if you look at my career, this is not anything new. In all the roles that I've had within several companies, I will certainly test and challenge organizations to move forward in expedited fashion to create growth in as many areas as I can conceive, and I think that will benefit shareholders. And so I want to address something that I can't approve or disprove that kind of perception. But what I can tell you is that if you think about the logic behind a company now that has really rung the bell within glaucoma, has a full sum dedicated pipeline that treats all stages from incipient glaucoma to late stage glaucoma, carries through with commercial value into the 2020s and beyond.
I think it's time for us to be able to look beyond into another growth area where we may be able to recreate this opportunity and recreate really prominent shareholder value. And so that's how I'd answer the question.
Okay. Fair enough. And then maybe something that's a little bit softer. Just the Santen deal, you guys haven't put a lot of air bars around what that's going to look like from a contribution perspective in 2020 or beyond. Can you talk a little bit about that?
And then also on the international side, it was really strong again this quarter. Just any color there would be helpful. Thanks.
Thanks, Matt. Thanks for saving the softer question for me. So on the Santen side, we really have to work with our partner before we can share much more. So what we've said there, quite frankly, is let us get through them having submitted and where we can talk more about potential timelines and coordinate with them around what we will and won't say publicly around the economics of that transaction. All I can say sitting here now is what they've said, which is they expect a filing in 2019 and approval and commercialization in 2020, and we're preparing accordingly alongside them.
Regarding international, in the international performance there, we really we couldn't be more pleased. Continue to see another quarter of broad based growth, reported at 53%, constant currency at 64%. It was across the globe. Our usual stalwart markets contributed meaningfully. Newer markets like Japan and France contributed meaningfully.
And perhaps the surprise for us relative to the setup going in, as I mentioned in the prepared remarks, was that the UK held in there much, much more robustly than we anticipated coming into the quarter. So that's really kind of where we sit today from an international perspective.
And one more thing I'll add, Matt, is if you think about when you talked about the strength of our portfolio, I think you heard in the prepared remarks that we now have this weight breaking readout. We have this view of the Phase IIb data now out to 2 years. This is new. This is the first time I'm reporting it publicly and the data shows durable, durable reductions in intraocular pressure and reductions in medication burden. This is exciting, and this is something that should give investors even more confidence in the path and the route that we're choosing.
And then supplemental to that is the fact that we figured out how to have a form factor that can look and feel very close to the initial eye dose that holds nearly 2x the level of medication within its tiny vessel. And so if anything, I think people's confidence and strength and conviction should be buttressed by this call and by the pipeline that I'm asserting.
Very helpful. Thanks so much.
Your next question comes from Chris Cooley with Stephens. Your line is open.
Good afternoon and thank you for
taking the questions. Let me just start by congratulating Tom and those are both potentially powerful combination you guys are putting together and look forward to seeing what you do here. Maybe first for me Tom, if you wouldn't mind, just give us some additional color as you evaluated the AVEVA transaction, things that you were considering, whether it's either the extension of exclusivity now potentially out to the 20 27 period competition outside the United States that has an Epi on offering as it stands today. And of course, the pipeline, I'm assuming most focus there on both low myopia and presbyopia. But just maybe walk us through how you kind of weigh those kind of 3 key tenants in evaluating the transaction?
And I've got one quick follow-up. Thank you. Okay.
I'll be happy to weigh in on what I found attractive about the organization as I agree to note. And please corral me if you want me to readdress the 3 tenants you talked about. But first, I looked at really the type the paradigm change in technology that is resonant and the fact that this is such a vast circulating embryonic marketplace. I mean, if you think about it, keratoconus is dramatically under diagnosed and there have been no treatment options. So this is the first of its kind and happens to replicate what we faced with MIGS entering with the first iSpend.
The pipeline is fulsome and extraordinary. It offers the ability to really make this a value proposition, if you think about it, of using a single application of a pharmaceutical to arrest a site threatening disease. And you think about that in context, I get terribly excited as an end of 1 and as a potential patient, if I had keratoconus to know that I could come in and with a topical application of a pharmaceutical that's activated by UV light and transformed on the surface of the eye that I could arrest the progression of a sight threatening disease and perhaps be able to ameliorate a condition of having to have a transplant later in life. These are things that are powerful, palpable and high evaluation propositions for patients. When I look at the strong clinical data they have, I think the numbers are something like 130 peer reviewed studies.
These are studies that Avidra has been part of them. And studies that have been done, the appetite for this area is extremely strong because a lot of these have been done with non granted physician sponsored studies. And so I know that the appetite is there and that with the right channeling that we can be able to access this. When I saw that Avidro had created the J code, to me that offers up a print and retires a risk and offers up a principal advantage. It's what we'll do with iDose.
It's what I've done in my career with other products. It was successful in creating it. It's going to be able to facilitate the adoption of this technology and of the formulations going forward. The fact that they're first to market is, to me, a very, very high value proposition for us. We're going to have open field running in combination with Avidro to be able to create an installed base that will be, I think, invariably difficult for any future competitor to try to unwind.
And I like being in that position. It's what we're good at and it's what we intend to be able to address and to achieve. I like the team. The team is focused. The cultures are similar.
I believe that the transition will be relatively seamless. I've done a number of these. No integration is without bumps. But I can't imagine a more trusting team and a team that I'd rather work with moving forward. So as I look at all those, plus the principal opportunity of time, again, we have really advanced ourselves and created this fulsome opportunity with glaucoma.
And to me, it gave me a time to take a deep breath and look beyond and see if I can create some significant shareholder value in other areas as we move the business forward.
I appreciate all the detail there. And then maybe I'll keep in line with everyone else and I'll give Joe the softball then. So much going on right now. And you just talked about $15,000,000 in incremental cost savings as we go into 2020 from a reduction more so than the corporate costs. It seems with the added infrastructure with the various R and D projects here, you have a pipeline pretty, pretty formal.
So how should we think about additional spend that may be required to run the business going forward? You're blessed with an incredibly talented team for a business of any scale. But what type of incremental investment should we be thinking about for GLIFOS now moving out since you're obviously going to be folding in the AVEKO organization as well? Thank you.
Yes. Thanks, Chris. It's Joe. So first, I just want to make sure one quick question on that. So our expectation of the $15,000,000 plus run rate is as we make our way towards 2021, we'll be able to see that 3 times through those.
But yes, I mean, as we think about
the overall
operating expenses and investment we're making in the business, the way I would answer it is this. I think the history is in some ways the best predictor of the future. You have a pretty good sense of the way we've run the organization here to date in that we've largely lived within our means, right, since the time of the IPO. We've made substantial investments in the pipeline as it exists today organically, over the last several years, while still generating, cash, quite frankly, at the end of the day and again, largely living within our needs. So while there may be periods here as we see opportunity to push forward investment and to reiterate what Tom said, long term growth is our objective.
Think that our historical track record speaks for itself in the context of being able to deploy and invest in a prudent way.
Your next question comes from Joanne Wuensch with BMO Capital Markets. Your line is open.
Hi. This is Steve on for Joanne. Can you guys just discuss some of the market dynamics in the U. S. In the quarter?
Are you still expecting mid teens volume growth for the year? And then just as a follow-up to that, can you add any more color on the same store, new store sales in the quarter with the inject launch? What was the sales force's ability to go on the offense and convert new physicians in the quarter? Thanks.
Thanks. So, I guess a couple of things on that first and the broader market dynamics. As I started off earlier in the call, largely unchanged from what we saw in the Q1. I think the market growth continues to kind of be in line with our expectations and we continue to track towards what we believe based on the information we have is mid teens growth for the year. I think the CyPass dynamics are unchanged in terms of the share recapture there.
The competitive landscape is largely unchanged in the context that we continue to see trying and trialing and it continues to be an important component of what we're seeing in the marketplace. But that so far it continues to track a little bit below what our internal expectations had been. So I think from a market perspective, we're not really seeing much different in Q2 than what we saw in Q1. I don't know, Chris, do you want to comment on what you're seeing in the sales force?
Sure, Steve. This is Chris. I would say that the only difference from the Q1 or excuse me, from the Q1 and the Q2 is toward the end of the Q2, we're now beginning to gradually move towards adding new docs more than we did since the launch of iStent inject. We've primarily been focused on converting our iStent users to iStent inject. Now we begin to focus on increasing utilization for same store sales growth, as you asked, within our existing accounts and adding more new docs as we head into the second half of the year.
Okay. Thanks for taking the question.
Our next question comes from the line of Robbie Misworth.
Hi, thank you for taking the question. Just a couple of people and then just a couple on the pipeline, the existing pipeline. So the you mentioned the 700 of 1100 of ADRO accounts. I'm just wondering, are you willing to provide any color around the 700 and kind of what percentage of your accounts that represents so we can get a handle of how Avatro can go after your market? And is there any breakup fee on that?
And I guess I'll wait post the response to
ask the pipeline question. Thank you. Hey, Ravi, it's Chris. I'm going
to address the first part and then I'll turn it over to Joe about the breakup fee. In terms of those 700 accounts, these are all accounts that we're calling on in terms of what the percentage is, where we have business, we're not in a position to discuss that. But as you look at that, the vast majority of these accounts, which are comprehensive ophthalmologists, are accounts where we're already in. And that is very exciting to me and it's quite synergistic for our people
to be able to not only talk
to them about glaucoma therapy, the corneal health as well. So I look at this as a great opportunity to leverage the 2 businesses. I think there's a lot of synergies here and I think this will
be proven out moving forward. And Ravi, on the breakup fee front, there's a customary breakup fee for a transaction of this nature.
Okay. And then if I could ask around iDose, you spoke somewhat about the follow-up data at 2 years. Can you maybe help quantify that compared to what you presented back in early January around the Phase 2 data and 12 months data that you were seeing? Then just one last one on my end. Just where are we on the kind of conversion from iStent to iStent inject?
Is that kind of complete? Or are we still kind of still in the late innings there?
Thanks, Robbie. I'll take the first question. And while I have said that we have the full cohort in with the Phase 2b, I've purposely kept it at a very top line draw talking about durable, appreciable decreases in intraocular pressure and medication burden. But if you think about that, what I've said from the very beginning is that we needed to have 6 months of delivery to have a commercial product. The idea would be a year.
And I've said that now constantly, I think, since our IPO. And what I'm telling you today is that we have data that suggests that the product is delivering intraocular pressure reductions and meaningful decreases in medication burden at 2 years. So I haven't gotten and won't get more granular than that. Phase 3 will be the ultimate determinant of the iDose's success. And certainly, I want to be able to husband data away from potential competitors so that they don't know the true capabilities of this product.
But I will tell you that I am more than enthusiastic and become increasingly convinced that iDose can become a very meaningful part of the glaucoma treatment paradigm. Chris?
As far as the second part, we complete in terms of converting our iStent customers to iStent inject. We're largely through that process. And I do want to remind everybody that that's not going to be 100% conversion to iStent inject. What we've seen in other markets in Germany, Australia, Canada is roughly 90%. Not to say that that's what it will be in the U.
S, but that gives you an idea of what's happened in other geographies.
Our next question comes from
the line of Ryan Zimmerman.
Great. Thanks for taking the questions. I want to follow-up on Ravi's question a little bit, maybe ask them a little different way. I mean, understand that there's 1100 accounts that Avidro is targeting and you're in 700 of those today. But from the accounts that Avidro hasn't identified, Tom, a resume, you can characterize of the cataract and refractive surgeons that are out there today, how many have interest in Cornell Health?
Or how would you characterize those that maybe have a corneal focused ophthalmologist or a corneal ophthalmologist who can do this, who maybe is not identified in those 700 or excuse me, 1100 accounts. And what that looks like over time and their ability to get those revenue synergies that you're talking about in 2021? And then I have a follow-up question.
Hey, Ryan, this is Chris, and I'm going to address that one. Those additional accounts are refractive only or cornea only accounts, where they're specifically focused on that and wouldn't have any crossover into glaucoma. So we'll address that in a different manner than just with our glaucoma team.
Okay. Understood. And then I think Tom you made some commentary around a secondary group of sales reps eventually. So appreciating that you're going to combine or leverage your existing sales force into Avidro's sales channel. But maybe you could just talk about kind of the timing or when you think you could have maybe a more specialized sales force secondary to your existing sales force today?
Yes, I'd be happy to. So what I said before is that, Ryan, we had 75 representatives that are currently on the street in the United States and that the total amount with Avidro are 17. Avidro has a very capable, highly qualified sales force. And so what we want to be able to do is to see if we can transform that sales force into a specialized sales force of what we'll call corneal health. And the deliveries will be a little bit different.
They will be supplementing the activities of the main sales force. They'll be working strongly on utilization within practices, showing practices how to find these patients, how to identify them, how to sell them from the beginning opportunity and to alert them to this new pharmaceutical single use preparation. We also are quite skilled in the market looking at OD referral networks and trying to put ODs and optometrists in concert with ophthalmology practices. We do this all the time in glaucoma. And this Corneal Health sales force will be dedicated to priming and utilizing those OD referral networks to be able to drive both identification, capture, adoption and utilization of the filtrexa formula.
So I'm highly encouraged. There are great people on the ground today, both at Avidro and at Glaukos. We're going to spend some time really reviewing how we can put both these sales forces together so that the synergies are powerful.
And just, Tom, if I could squeeze in one last one. What do you see as the ideal number, given that they have 17 today? Is that how undersized in your view is that sales force? And where do you see yourselves taking that size over time potentially?
Well, I think I wouldn't comment on kind of the upper scale. But what I would tell you is if you think about it, what Avidro is accomplishing with 17 people is now going to be multiplied by again, by the new math, by 5 or 6 actually total of over 90 combined people that are going to be able to go after the adoption and utilization of OTREXZA. So I think if I had to say today, I think that's going
to be more than
ample to be able to achieve the desired adoption rates that we'll want to see within the marketplace. But like all things, Ryan, we'll assess as we go. If we need to add more representatives, we will
do so.
Okay. So with that, first, I'd like to thank Res and Tom for their diligence in this process and really welcome their team into Glaukos. And I'd like to thank all of you for joining us today for your time and attention and for your continued interest in Glaukos and Nowlet's combined entity. Thank you very much.
Thank you for your
presentation. And this concludes today's conference call. You may now disconnect.