Good afternoon, everyone. Thank you for joining us. My name is Patrick Mercer. I'm the President and Chief Executive Officer of IRIDEX. Also with me today is my Chief Financial Officer, Romeo Dizon. Appreciate your time and attention today in learning about IRIDEX. I'm grateful that you could be with us. I'm going to be providing some forward-looking statements, so there's the disclosure with that. I'd like to start with our vision and our mission at IRIDEX. Our vision is to transform laser-based eye care to preserve sight and improve quality of life for patients suffering from ophthalmic conditions globally. Our mission is to deliver innovative, clinically proven, non-invasive laser technologies that safely and effectively treat glaucoma and retinal disorders. Let's learn a little more about IRIDEX and who we are. IRIDEX has a long-standing reputation in ophthalmic lasers.
The company's been manufacturing and designing lasers since the early '90s. We've really been the technology leader. We have strong clinical credibility, and our global customer base have been really keys to our success. Our product portfolio covers two main areas, retina and glaucoma, giving a solid reach across two markets. Our retina business is primarily a capital equipment business, although 22% of that is reoccurring revenue. Our glaucoma business is reoccurring revenue business. In 2025, our revenue was $53 million, $30 million from retina with a 51% direct margin, and $14 million from glaucoma at a 72% direct margin. One of the things we're proud to announce is that Q4, we achieved positive cash flow operations for the first time in the company's recent history. We were also EBITDA positive for the full year 2025. Let's talk about our retina portfolio.
It's one of the broadest in the business. It includes our PASCAL pattern laser system, our IQ laser platforms, and our legacy lasers. These laser solutions cover both our surgical and medical retina needs. When you look at our delivery devices, our retina disposable probes, and all our accessories, it gives us a full suite of products to use in the space. On the glaucoma side, our Cyclo G6 platform and our full range of MicroPulse and continuous wave probes are keys to the specialist treating all types of glaucoma disease. MicroPulse TLT in particular is quickly becoming the go-to choice for clinicians because it's safe, effective, and predictable, and repeatable. Glaucoma's on the rise around the world, and our probes offer a great mix of clinical benefits and economic values for practices.
Looking at our global commercial footprint, we have a strong global presence with direct sales in the U.S. and worldwide distribution. We're currently in over 100 countries. This really allows us to scale efficiently while supporting growth in both our capital equipment business and our reoccurring revenue business. Let's dig further into our retina product overview. Our U.S. retina business is aging, especially with PASCAL and the IQ platforms. Nearly three-quarters of our systems are approaching five years or approaching end of service. This really creates a significant replacement opportunity for us, which is really timely as we introduce some of our new products like PASCAL. Our PASCAL system is one of the fastest, most reliable systems out there. It offers clinician a full range of tissue-sparing laser options. These are like sub-threshold treatments. There are three software options that can be purchased with a PASCAL system.
MicroPulse, Endpoint Management, and PSLT, which is actually a glaucoma treatment. The software options are safe, efficient, and they are effective. This is one of the reasons why PASCAL's becoming our flagship product out in the marketplace. The global retina market is really big and growing. It's really fueled by the rise in diabetic eye disease and the aging populations. With over 8 million retina laser procedures performed each year and more than 55 million people suffering from diabetic eye disease, it's a real opportunity for us. The demand for really safe, effective treatment is on the rise. The DAME trial, which is mentioned here, it looks to extend visual acuity in the diabetic macular edema patient population. It addresses the economic burden of performing repeatable pharmaceuticals. Using MicroPulse in conjunction with injections would reduce the amount of injections a patient needs. That's where the real opportunity is.
Looking at our MicroPulse patented technology, it's clinically proven. The comparison here simply illustrates the difference between continuous wave and MicroPulse technology. With our MicroPulse technology, there's no scarring. Really, how that's achieved is the laser's turned off and on. It's got a 31.3% duty cycle. It allows the tissue to cool before reapplying the energy. No scarring, no damage to the retina tissue. I mentioned earlier that our retina business is primarily a capital equipment business. That's true, but 22% of it is reoccurring revenue, and those are our EndoProbe line, which is really a strong contributor. These products integrate seamlessly into vitrectomy procedures. These single-use devices enhance surgeon control while generating reoccurring revenue with each case. Let's talk more about glaucoma. The U.S. market for glaucoma offers a substantial opportunity for us. IRIDEX is really just scratching the surface.
We're doing 20,000 cases, and the market for moderate patients is 2.1 million. That's a huge opportunity for us. We're seeing a lot of momentum here. We are seeing more comprehensive doctors use MicroPulse TLT to treat patients earlier in the continuum of care. Then, with the Medicare LCD that came out last year, which basically limited reimbursement on MIGS procedure, it's helping create early adoption for G6 for both mild to moderate and post-MIGS patients. You combine that with our Sweep Management Software that we rolled out last year, it puts us in good position for 2026 to sustain growth going forward. Internationally, the opportunity is even larger, with millions of treatable eyes and a large global surgeon base. We estimate about a $700 million probe opportunity in the rest of the world markets alone.
As we strengthen our distribution performance and relationships and introduce our enhanced training, we are set up nicely to increase utilization there. One of the things that's unique about our procedure, when you look at the procedures that are done for glaucoma, the unique thing about our treatments is its versatility. It can be done with any of these procedures, standalone or in conjunction with. Glaucoma's being diagnosed earlier, and patients are living longer. Used to, glaucoma would be diagnosed at age 60. The patient would live maybe to 75, and that was really the treatment life cycle. Now it's being diagnosed earlier, patients are living longer, and we offer probes that can treat glaucoma early stage all the way through the life cycle of the disease. Just to stress, this is non-incisional procedures.
Our recent prospective data is quite compelling, with greater than 50% reduction in IOP over time, over a year, over 12 months, with more importantly, an excellent safety profile. What's important here is that when we escalate the dose, we can improve efficacy predictably while maintaining extremely low complication rates. This reinforces MicroPulse TLT's position as one of the safest non-incisional glaucoma therapies available. This study by Dr. Kron is very important. It shows that when we look at patients long-term, we continue to see sustained IOP reduction even after five years. In this particular study, we saw an average of 32.5% reduction, and more importantly, a decrease in drops administered. This is an outstanding achievement. Looking at repeatability, this isn't a one-and-done procedure. Clinical data shows that MicroPulse and continuous wave treatments can be repeated, providing meaningful, sustained IOP reduction.
It's a competitive differentiator for us, it allows us to manage glaucoma longitudinally across the full disease timeline, something incisional approaches cannot do. There's been a lot of volatility around reimbursement, particularly with the LCD that no longer allows stacking of MIGS. MicroPulse TLT is not a MIGS procedure, the LCD actually created a tailwind for us going forward. It supports the early adoption of G6, not just for refractory glaucoma, but mild to moderate patients as well. This really broadens the addressable market for us. Just to add, we're seeing the reimbursement go up every year, and it's a really stable CPT code. The ROI for purchasing a Cyclo G6 laser is 12 months when performing three or more procedures per month. The economics are even more favorable when you're doing the procedures in a hospital.
Since my tenure as CEO, I reduced the size of the sales force by half while maintaining the same revenue. Tools like MedScout give us granular visibility into where clinicians are doing the procedures, what day they're doing them, and what type of procedures they're doing. This is important because it allows us to target places where hospitals or ASCs where we could increase utilization. It also gives us visibility into large glaucoma users who may or may not be doing MicroPulse, and allows us for targeting of them. Let's talk about the financials. Like I mentioned, when I came in, my goal was to right-size the company for the revenue. Here's a list of some of the actions we took. We reduced the headcount from 127 to 93. We relocated our G&A to the Philippines. We increased our ASP on all the probes sold in the U.S.
We outsourced our PASCAL service to a third party, one of our devices as well, part of our contract manufacturing, our efforts to outsource contract manufacturing, which is one of our goals for 2026, which will go into 2027. We're continuing to do that. Looking at the financials that we achieved. The charts tells a compelling story. Comparing Q1 2024 to Q1 2026, on a comparable basis, OpEx declined by $2.7 million or 34%. Operating losses improved by $3 million or 90%. We sustained positive adjusted EBITDA in Q1, and cash at quarter end was $4.6 million. Critically, we are continuing our efforts to outsource all our manufacturing outside of California into other areas. We are still focused on reducing OpEx, improving our margin, and reporting cash flow positive operations this year. We are reaffirming our guidance of $51 million-$53 million in revenue.
Adjusted OpEx of $19 million-$19.5 million and positive adjusted cash flow for the full year. We have proven that we're good stewards of capital. We're going to continue to focus on the keys that got us here over the last year and a half. I want to thank you for your time today. I'll take any questions now. Okay. Yes, sir.
I did some due diligence because I have now. Did I read correctly that you're going to be refocusing the business on trying to sell probes? [audio distortion]
Yeah, the question was, are we going to continue to focus on selling probes or the hardware? On the glaucoma side you're speaking about, we are going to continue to focus the razor blade model. We're not fully saturated on system probes systems out there. We still have an opportunity for placements as well. To your point, the whole point behind the targeting that we're using the MedScout software is to drive utilization. We want to drive more probe growth. The opportunity is huge, particularly in the moderate patients. IRIDEX has been treating late-stage glaucoma for some time. We're well-known there. We have a continuous wave probe for that. As we move early in the continuum of care for treatment of glaucoma, that's where the real driver is for us.
What's the penetration rate of the retinal device internationally? Is there room for more growth on selling those things as capital equipment?
The question was, what's the penetration? What's the real growth internationally for our retina equipment? There's a really big opportunity for us outside the U.S. with our new PASCAL product that we just released, one I talked about earlier in the presentation. We don't have MDR approval yet in Europe for that product. We're in the process of getting it. We received questions from the notified body. Once we get those approvals, that opens up a huge market in Europe. There's other countries like China that take a couple of years to get approval. There's a large opportunity globally as well. Particularly the replacement market that I mentioned in the U.S. is also true outside the U.S. We still have those options as we introduce the new platforms.
[audio distortion] Why are these devices being replaced? Why?
We have devices that have been in the market for 20 years, our legacy probes, but particularly we're talking about PASCAL and IQ products. They have come out with new features, new advancement. We are seeing doctors, clinicians that want to upgrade to the PASCAL after five years. Our service life is seven years. At that point, we won't service it anymore anyway. If we do, it's going to cost a lot of money.
Generally, when it breaks down, it's cheaper for the doctor to buy the new equipment than pay for the repairs. I want you to ask another question.
Great.
During one of your presentation slides, you said that you had a tailwind that created some [audio distortion].
Yeah. I can talk to you about that. The Medicare LCD that comes out for reimbursement, our competitors who use MIGS devices are no longer allowed to stack those procedures. For example, they would do a canaloplasty and a goniotomy, for example, and then turn that in to get reimbursed. That's cut out. There's no proof that that was efficacious for the patient. Our device has a different mechanism of action. We use laser energy. We're not incisional, so our device is not a MIGS procedure. What we're seeing from this each quarter and coming out of the AAO last year is that our device, because of that, doctors are starting to use our device more earlier in the continuum of care. Okay.
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Thank you.
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No, go ahead.
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We were talking about the reimbursement, the LCD.
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Yeah.
What you just said is that Medicare basically shut down one of your competitors?
They didn't shut them down. They didn't allow stacking, meaning doing two MIGS procedures in a row at the same time. stacking means you're going to do a canaloplasty, for example, and then a goniotomy at the patient at the same time.
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A lot of them took a hit after that. Yeah.
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I took a tailwind.