Global Healthcare Conference with the management of Glaukos, and welcome.
Thanks for having us.
I have extremely clear memories of sitting at this podium a year ago, and you were just starting to launch iDose. And I will have iDose questions, but I also have other questions about other things.
Fair enough.
Like Epioxa, that were not even on the horizon a year ago.
Yeah. For you, or for investors in general.
For investors, I know.
Yeah, yeah.
All right. So I want to just do my favorite, step back, sort of take attendance. Where is Glaukos today? How do you think about the company? And how is it different, maybe not versus last year, but maybe versus three years ago?
Yeah. I mean, I think what you're starting to see is the emergence of something that we've been hard at work at for a really long time. And obviously, pipelines and products don't emerge overnight. And so it's a part of Tom and the team's strategy from 10-plus years ago to be creating what we think are differentiated product solutions in large market opportunities and taking differentiated bets on how to tackle diseases based upon the needs of the patients and the physicians more than, say, core competencies of the organization going in the past, right? To your point, we started as a microtechnology manufacturer of stents and everything associated with that that developed the MIGS category in medical devices. And here we are today on the precipice of doing more pharmaceutical revenue than we do device revenue.
And certainly, from a pipeline perspective, when you look at the breadth of that, there's an awful lot of sustained-release pharmaceuticals, procedural pharmaceuticals, of hybrid products that are around that. And so we've been quietly and methodically at work putting together the puzzle pieces of the infrastructure to make that happen, both in terms of development talent and now commercial talent. And you referenced, obviously, Epioxa. And that's been something we've been hard at work at for three years to have the right people in place to truly manage the launch of a rare disease category that is so different than anything else that we've done historically or that, quite frankly, most traditional pharmaceutical companies even really try to tackle. And so we're pretty proud of kind of sitting here today and what we've got in front of us.
And I think we're just now at the beginning of unlocking some really meaningful opportunities for the company. And we're happy that there's investor enthusiasm for that. But there's just so much opportunity that we're mostly focused on just continuing to put one foot in front of the other and making it happen.
So I want to start digging in just a wee bit on the core MIGS market. And this market has grown double digits this past year. It's on track to decline single digits. I think your commentary was for mid-single digits next year. I might be making that up. But I'd like your view of sort of a state of the union now that we're a year after the LCD impacts.
Yeah. And I think you're so this is a good building block question, I think, in the context of the legacy stent and MIGS franchise and really not talking about iDose at this point. But you're mostly focused in there around combination cataract MIGS. And clearly, this is not the exact number, but if there were about 250,000 devices being deployed in 200,000 procedures prior to the LCD, you saw the extra 50,000 largely be taken out of the market. And that was the impact that you mentioned. And if you look at our own results, we really saw the peak of that in the second quarter from a year-over-year comp standpoint. The third quarter was obviously some progression there. And if you unpack even our guidance for the fourth quarter, it shows continued sort of heading the right direction on sort of, I'll call it, stabilizing.
As we think about next year on that side of the franchise, if we didn't have iDose, I'd be pretty bullish around what kind of growth we'd be seeing out of the stent business simply because we'd be driving into that larger pool of patients in standalone care. You're no longer just constrained to my prior point, 250,000 or 200,000 potential procedures. You're now going after much larger. But it's hard to address that without also thinking about iDose and the fact that when we approach any customer of the conversation, we're leading and finishing with the iDose part of the conversation much more than, obviously, the stents, as you can imagine. And so where we've kind of landed, I think, with the investment community is let's assume that the situation is stabilized.
And I think it's a safe place going into next year, assuming that the business is more of a flattish-type approach or from a results standpoint, a year-over-year basis. And then we'll see how that plays out, plus or minus that, over the course of the year. But I think relative to the other growth drivers that you're going to spend more time on from iDose and Epioxa, it's a safer place just to kind of assume that the stent business is flattish next year.
So flattish next year. And I want to just—you're right. I am using this as a building block question. You've heard my questions before. But you said if you didn't have iDose, is that because of patient Mr. Smith would previously have gotten an iStent Infinite, but today is getting an iDose? Or is that more a reflection of Dr. Jones, who normally would use their time for an iStent Infinite, is now using their time for an iDose?
Yeah. It's a little bit of a combination of the available technologies, as you say it. So today, if you have a standalone or even a combination cataract patient, if they can qualify from a market access standpoint or reimbursement standpoint for iDose, many physicians are going to lean that direction because when you look at the clinical profile, the outcomes, the safety, as well as the duration and just that even responder rate associated with it, it's a great place to start. It's foundational, right? If you didn't have iDose as an option, then in that case, iStent Infinite provides a great tool for going after that.
And if you overlay on top of that, I'll call it our own sales force and marketing efforts, just the sheer amount of dollars, capital, and airtime we're deploying towards iDose, relatively speaking, if that was to go away, your entire effort and focus would be on iStent Infinite and unlocking that same standalone opportunity just with a different tool. So I think it would be, on its own, growing quite nicely. But today, we're cannibalizing that with iDose. And I think that's what you all, as the investment community, would want.
When you think about reimbursement for concomitant MIGS, it looks like it's down low double digits for 2026. Am I reading the details of the reimbursement codes correctly? Does that matter? How does it matter at this stage?
Yeah. So you're talking about the professional fee. So on the facility, the economics are still up again this year, modestly. On the professional fee side, you are looking at low double-digit decreases. Now, that is consistent with nearly all of the ophthalmic codes. And as you know better than most, also consistent with many of the other subspecialty codes that are beyond ophthalmology. So it appears to us that CMS, as a part of the rulemaking cycle on the professional fee side, prioritized certain disciplines and certain procedures in the hospital setting and things like that at the expense of what they perceive to be a more efficient care paradigm in specialty groups. And ophthalmology is one of those. And so you saw that hit really across the board. And combination cataract MIGS is certainly one of them.
And before I leave or we leave MIGS, are you seeing more standalone MIGS being done? And I'm talking traditional MIGS. I'm not talking the iDose family yet.
I think all technologies benefit. My guess is that, in what we see, obviously, iDose is first and foremost for us. Clearly, we see more stenting going on, whether it's in combination with iDose or on its own from a standalone perspective. And I suspect when you talk to others in the industry, they would say that they're also benefiting from continued expansion of standalone procedure volumes in various technology modalities. I've said this before. There can be a lot of winners when you're going from a market that's 500,000 eyes to 20-21 million eyes. While I hope that the majority of those are done with an iDose or an iDose and an Infinite or Infinite, I have no doubt that other technologies will also play a role in that. And we want those conversations to be happening because we're trying to change the standard of care here.
It helps when it's not just one voice.
I've made it almost a whole 10 minutes before I say.
I'm impressed.
I work at these things. iDose. So what has surprised you about the iDose launch in 2025? And what were you like, "Yeah, that's what we expected"?
I think I continue to be a little bit surprised by getting over these last couple of MACs in their professional fee schedules. And I would not have necessarily predicted coming in that we'd still be trying to turn over those river cards. When you live it, you see how that happens. But at this point, we've had established professional fee schedules with Noridian and Novitas for some time. These are very large MACs covering the biggest chunk of lives. You most recently saw NGS come on board after the third quarter call. And so whether it's expectations or just frustration, you really want to get to a place where physicians can make decisions based upon clinical determinations and not be held back by things that are not clinical, like whether they can even get paid to do a procedure.
And so getting through that has probably been the biggest one. I think where we've been, if Medicare expectations are exceeded, it keeps coming back to the actual performance of the product. And that's what makes us so bullish about the future. I mean, the number of physician texts and conversations and just exceptional outcomes that I receive personally, let alone our field team and all of our clinical personnel and folks alongside of that. You can't help but be excited when physicians are excited about what they're seeing. And again, one of the hard things for the investment community is translating that and then overlaying reimbursement-related considerations and not getting ahead of yourself in terms of the way a product like this ramps. But I'm excited that we're doing it off of a foundation where the product is terrific clinically. And that continues to exceed our expectations.
So a lot to unpack there. I'm going to go first with investment community and getting ahead of ourselves. I think we all see the stock price year to date and a nice rebound over the last, whatever, weeks, months. But do you think that the investment models, as you see them? And Alex, this may be for you. Do we have the right numbers now?
I can talk about the top line. Alex can talk downstream from that. I think we went through this. This is my own interpretation. I think it's up to all of you. I think late last year and going into the beginning part of this year, there was a degree of unbridled enthusiasm around what it was going to mean in terms of the ramp. That was based upon hard data, which was surveys and clinical and investigator enthusiasm for the product. What often gets missed in situations like this is that while a physician may want to use it for everything, they have administrators and other folks who are saying, "Not until we know we're going to get paid," right?
Or that you're going to get paid or the various things that act as headwinds to any adoption, but particularly in procedures and procedural pharmaceuticals. And so I just think that that's what got ahead. There was a mismatch between taking what was coming from the surveys and putting the proper market access headwind overlay on that. I think we then went into a period of time where, to a certain extent, again, I understand, it's a little bit of an overreaction where people say, "Well, okay, show me." And then as we continue to make progress and obviously the trajectory we've been on over the course of the year and as you saw in the third quarter and kind of what's implied in next year's guidance, we continue to see a lot of opportunity. And we're seeing really attractive growth in our U.S. glaucoma business driven by iDose.
So I think I can't speak for every analyst and every investor and every hedge fund and every long in that. But I think in general, the street's gotten to a better place in terms of expectations around iDose. And they certainly were coming into 2025.
Alex, you want to jump in?
Sure. I'll just comment on the rest of the P&L. Joe talked about the top line, which has been the focus. I think some of the answers I'll give go back to what you originally asked for, which was if you think about where we were three years ago and you think about the financial profile of the company and where we are now, it's changed quite a bit. Three years ago, we were burning cash because we were investing in building a facility for iDose. We had a convertible debt that was hanging over our heads. We were working our way through towards an iDose approval and looking forward to those revenues and the things that could come out of that, but not knowing whether we would get approval, etc. Here we are today, and the convertible debt has been retired.
We are largely back to our normal capital spend on an annual basis, which is really capital light, and we're getting to the point now that we've been aiming for a while, which is to get back towards a cash flow break-even type of profile in the company, so all of those things have materialized over the course of this year, this show-me year, as Joe referred to. In addition, you start to see leverage in our model, so even though revenues are increasing and our operating expenses are growing, we're still showing leverage in that model as we continue to progress the company financially, so I think we're getting towards that right place and where we're heading in the next several years. We're heading in that right direction.
Excellent. I want to spend a little bit of time on the CAC panel, which freaked a lot of people out and then seemed to be a nothing burger. Is that the right interpretation of what went down?
Well, I think that's the right interpretation from an investor sentiment perspective. And so totally appreciate that. I think if we were to look at it, and I'll repeat what I said before it and then during and then after.
Now after.
Yeah. This is a part of the process. And so from our standpoint, the actual event of a CAC meeting is a step in the education process for these MACs. I think people forget that these same medical directors, these same institutions are dealing with an Alzheimer's drug and an oncology and a glaucoma and all the various things around it. And so to expect them to be experts in how these things all work is a bit of a bridge too far. And I think you saw that in the CAC meeting itself, right? I mean, I think clearly there's a process in which they're trying to figure out what does standard of care look like, how is it shifting, how does iDose play a role in that, what evidence is associated with that.
And the way they ask those questions can be messy and highlight the fact that they don't totally understand. And if it was just up to the clinicians, this would all be easy. But you go into any of these processes where the tug of war is between what you know is the right answer, what they understand or don't understand, how you educate them through that process, and then how that does or doesn't land in policy. And the reality then and now is that the path forward has scenarios that are positive for us, scenarios that are neutral for us and the industry, and scenarios why I think hopefully are a little bit more remote are negative, in which case it requires more advocacy and more effort to make sure they're properly educated and get to the right place in any final "LCD" that would happen.
And in that latter part, if it emerged, I think it probably becomes a bit more of an investor trading sentiment issue than something that really fundamentally changes the way we view the near, medium, and long-term opportunity associated with iDose and the market and everything we're going after for interventional glaucoma. So I thought, and we thought, the physicians who were selected, we have no say in that, right? That's just the medical directors and the CAC members that were participating. They did a really nice job of. It's never exactly how I would answer every single question, but they were, I think, thoughtful and objective around where everything is at and the amount of evidence that's associated with iDose and why it's supported and should be a tool that's in their armamentarium to actually treat this disease.
And so from that standpoint, we walked away as pleased as you're ever going to be around a conversation like a CAC meeting.
I mean, the conclusion essentially was it should be part of your toolbox.
Yeah. Yeah. And really, I think it should be a part of the tool. The exact deployment, when and where, is still something that you have to have more utilization. Physicians have to continue to figure out. I mean, you can make debates that it is a topical medication. Topical medications are first line. And the only thing that's different about iDose is that you've taken patient non-adherence and compliance out of the equation, in which case you'd argue that for many physicians, they would want to have it a first-line therapy. But we're not naive enough to think that's where it starts. It doesn't. It never does.
Their point was you have to let some of this stuff play out for an informed physician to be able to say, "This is what we think the standard of care is starting to look like." If you do that too prematurely, you're actually stifling, obviously, clinical innovation and what they all want to be able to do in practicing medicine and trying to tackle this disease.
At this stage, my math is correct. You have five of the seven MACs that are reimbursing. What does it take for the next two?
I think it's actually four, right, on the professional fee. I mean, they're all reimbursing on the facility and the drug. One of the seven still has some issues on the facility side, but the drug is getting paid in all seven. Four of the seven, representing about 70% of the Medicare lives, now have a professional fee schedule, and three, representing the remaining 30%, still have not posted a professional fee schedule yet.
What does it take for those three?
If I had a perfect answer for that, we would have already done it. It's a process associated with just continued education. I think the only way you really get through it is continuing to have clinical demand, providers submitting claims, some of those claims getting denied, some of them getting paid, and getting through the process to where it eventually gets enough volume where the MAC itself has to put on the professional fee schedule and adjudicate it in a more streamlined way, and there's no statutory level, process, etc. It is up to each MAC independently and how they price, what they price, and when they price any Category III code. I'd like to be optimistic that says that now that you've got 70%, including the largest three MACs, that that's pretty good evidence about how it should be valued and how it should be adjudicated.
But you still have to engage in the conversation to an extent. The society has continued to be a part of that education process. And I can tell you this. I think our market access organization. No one will be happier in this country or another because that means they'll stop getting the daily questions from Tom and myself.
Is there a stage, and I hope you say yes, where we're not monitoring the reimbursement arena for iDose?
I could answer that yes to satisfy what you hope.
Don't do that.
But I'll give it a more nuanced answer, which is I think on a relative basis, sure, right? I mean, I think anytime you're pioneering new categories and driving new treatment modalities, there's an inherent messiness in establishing proper access and coverage and payment. And that's going to come with fits and starts, and then sometimes there will be pullbacks. And there's just inherently some volatility that all works itself out in the way our healthcare system works, right? But there is a point where you get through. I'll call it enough to get over the hump, where back to my earlier point, physicians stop having to think so much about reimbursement, and they can start thinking just about what do I prefer for my treatment algorithm. And that's where you want to get to as fast as humanly possible.
And that's where your salesforce and your medical affairs colleagues and everybody else has a lot more fun because they're able to engage in clinical conversation, not can I get paid properly and run my business conversation. My caveat to all that is, as you know, having done this for a long time, it doesn't matter what you're never completely out of the woods on these things, right? Even if you're in today's world super successful with a pharmaceutical, you might eventually find yourself negotiating with CMS around that price if you get on that grid. And that's a high-class problem, but you might get there. And commercial payers and Medicare Advantage and everything else, as you get more and more on their grid, there's more and more things that kind of come up in and around that. So I don't think you ever are done.
And I think for our market access team, they've got a lot of job security because of the way our system is structured, right? So you're never totally out of the woods.
When all seven are reimbursing facility and professional fee, do you have a number that's a revenue run rate?
I mean, so in that scenario, you're talking about a little less than half of the Medicare-covered lives today based on MA versus Medicare fee for service. And then you've got another, call it at least based upon the iDose clinical studies, half of the overall patient population are non-Medicare age that are around there. And so I'm just doing this honestly kind of on the fly this way for you, Joanne. But if I think there's 21 million eyes out there and I say, let's say half of those are non-Medicare age and half of those, just to make the math easy, are Medicare, you're talking about a 3, 4, 5 million eye market that you're going after for those patients. And not all of those are found and diagnosed and all that kind of stuff. So you continue to haircut that down.
But you are going after a pretty large patient population. Glaucoma is a very real disease that affects an awful lot of people, both diagnosed and not, suspect, high pressure, various stages of glaucoma damage. And today, it's one that's severely undertreated in the context of prescribing drops. Such a large percentage of those patients who are prescribed drops today never show back up. It's just unfortunately one of those disease states that it's asymptomatic and slowly progressing, and patients hate taking their drops. And as a result, they don't, and they're not reminded on a daily basis that they should be. And as a result, they're the ones who unfortunately show up with late-stage disease several years down the line. And our goal is to try to prevent that.
And I think at least to the point of your question with the Medicare patient population, I think as we get those policies on, we can start trying to really go after it.
We've got a next-generation iDose in the works, which may address things like, can it be done in the ASC? Can you do a secondary implant? Can you remind us what the features are of the product and what the timeline is?
Yeah. So the iDose TREX or extended version of that, what we've said is it's designed to carry approximately twice the amount of drug payload as the existing iDose TR within a very similar footprint. It's just through kind of, I'll call it next-generation engineering in the design, we're able to hollow the canister out a bit more and achieve a larger drug payload. And so our hope is that you can provide an even longer duration of effect in that product. And our clinical studies are underway, and we've talked about it being something that we hope to have on the market as a part of this planning period, if you will, or this decade of how you look at it. And we'll obviously give more updates as we get closer to having full enrollment and all the things that are around that to dial that in for you.
It is one of the belt-and-suspenders approaches around being able to provide multiple Glaukos technologies for lifelong interventional glaucoma therapy, right? The average patient has glaucoma from diagnosis to passage of 21 years. So you want to have, whether it's multiple implementations of iDose TR or TR plus TREX or iStent Infinite or the various things or other competitor technologies where you can continue to manage that patient in an interventional way over the course of that life cycle with the disease. I think TREX will be another important step in that to provide even longer duration of effect for patients in a single procedure.
So does that allow for secondary procedures, and will that allow for in-office procedures?
I'll do the latter first. The in-office is a separate equation. In a theoretical and clinical sense, you could do in-office procedures with iDose TR. You could do it with iDose TREX. We also have an injector system for doing that that we're taking through the clinical paces right now called Trio in-office. Any one of those can be done in the office. The in-office component of all this really is more of a turning on the coding side of that for in-office coding from market access side of service 11, so outside of the hospital ASC environment. And you do that by applying to the individual MACs and requesting that that coding goes on. They go through a process to enable that. And that's something that we expect to do over the course of next year.
Okay. Epioxa. I think everybody was surprised when you gave the ASP on the last earnings call. Can you remind us of how you're approaching this market? I have 14 other questions, of course, but let's start with that one.
Yeah. So we tried in our own subtle way to signal to folks that we saw this as a rare disease drug leading up to it. And I know with all the focus on iDose, that probably got lost in the shuffle a bit as we were kind of leading up to it. So I know it did surprise some folks. But there's a fundamental reality of where we're at today in treating patients with keratoconus, and that is we're currently treating about 10,000 patients. You do the math, it's whatever your model shows, 18, 19, 20,000 eyes. Any way you slice that, that's a rare disease. Similar volumes for drugs like Oxervate or Tepezza in ophthalmology, and certainly when you look more broadly, many would actually classify that as ultra-rare disease, not just rare disease in terms of the patient volume.
And that was a recognition for us as a company, as on our own journey post-Avedro acquisition, in realizing that to get patients found, detected, and accessed, and ultimately treated, you had to look at it completely different. It's not the same as treating with an iDose where with 21 million eyes, doctors wake up in the morning and go to bed at night thinking about glaucoma or some form of that. It's prevalent every day in their practice in some way, shape, or form. Rare disease doesn't work that way.
You have to take the mantle, if you will, and make sure that you're driving education and awareness so that people are asking the question, "Do I have keratoconus?" when they're seeing that visual disturbance and the change in their vision of their optometrist, of which there's 50,000 of them out there, and of their ophthalmologist, whether it's comprehensive or cornea or otherwise. You really have to take a totally different approach to how you're set up as an organization. The tools and assets, both from a human resource perspective as well as supporting that patient in their journey and all the various things I was just sort of alluding to, it's a complete transformation. One of the things that we were excited about with the approval and being able to talk about this is we've been hard at work for this for three years.
Alex has been a part of helping. We've been hiring people from the Horizon and other organizations of the world that know rare disease and know direct-to-patient advertising and all the various things there quietly behind the scenes, and now they get to really run with this product launch. I think we've built a unique foundation for rare disease drugs, and Epioxa is the first. I hope there's more. We certainly have more in our pipeline that we can actually bring to market to help these patients.
But it's the same doctor who's doing Photrexa now that will be doing Epioxa.
Many of them. Yeah.
Many of them.
Yeah. It won't be every single one, but it may.
So you already know where the patients are more or less.
We know where the existing funnel. The challenge is that it breaks down at every single level. We know that a huge percentage of actual patients out there, we may ultimately find it's not a rare disease. We may even find that it's a rarely diagnosed disease today. It doesn't change the go-to-market strategy because you still have the same fundamental problems. But today, we've got to go. So the patients that are out there being found today, yes, we know where they're going. We know what optometrists are sending them and what ophthalmologists are treating them. And many of those will be our customers as a part of this. The question is not enough people are getting to the optometrist to get screened, and not enough of those that are getting to the optometrist are being properly screened for keratoconus. They get misdiagnosed as having another visual acuity issue.
Finding them and getting them screened and then getting them referred to a treating ophthalmologist, every step of that journey, there's significant breakdowns in the way, and they require significant investments to get it going the right direction. Yes, of the 10,000 patients that exist today on an annual basis, we know where they're being found and where they're going.
My memory is that when the company that Avedro purchased, when they launched Photrexa, it wasn't well launched. Is that correct?
That wasn't the we acquired Avedro. Avedro had launched this. This was the foundation of Avedro, cross-linking technology as a part of it. And I would say it differently. I think it was launched with a different intention. So I don't want to put words in the mouth of the original founder of Avedro, but I think in general, they viewed it as more of a LASIK adjunct procedure. And so the idea that you could do a refractive procedure and then use the cross-linking to strengthen the cornea post-LASIK, people would call it LASIK extra as an idea. And some of that is done in Asia today in particular, was the real strategy. So it was much more about a cash-pay refractive market.
But the challenge with that is, as it became clear that the real opportunity was treating this rare disease and keratoconus, and you moved into the reimbursement world, and this is what you'll remember from that time when Reza and others were involved there, is that the pivot they had to make from a cash-pay drug into a reimbursed one was a very painful one for them and also one that comes with a whole host of unintended consequences around the way, in our case, the Medicaid drug rebate program works and other things that are there that you're right, in retrospect, you would never launch a rare disease drug this way. But the why they got there wasn't because they really weren't trying to launch it as a rare disease drug for keratoconus.
This with Epioxa becomes the first time that we or anybody associated with this cross-linking is able to try to do it the right way from a market access, from a payer perspective, and certainly from a disease awareness detection and treatment perspective.
Spend a little bit of time on the income statement. And I know I asked you this last year. I think I might ask you this once a year. How do we think about profitability and reaching it?
It's a great question, well, luckily, Joanne, our focus hasn't changed from last year, which is, again, in the short term, our goal is cash flow breakeven and living within our means, we like to say internally within the halls of Glaukos. And what that means is we look to balance our revenue growth and revenues generated against the investments we need to make in Joe's organization to launch these great products, in our R&D organization to continue to feed the pipeline that Joe's referenced as well, but to do so in a responsible manner and really, again, breaking even on our cash flow. So that's in the near term. As we progress throughout, let's call it the medium to long term, then we start to look at the things you're referencing, which is that pathway to profitability.
We are very fortunate to have a business that has high gross margins. With those gross margins, that will allow us to continue to invest in the business, both on the SG&A and R&D side, but still realize operating margins in the 30% to 35% range, we believe. So that is the pathway to profitability is over that medium to longer term where we get to that point where we can do what we're talking about doing and still realize those operating margins that we should do in a mature business.
My hope is to help Alex by continuing to grow the top line faster than expectations so that it's even with our ambition on the development side that we can outpace it, in which case you just get the natural benefit of the leverage of the margin profile. But we'll continue to do our best.
What do you think at this stage investors are missing?
You're probably better positioned to address that than we are.
This isn't my deal, but I'm curious of yours.
No, I think this is always investor relations in that sense is a journey too, right? And I think we're in this unique point in time where I hope that we're starting to shift from the drama from an IR standpoint of small they're important, but smaller things in the grand scheme of what it means for the next two, five, and 10 years to a better understanding of where this company is really going, the markets that we're playing in, the breadth of our portfolio, both commercial today and the pipeline behind it to achieve that. The kind of conversations that we're trying to engage more in is, for example, in iDose and Glaukos, do you believe in interventional glaucoma? Do you believe when you have the conversations that glaucoma is an interventional disease? We do. And most of the physicians we talk to do.
But from an investor standpoint, do you? Because if you do, then not just Glaukos, but multiple participants in the industry are going to win over the next five and 10 years because of the opportunity to do what's right for these patients and the commercial opportunity that comes with that.
That conversation and being able to start seeing the thematic elements of what is resident in Glaukos now that we're not $50 million of revenue or $100 million of revenue, that we're actually starting to become a place where you can count on the stability of us and the growth that's there, understanding what that rare disease investment means, what opportunities are resident within our pipeline, thinking about the early shots on goal we now have in retina and the things that are around there, and really starting to look at hopefully the, I'll call it the long-term risk-adjusted opportunity associated with our story more than, say, tomorrow's trading event or a short thesis on whether you're going to miss the iDose number by $100,000 or beat it by $100,000, I think is still we're in that transition.
And I think as we continue to deliver on iDose and now with Epioxa, that frees people to worry a little less about those things I'm referencing and focus a little bit more on the long term. And I think that excites all of us from an investor relations standpoint as we think about the coming years.
In our last two minutes, when we're here this time next year, what will we be talking about?
I hope we're talking about an elevated version of some of what we talked about here, which is I hope that we're largely putting behind us the reimbursement-related conversations associated with iDose and even to a certain extent Epioxa, and starting to talk a lot more about the clinical adoption paradigms and the opportunities associated with that and the pace in which we think we can continue to drive the standard of care shifts I'm talking about, and really having the foundation much more poured with and solidified so that we're really talking about the offensive strategies we've got versus continue to kind of get through this piece. We're just going to keep putting one foot in front of the other and trying to grow the business between now and then to the maximum extent possible.
We're all bullish around what next year and the years to come have in store for us. Now it's just about heads down and executing.
Joe, Alex, thank you so much for joining us.
Thanks, Joanne.
Thanks, Joanne.