All righty. Okay, it's Patrick on the MedTech team. As you all know, disclaimer, I'm just not even going to read it. You all know that one. You've heard it about 25 times and it's very boring. What is not boring is obviously having Joe, Alex, and Chris here from Glaukos's COO, CFO, and Head of IR Communications, respectively. So massive thank you for agreeing to do this and to join.
Thanks for having us.
I mean, there's plenty to talk about. There's one topic that consumes a lot of oxygen in the room, but.
Sure
Like, time probably makes sense still to go there. Maybe it's worth it. I know that there's a couple of people in the room who are newer to this story, so maybe just a quick overview of iDose, the proposition, why it's exciting, just to level set everybody before we go in a bit more detail.
Yeah, I appreciate the question, and I might actually start off with a broader conversation, a level setting around interventional glaucoma, generally speaking, and iDose being, you know, one of the most important vehicles to achieve that. I think where a lot of the enthusiasm around Glaukos and where we're heading as a company centers around the product side of iDose for good reason. What really is happening, you know, fundamentally in our industry is so important, and that's the idea that glaucoma really should be a disease that's treated proactively instead of reactively. Historically, with the lack of products that had the right risk-benefit equation available to do so, patients were relegated to, you know, years of chronic drop and more drop and incremental drop therapy before they ultimately progressed to very invasive late-stage procedures.
But that paradigm is really shifting, and iDose is a big part of that. You can now take the benefits of these topical therapeutics, which do work. The challenge is, patients don't take them because it's an asymptomatic and slowly progressing disease, and it doesn't matter which publication you look at out there, there's all kinds of different statistics, but the one thing that's aligned is that patients simply don't take them. They don't adhere to the topical prescription regimens that are prescribed to them, and as a result, their disease progresses. But you had to have solutions that were minimally invasive enough to make sense of shifting that patient into a different type of treatment paradigm.
iDose, through its scale and sort of easily understood mechanism of action, becomes an elegant way of really taking on that patient burden of adherence and delivering that medication in a safe, effective way, twenty-four seven, you know, over a sustained period of time. That's what I think gets, you know, folks both excited in terms of the overall opportunity associated with it for the industry, and Glaukos specifically, in terms of driving that standard of care shift, but then specifically, what it means for iDose as a product and for us as a company.
I thought one of the things you were saying earlier was quite interesting in one of the meetings, which was, you know, a lot of the ophthalmology landscape is a kind of one-and-done patient in, out, process. And you could argue bits of glaucoma historically had also been that way inclined. How do you think, and how have your discussions with the practices, whether it's private equity, the practices themselves, been in relation to. Are you going to own this patient journey for a revenue stream and a clinical perspective for a prolonged period of time? How has that discussion gone?
Yeah, I mean, I think it, it's a pretty profound shift for them in the way they think about the practices themselves and the, the inner workings of the practices. If you, if you think back to that point of the way glaucoma has been largely cared for historically, the vast majority of practices didn't spend as much time caring for the glaucoma patients. It was either relegated out to glaucoma specialists or optometrists who were writing the, the scripts that were out there. And for the average, you know, more cataract and refractive-oriented practice, they spent most of their time as a practice focused on referral networks associated with cataract and refractive or LASIK procedures, and for good reason.
They could do the right thing for the patient, they could make a difference in that patient's life, and from a business perspective, it made sense to their bottom line as well. They didn't have that opportunity in glaucoma because the simple act of writing scripts, more scripts and more scripts after that is not really a business model, nor is it something that's particularly rewarding in the context of care for these patients who they've watched continue to progress and ultimately, they couldn't do much to stop that.
So now you fast-forward to where we're at today, and that ability to take care of a patient for, you know, 10, 15, 20 years of their journey, having them as a part of the practice, now they move from a patient that you used to largely push to the side from a day-to-day, you know, care perspective, to someone that becomes the cornerstone or the anchor of the practice. And, you know, I think one of the most encouraging things that we've seen in the early days of the iDose launch, and even for the last 12 and 18 months, as we've been preparing for that with iStent infinite and otherwise, and having these interventional glaucoma conversations, is the receptivity to that. Now, it's not to minimize the fact that there's a lot of work.
It's one thing to have a strategy, a concept, a belief amongst these physicians in the practices themselves, but then to go out and actually do it, to change how you do scheduling, to change how you do your OR time, to change how you manage these patients and bring in an awful lot of new folks who become that cornerstone. There's a lot of work attached to that. But the good news is that's the path that we're on, both as an industry and we as a company, and those practices that are part of that.
I get that it's incredibly early in the launch, but how... What feedback are you getting from the field in terms of the doc experience, the type of patients who are being treated? I get the volumes at the moment are extremely low and inflecting later, but what's the composition of that looking like at the moment?
It's been very encouraging. So you think, first and foremost, it has to make sense clinically. The outcomes need to match the expectations that we're both, you know, ahead of and obviously seen as a part of the clinical trials. And that's been a really positive part of these, you know, I'll call it, early days of the launch, is the physician feedback has been terrific in terms of various settings and different patient types and in different stages of disease that intervention with an agent that they know works, and quite frankly, works really well. But by bypassing, you know, the cornea and the compliance considerations, being able to deliver that and then seeing the results these folks are seeing is very encouraging.
Now, you have to continue to watch that over a prolonged period of time, make sure you're continuing to replicate what we've seen in long-term clinical trials, which we certainly expect. But that initial tactile feedback from the surgeon in their hands has been good, both in terms of the outcomes, but also in terms of the surgical procedure itself, and the elegance of delivering iDose intraoperatively. So I think those things are there. In terms of the patients, and the type of selection that's there, it's varied.
I mean, I think what you see for a lot, if you're a doctor who, for example, has been doing a DURYSTA or similar type, really DURYSTA from that standpoint, this becomes a logical thing that now as those DURYSTA patients are ready for a different intervention, you can do that. If you're a doctor who does a lot of SLT as first line or second line therapy, as the benefits of that SLT start to wear off, bringing iDose in as a next generation solution makes a lot of sense.
For a lot of patients, they have consistent chronic complaints about the fact that either whether it's the cost of the drops to the patient or whether it's just the burden of having to remember to take two or three different drops, two to four times a day, everything that's there, they now can have that conversation with the patient saying, "Well, we do have an alternative solution for you. It's newly approved, etc. Assuming you have the right insurance, we, we can consider that for you." We're seeing that across the board there and kind of aligned with what you'd expect in terms of the potential patient population.
Maybe it's worth for the audience, giving a sense of, what are we calling it? Like, reimbursement confidence, essentially, or that side of, b ecause you have the J-code, and then there's also the pro fee, but there's also giving the clinicians that confidence that the cycle of being actually paid.
Yeah
Is working its way through and how that interplays with the demand for iDose as we move through the year.
Absolutely. Yeah, whenever you think about procedural pharmaceuticals, certainly in the case of iDose, you have to break it down to its constituent parts from a reimbursement standpoint. There's the facility fee for doing the procedure, there's the professional fee for the doctor and their time, and then there's obviously the payment of the J-code. You know, I often say that the earliest phases of a launch like iDose, it's all about reimbursement confidence, especially associated with the J-code. There's a hierarchy of needs there. And making sure that the drug itself is being paid is first and foremost. That was true as we had the miscellaneous code, but even more so now that we're getting into the permanent J-code and that's being commercialized.
And so from that standpoint, we continue to make the progress that we expect. You know, these things always require more work than you would like to see. But the J-codes were uploaded in the system of all the MACs. And then you go through a process of narrowing down the various technical issues that they have in terms of adjudicating those claims. But we've made a ton of progress on that, and every day we continue to make progress on that. We're seeing those payments flow through. In some of the cases, in certain MACs, we're seeing them flow through on a timely basis, where you know, you're seeing much more typical payment terms of you know 10, 15, 20, 25 days. So all those things are encouraging.
And across the board, we're knocking that down. Yeah, that will happen. Obviously, to the extent that you're doing an on-label procedure with an approved J-code, it's just an administrative process, not really a risk process per se. And so we expect, you know, across all these MACs and across all these procedures, they will ultimately, you know, get paid, and every day is good. As that reimbursement confidence box gets checked, then you get to have the much more enjoyable conversation of, clinically, where do you try to adopt this and how do you shift the standard of care and all those type of things associated with it? And we're seeing that. And so in varying ways, as J-codes are paid, some accounts start. They'll take another step.
Rather than doing one or two, they'll do five or 10. Others are getting the green light to be moving forward much more freely. And so it's just, you know, one account, one situation at a time as they get paid, and then really opening that up for them. The last of those, I think. There are many gating items when you think everything about this from a reimbursement standpoint. You know, going past Medicare fee-for-service, turning on commercial policies, Medicare Advantage policies, etc. And then, you know, but it is equally the professional fee side of this as well. And we saw the first of the pro fee schedules be published with Noridian, which is an encouraging step. We are seeing payments across, although it's sporadic, as you'd expect, until you have a pro fee schedule.
We're in that process of continuing to knock that down. Volume really drives behavior there. So I think as the J-code confidence drives increasing volumes, you'll see more and more of these MACs ultimately put the pro fee, you know, on a schedule here in the coming months and quarters, and that's pretty aligned with what we expected from the initial launch.
Is it fair to say that some of the initial pro fees are landing in that sort of $700 sweet spot? Is that kind of initially where we're landing?
Yeah, I think it's probably safest to focus on the one schedule we have. You know, obviously, there's payments across the board, across all the MACs. In general, the payments are aligning with glaucoma standalone procedures, which is what you'd expect. And when you look at published fee schedules across the board on that, they kind of range in that $600-$1,000 range. And in the case of Noridian, it's, I think, roughly $650-$850, with the majority being in that $700-$750 range.
That makes sense. How do you think, it's obviously very difficult for you guys. You don't want people to get ahead of themselves and things like that. How are you thinking about this, forget twenty-five, more mid-term, you know, more than 20 million potential patients, cutting that down? Like, how big could iDose be in an idealized scenario for Glaukos?
Yeah, I'll probably stop short of giving a specific number on that, and I think you're right. I mean, obviously, the blocking and tackling associated with any launch is real, and there's always operational considerations as you're making your way through these things. Along the way, you continue to see affirmative steps of customers and conversations that, you know, I think give you increasing confidence around that long-term potential. You know, again, stopping short of an exact number, what I will focus on is that there's a lot of opportunity here. You know, the most prevalent statistics that are often quoted is there's a little north of 20 million potential eyes that have high pressure and/or glaucoma in the U.S. 12 to 13 million of which are diagnosed at any given time, and 10 million, roughly, that are actively treated.
And so when you think about a product like iDose that has a wide-open label for the treatment of patients with ocular hypertension or glaucoma, it's a very large, you know, opportunity. And that's notwithstanding the challenges of making sure that you're getting all these building blocks put in place the right way, whether it's reimbursement or operational. But it gives us the confidence that we are going after a pretty large TAM here, and doing the right thing for the patients clinically is ultimately what drives the utilization within that TAM, and we feel really good about the way iDose performs in that context.
The, obviously, that patient pool, there's a selection, and some of them are on multiple sets of drops, and some are on two, and some are on one. You know, do you have an expectation of who is going to be the heaviest user early on for iDose out of that, out of that pool, or are you kind of agnostic about it?
You know, I kind of look at it in terms of there's the lowest hanging fruit in terms of where the utilization curve will pick up first. And again, for those patients who've already entered into the interventional treatment paradigm, the doctors had that conversation with this patient. Or maybe they've even had MIGS in combination with cataract surgery before, and they've seen the benefit of having an interventional approach. For those patients, they're already in that treatment paradigm, so continuing that journey with iDose and/or other products makes a lot of sense. Those are patients who've already made the decision to have a procedure and hopefully benefited from an elimination or reduction in drop utilization, and as a result, most importantly, a slowing of the progression of their disease.
If they're there, that doctor conversation around continuing that course of therapy makes a lot of sense. But beyond that, there are large swaths of patient populations. You know, there is a fairly large percentage of these patients who are intolerant to topical medications for a whole host of reasons. There are patients that have been on drops for a period of time, and because of the cornea specialist or the glaucoma specialist, the comprehensive doc, will diagnose a severe dry eye as a result of it. There's a large percentage of patients who have been on the topical medications who have severe hyperemia. And persistent hyperemia, so that's bloodshot eyes that aesthetically, in terms of the feel of the eye, is not what people want to have.
There's a significant portion of these patients who have memory issues, you know, obviously as severe as Alzheimer's or dementia, but even less severe in terms of just the typical aging process and what that can do to your memory and the ability to remember to take your medications. There are a lot of patients who have physical limitations in this age group. It's hard enough for me to put in eye drops, and you imagine now, for a lot of these patients, trying to do that two, four, eight, 12 times a day and get that instillation in and get it accurate and not have it be a mess, even if they physically can do that, is a real challenge for many of these patients. So I think the conversation is meeting the patient where they're at in the journey.
Like any other, you know, pharmaceutical launch, there's those where that's a lower-hanging, you know, fruit exercise and those where, you know, we'll work much harder over the course of the next, you know, two, five, and 10 years to drive that standard of care.
I definitely feel like I have memory issues.
Yeah.
I sympathize. Any launch, one of the challenges of devices and things like that is all the launches. This bit always looks exactly the same. But there's obviously a big difference between that and that, and then, like, is there, like, a non-numerical thing that you guys are looking for? Something that you're like, "Okay, this is absolutely about to go prime time." I mean, of course, it's like, it's a very exciting product already. But is it like a certain KOL feedback that you're getting, or a certain type of patient that's adopting it, or something that you internally be like, "Okay, now we feel extremely confident that this is a massive blockbuster?" Is there anything you can think of?
I think you see some of the leading indicators that I referenced earlier in those initial conversations, and when you're kind of bringing together what the clinical community knows is the right answer in terms of proactive management of a disease like this, combined with what the, you know, I'll call it the practice management side and what that can mean from an opportunity standpoint there. When you see that resonating with these practices and physicians the way, even in these early conversations, it gives you that incremental confidence. Now, I will say the same thing that we often talk about with our sales organization, our commercial organization in general.
To your exact point, I think the opportunity set in terms of both the number of patients and what iDose can do for that, can drive strong performance over a period of time, simply because the opportunity is so large, and the use cases are so varied and obvious. The challenge that we have as a commercial organization, and I think as an industry is: Are we doing everything every day to put the building blocks in place for that broader interventional glaucoma revolution, if you will, over the course of the next five and 10 years, versus harvesting the low-hanging fruit of the next two?
And so, so much of what we're doing as an organization is continue to put that front and center while we focus on the blocking and tackling, of course, of the early stages of execution for iDose. But we're putting as much effort around that broader, I'll call it, sea change, as we are tomorrow's element of the iDose launch. That's the best we can do as a part of that. And I think we've proven over the last, you know, decade plus, we're pretty good at pioneering these markets, and we're gonna, you know, do the same thing in glaucoma for the standalone patient.
Pivoting a little bit. I had a client who threatened me with physical violence unless I asked you about AMD. So, maybe worth level setting the audience, the opportunity set, and also more broadly, I think the pipeline, because you're not the iDose company. You know.
Yeah
There's a lot else going on.
Yeah. And I think, you know, we respect the number, frequency, and depth of the questions around iDose. It's clearly an important part of the value proposition as it exists today. But you're right. I mean, there's so much more, and we've been hard at work for some time. You know, we were very fortunate over the last 10 years to bring in an awful lot of talent into the development side of our organization and really build multiple platforms. iDose is an essential one of those platforms, obviously serving the glaucoma patient.
But when you take a step back, whether it's bioactivated pharmaceuticals, in the case of where we're going on keratoconus and rare disease, whether it's the, you know, topical cream-based formulations with iLution in that platform, which is much more relevant to a broad array of of diseases in ophthalmology, or whether it's bio-erodible technologies, which we've chosen intentionally to deliver for retinal conditions in the case of what you're saying on AMD, and it's probably been a little lost in the shuffle of iDose. And again, we understand that, but it's a pretty exciting opportunity. You know, when you look at and it's early, and I'll quote Tom on this.
He's been saying it for years about iDose: "It's terribly exciting, terribly early." But it's a game-changing shot on goal. You know, we've shown the data from the, you know, animal studies that we've done that are pretty translatable, in terms of duration of effect. And from a single administration and injection of our product, we were controlling retinal leakage for up to two years. And you compare that to the existing standard of care, and that's a pretty, pretty meaningful shift in the management of that disease. Now, we have to see it play out as a part of, obviously, human clinical trials, which we're now in. So the objective of our early studies are, of course, to assess safety much more than efficacy or duration of effect.
But there's an awful lot of excitement around what, you know, that can mean as a fourth or fifth pillar, however you look at it, within Glaukos over the coming, you know, five and 10-year period.
I've now avoided my physical violence.
Yeah, good. Check the box.
I mean, but in relation to the pipeline as well, you know, you already have exceptionally good gross margins. You're at a place where your top line might end up accelerating quite a bit. How are you guys thinking about even the ability to reinvest? Because there's a scenario where you flip to very, very profitable very quickly. That's not off the table. You know what I mean? Like, how are you thinking about that interplay?
Yeah, no, that's a, that's a great question, and when we think about, right? Because we do have high gross margins right now, and but we do have a really deep, rich pipeline, some of which Joe just referenced, and a lot of programs we haven't even publicly announced yet. But we've been active in acquiring early-stage technologies, and there's a lot to do. We also work for a CEO that's very ambitious and wants to continue to fund that pipeline. So we're gonna try and balance that equation the best that we can. I think in the near- term, our focus will be on generating cash flow, right? Getting back to break even, and then starting to build up our balance sheet on the cash flow side.
And eventually, you know, we'll turn at some point in the mid to longer-term to focus on profitability. We're not there yet. We want to continue to invest, build out those pipeline products that we think are valuable to investors. And there's no reason in the long- term that this business can't be 30-plus operating margins with a really strong R&D presence still. But, you know, a lot of it depends on what Joe does with iDose and Epioxa behind that, etc.
Yeah, so much of it is. You know, I mean, part of the goal and objective is, if we can build those franchises fast enough, that it's inevitable, obviously, that you'll start driving the cash flow associated with it, even with the ambitions that we have from a development perspective. So we'll see.
There's been a notable tick-up in the rest of my coverage universe's interest in the glaucoma space. I'll make a mean quote on stage. A few years ago, one CEO had described it as the backwater of ophthalmology.
Yeah.
That's not true anymore.
No.
A lot of them are investing a lot of money now, trying to sort of look at it. How do you feel about that competitive environment, about others trying to row in the same direction as you guys?
I mean, I actually think it's great. And so first, I wouldn't disagree with that statement historically. Maybe not just a couple of years ago, but a bit before that. Certainly, when Glaukos went into, you know, pioneering MIGS in combination with cataract surgery, that was absolutely the case. You would go to the major ophthalmologic conferences, and glaucoma would be on the last day, where most people are gone. And today, now it's on the Friday. It's a major part of where things are going, and it's probably the biggest area of transformational investment, and we've played a big role in that. It's been a shift over the course of a decade, at least in combination with cataract surgery, and now certainly as a part of this broader opportunity.
You know, the way we kind of look at it from the perspective of competitive landscape in this is that the more voices right now rowing in the same direction in making the adjustments that are needed to really treat these, you know, 10 and 20 million patients the right way, the better, and so from that standpoint, we welcome those voices, and we welcome that rowing in that direction, and you know, again, you know, if a patient on average lives with this disease 20 years, there's plenty of room for multiple interventions that many companies and can benefit in doing the right thing for these patients, so from that standpoint, it's nice to have them on board, and you know, welcome to the pioneering journey.
I love that. I mean, on that topic of MIGS and thinking about stent, you know, the core, in many ways, the core part of the business, maybe worth giving people an update of how we stand iStent infinite. Some of the noise that happened last year and the recovery that you've now seen, I guess, for the whole industry in some ways.
Yeah. Well, I think, you know, obviously back in 2022, we faced the adjustment when they combined the codes from a Category 1 standpoint and what that meant on a relative economic basis for the doctor and some of the impact there. We were really pleased in 2023 to get that, you know, back into the growth column, have it going in the right direction. I thought we weathered that storm in terms of the right thing clinically for physicians quite well, and then ultimately getting back in the mid-single digit type growth was a step in the right direction. Obviously, we've seen a meaningful uptick in that over the course of this year. I think there's multiple drivers, but a big part of that is that the standalone utilization of iStent infinite is now an economically viable procedure.
And so, you know, you started to have both the professional fee schedules get published, combined then with the changing of the APC assignment, where it became a viable procedure for these practices. And again, that enabled the practitioners to be focused on the clinical conversation, of which, you know, I always say, how and why would you be treating a patient who's headed down that path to a XEN or a tube or a trab without at least considering iStent infinite along that way, given the results we've seen clinically and now commercially with it? And so, thankfully, an increasing number of surgeons and procedures are in alignment with that view, and we've seen the benefit certainly in the performance of that business. We said both in the first and the second quarter, that was mid-teens growth for us on a year-over-year basis.
How internally are you juggling the focus to ensure that a bit like the start of this conversation, iDose doesn't consume so much attention that the base. You know what I mean?
Yeah.
Like the juggling of the priorities.
I mean, you have to have the right incentives alignment. Obviously, that drives a lot of behavior in the commercial organization. You know, the organizing principle here, though, is still all around interventional glaucoma. The products are servants to the master that is shifting the standard of care. And so when you think about it that way from a marketing perspective or an organizational perspective, and then you put in set in place the kind of incentive structure we've always had, which obviously has separate pools of compensation that if you deliver on both provides a multiplier effect or vice versa if you're struggling in both areas. I think we've got the right structure to continue to do that.
It doesn't mean, and I think I called this out on the second quarter call, that, you know, it is one of the things that we watch for, and you may even see some, you know, I'll call it relative headwinds to the growth profile of the stent franchise as the sales organization leans harder and harder into the iDose launch. But I think from a relative ROI of every minute of that salesperson's time, that'll make sense both for them and for us, and ultimately for the investment community.
Long- term, like, to what degree is there like a halo effect from owning that patient journey in totality, relative to some players who are only operating in a segment of it?
Yeah. Well, you know, I mean, I'm sure there will, and I think there is. From our standpoint, what we hope is that by having products across the spectrum, we can be more impartial and really having that holistic conversation around why and where to deploy technologies, versus trying to be, you know, having a bias towards one particular. I think ultimately for clinicians and for these practices, that's a refreshing approach because then they can say, "It's not so much about, you know, I'm hearing the pitch on this. It's more I'm hearing the pitch on why I should be intervening these patients, and I have multiple tools from which to deploy to manage that disease over the course of 10 and 20 years," as we've talked about.
So I think that's where the halo comes in, is the credibility associated with being able to really look at it from their perspective in managing the disease versus being beholden to any one individual product and the features and benefits. There's not any one panacea. Glaucoma is a, you know, a heterogeneous disease with a lot of different factors that drive it, and anybody who tells you differently is focused on a single product. So that's why, from the very beginning, we've tried to develop a full portfolio to go after it, and I think we've done a great job in doing that.
You made some interesting comments earlier today around seasonality. We all know that on the guide and the Q3, aware of that, but more for the broader sense of seeing slightly more seasonality in the U.S., in that August timeframe than maybe historically. It might be worth sort of explaining what you meant by that.
You know, it's been an observation, and, and we'll see whether those trends continue, you know, this year and into the future. We just noticed that historically, all new seasonality existed, particularly in, you know, markets like Europe and Japan, etc, there, Canada, where everybody goes to the, to the warm, you know. But in recent years, post-COVID, we've certainly seen more of that in the U.S. And it's not any one product or any one... It's, it's different franchises, everything within that. You just see a little bit more aggressive holidaying, if you will, from the, the surgical community over the month, you know, kind of the July, early August timeframe.
You know, we always saw some of that, but it definitely seems, as a relative measure, to be a little bit more pronounced in recent years in the U.S. versus what we have historically seen.
On that sort of seasonality commentary as well, if you end up having a, let's say, hypothetically, a bigger Q3 than expected, let's say, iDose, since it's coming in, you know, ahead of schedule, should we be careful around the Q4 about, you know, getting carried away in that side of things? Or would you take that as a sign of the, you know, the reimbursement pathway is getting adopted faster than expected? How should we think about that?
I have to say, I hope you don't get carried away always when it comes to the sort of forecasting of anything near- term, and I think it pays to be, you know, cautiously optimistic when it comes to that, anytime you're going through a launch like this. You know, I think we'll continue to take one step at a time. We'll do our best to give directional, you know, views on how the launch is going at each stage of that. You know, if you take a step back from, you know, back when we first launched the product or announced the approval in December of last year, we talked about taking sequential steps, you know, forward with iDose, certainly as you turned on the various elements of the reimbursement equation.
But the real goal ultimately was to make sure that you were lining up some of these things so that twenty twenty-five could be, you know, a special year for the company. And so everything that we can pull forward, you know, we're not resting. Any given day, we're gonna try to drive as much of that in Q3 and in Q4 and ultimately. But I think so much right now is about setting those foundational building blocks, getting that streamlined, getting the J-codes paid, getting the professional fees set with the schedules. So that just similar to what we saw with iStent infinite coming into this year, we start to see the same thing as we transition into 2025 for iDose and beyond.
Last one, I want a prediction from you guys. How many quarters do we have to see before the sell- side stops throwing its guesstimate of what iDose revenues was in the quarter, hoping that you'll make a comment about it? When, when will people give up? Or when will you give us light?
Yeah, I can't make any promises.
Long time.
It's a matter of open conversation for us. You know, we'll always want to be directional. I think that the very nature of iDose is that you really can't hide from it in the context of the quarter in and quarter outperformance. I think that most analysts are gonna be relatively close to it, just simply because of the quantity of it relative to the existing stent franchise. Whether or not we'll give that level of specificity, in some ways, I understand it, and certainly from a modeling exercise, but at the end of the day, you want us to drive growth, and our focus is on doing that across the whole, you know, portfolio, within the U.S. and obviously then internationally and in the other business units.
I don't know that we'll get as granular as you want, but I think you're gonna be able to get pretty close anyway.
Love it. Joe, Chris, thank you so much for joining us. Thanks, everyone.
Thank you.
Thank you.