Great. Good morning, everyone. Tom Stephan with Stifel . Really excited to have Sight Sciences here with us. Paul, Ali, Jim, thanks for joining. Maybe to kick things off, just to kind of level set the audience, Paul or Ali, maybe if you can start by just quickly recapping the recent third quarter print and maybe what you view as the highlights.
Sure. I'll start at a high level and then go into further detail on perhaps TearCare in particular. I think some of the key highlights for the quarter, obviously we announced TearCare market access wins. We've been at this for a decade now to transform the category of meibomian gland disease and evaporative dry eye. The efforts finally paying off, and we're excited to begin commercializing within those two covered MAC areas. Ali can talk more about that. We obviously have also been performing very well in our surgical glaucoma business. I think we're doing very well in MIGS this year. It's a headwind of a year, but with those restrictions, the LCD restrictions, we're lapping those headwinds in about a week.
Between the TearCare market access wins, the commercialization that's underway in those covered areas where we've established pricing and fee schedules, our ongoing MIGS commercial excellence, as we head into 2026, we're super excited about now having two growth engines in MIGS and in evaporative dry eye disease. It's not easy. It comes down to execution to deliver that growth. Also, in the last quarter, we've done a good amount of restructuring to enhance the focus on these two exciting growth opportunities. We've streamlined the business. We're operating even more leanly in terms of cost, but more effectively given the enhanced focus. I think we've made a lot of correct decisions on enhancing our commercial execution. Most recently, at the senior leadership level, we promoted Ali to Chief Operating Officer and Jim to Chief Financial Officer. We think we got that right also.
In particular, Ali, in scaling the TearCare business, Ali's background prior to Sight Sciences is highly relevant. I'll let Ali talk about everything that we're looking at with TearCare.
Perfect. No, that's great. And TearCare is where I wanted to start. I think certainly most topical and incremental for the Sight story as we sit here today. So Paul, I might stick with you. Just kind of starting on TearCare, talk about the value proposition of the product, notably what supports your view, I guess, that it should be a reimbursed procedure for patients.
Sure. Yeah. I mean, it all starts with clinical outcomes consistent with our mission at Sight Sciences. We're developing interventional technologies that elevate the standards of care. That's really important. We're not here to do me-too. We're here to disrupt eye care and elevate the standard of care. Clinically speaking, why does TearCare? Why should TearCare be reimbursed? Because we've done a head-to-head RCT that proves just that. We've gone head-to-head with the standard of care. Twice daily, the leading prescription eye drop, twice daily for six months straight. We randomized that against TearCare. At six months, we showed superiority in our primary signs endpoint and clinical and statistical significance in all signs and all symptoms. We also demonstrated durability of treatment effect. We ran this RCT out for two years. From a clinical perspective, we're elevating the standard of care.
We're doing so with a technology and clinical outcomes that are both immediate and durable. With that, we've taken that clinical data to payers, also compared it economically from a health economics perspective. Not only is TearCare more clinically effective in MGD, it's also more cost-effective. For those reasons, from the immediate clinical impact, the durability of treatment effect, and I mean across all signs and all symptoms of dry eye disease, and the health economics and the cost-effectiveness of TearCare, it's an excellent value proposition to payers. It's also important to mention, this is one of those unique opportunities where we have a large TAM. I used to invest prior to Sight. Every company has a large TAM, it seems. Can you actually execute and realize that TAM?
Often the reason why companies fall short is one of the key stakeholders or multiple stakeholders along the way as you're trying to realize that TAM doesn't really benefit from the offering as much as perhaps the other stakeholders. In our case, every stakeholder benefits from reimbursed TearCare. Patients get better treatments for their MGD. Doctors, whether that's an ophthalmologist or optometrist, get to offer their patients a new standard of care that works better for MGD. They also participate in the value and the economics of performing a procedure, a high-throughput procedure in office. Now there's a new value stream for providers. Payers are better off because their patients get better MGD treatments with better costs. Obviously, Sight Sciences, it's a very interesting business model, high-margin recurring revenue. Unlike glaucoma, surgical glaucoma, where we're successful, we try to make OMNI last as long as possible.
Hopefully it's for years and years and the patient doesn't need another surgery. In MGD care, I mean, the reality is it's more like a dental model. Patients are going to need one to two treatments per year. So patients stay in the model.
Got it. That's great.
It's interesting in that regard.
Paul, you stressed the clinical outcome, certainly how there's a lot of value there and the value proposition to payers is meaningful as well. You mentioned this, but for the physicians, can you frame for us maybe sort of the practice economics of TearCare, what profitability looks like? Will this be lucrative for them?
Yeah, and I can take that one. When we think about this category, first of all, eye care providers are looking for a solution for these patients. This is one of the leading causes of why patients go see their eye care provider. The current treatments today are primarily prescription drops, and then there is this small cash pay procedural market. This really is a unique solution for doctors' offices that are looking for ways to treat this patient population and provide a better solution. Obviously, we'll have to see how reimbursement shifts over time. Right now we've had two payer wins, as Paul mentioned, with First Coast and Novitas. We do expect commercial plans to layer over time that likely will be at higher prices.
Where we are at right now, we do think is an appropriate spot for, given the value that the ECP brings to the table, that will allow us to be able to work on this journey with them. There is fair economics for them, fair economics to the payers, fair economics to us based on the huge investments that we've put into TearCare over time as well. We do feel like there is that right economic profile. Again, this is still very early stage at this point in terms of our journey to establish this market.
Absolutely. Ali, maybe I'll stick with you. Very early in the journey, Novitas, First Coast now in place. Congrats on that. Maybe if you can talk about kind of the strategy over the next three to six months to get those regions ramped up. More importantly, how scalable is this strategy as we think about more payers coming online?
Yeah, of course. When we think about the strategy, as we said, first of all, we're not starting from zero. We have an established customer base. We've done over $70,000 cash pay procedures over time. At our peak in 2023 on the cash pay model, we did over $20,000 cash pay procedures that year. This is proof that there is high demand. That was with a pretty small sales and commercial infrastructure to drive that volume. We do think there is high demand for the procedure. When we think about our approach into the market here, we have the small sales team that we will be growing over time. We will also be leveraging our surgical glaucoma team as there is a decent amount of overlap of customer base there, of new accounts we can target, and also leveraging existing utilization of TearCare.
Our approach here is kind of two-pronged. We need to first increase payer density. While this is a great step in these markets and the big markets in Novitas and First Coast are Texas and Florida, those are kind of two primary states for us in these initiatives. We will be trying to increase payer density, looking at plans that have a lot of utilization within Texas and Florida and the other states covered by Novitas and First Coast to try and get that density up. Right now, we estimate about 25%-30% of the patients that they see have traditional Medicare fee-for-service. It is already a decent density to start. It is not like one in 100 where you are trying to find it, but it is not as great as when you can have over 50% or over 70% density in these markets.
We will be working with other payers to increase coverage for TearCare. We also will be working with other MACs as well to expand into other areas. We have gotten huge interest from our other customers that are outside of First Coast and Novitas saying, "When are you going to get coverage in my area?" That is something we are also heavily focused on. In terms of our actual commercial strategy, we are primarily focused on the accounts that already have TearCare SmartHubs and saying, "Okay, you have an existing hub. You've been trained on it over the last couple of years. That's at 200-ish accounts. How can we re-engage with you?" Most of those went dormant through this last year as we were pursuing reimbursement. Most of them are going through a process of saying, "Okay, I want to try a claim or two.
Let's see if I get paid. Now, we are very happy to say that we are seeing consistent claims paid from Novitas and First Coast, whether that's a new patient, whether that's a reprocessing of an old claim or an appeal. Those claims are being processed. That is giving our providers confidence that this is going to be a simple process from a billing perspective. We are then working with accounts to train on what are the right patients within their patient pool that come in from dry eye. How do we integrate this into their practice workflow? Are they going to have a dry eye day where they have TearCare treatments? Are they going to try and consolidate that? Are they going to have specific rooms? That structural side is important here.
Really, we're focused on education right now, awareness, and making sure that we see that success with the initial utilization. That's really the focus for the fourth quarter, I would expect. As we said, we expect relatively modest sales in the fourth quarter, still a step up, but $500,000-$1,000,000 of dry eye sales in the fourth quarter associated with these efforts, with those sales ramping in 2026.
Got it. That's great. Maybe to pivot to somewhat more long-term TearCare questions, I guess from a physician standpoint, talk about kind of receptivity, notably from the Novitas and First Coast doctors. Ali, you mentioned a lot of excitement, but maybe just elaborate a bit on what's kind of the chatter, what's sort of their feedback to these reimbursement wins?
It's a lot of excitement around this. Now, we were very happy to be able to announce this basically concurrent with AAO, a big industry conference. This did create a lot of excitement at the conference because there was a lot of skepticism of whether we were going to be able to establish reimbursed procedural dry eye, which had never really been done at these levels of reimbursement. A lot of excitement around that idea and how this could help their overall practice economics and the treatment of their patients and how this really could integrate into their workflow. We have seen a lot of people say this is a huge problem in their practice and this is a natural solution. What we really need to work through is just how to activate with them.
It's been less than a month still since we announced this, so we're still in very much early stages here. The response has been very encouraging in terms of people wanting to get access to this technology and use it for their patients.
That's great.
Tom, I would just add, we're not getting like a first response post-payer wins. We've been in the market. We've been in Novitas and First Coast in a cash pay environment with these same providers for many years. They've already spoken. They know they have long lines of MGD patients. There are no other treatments that address the root underlying cause of these MGD patients, which are obstructed meibomian glands, a physical problem that needs an interventional solution. That's what TearCare is. That's sort of already been proven. We were able to sell our equipment into these practices relatively easily because they know it's a real problem and there aren't any good solutions that address the root underlying cause. The business model was the problem, right? Selling cash pay to a patient for an ophthalmic disease is not typical in eye care.
Getting it reimbursed is what will unlock it. Now, we know this is a tremendous category we're going to create. The question is the timing, the timing to Ali's point, timing to get the other MACs on board, timing to get the large commercial, national commercial payers on board or the regional plans on board and how fast the customers ramp. Will this be a significant category? Are we creating a very big new category in eye care? Without doubt.
For sure.
What does that look like over the next 12 months? It's hard to predict.
Makes sense. Makes sense. Paul, I'll follow up to that. Ali mentioned kind of increasing payer density. Talk about kind of your visibility into additional payer wins in the near term, in the intermediate term. I guess to drill in more specifically, can we expect any additional wins in the next three to six months? Curious if there's any, we'll call it late-stage conversations.
I can actually take that one. This is something that has accelerated as we've come out of having our first major win with First Coast and Novitas. We are actively engaging with both other Medicare Administrative Contractors as well as commercial payers. Those conversations have been ongoing. Those are continuing to progress very well. Frankly, it has helped to have a fee schedule established by First Coast and Novitas, who has done basically, we've been engaging with First Coast and Novitas for the last 18 months. It's been a very long process to get them across the finish line here. There are natural followers to First Coast and Novitas. We are engaging with those payers. I would be surprised if we got six months from now and we didn't have other payer wins under our belts because we do have a large funnel.
We have had good conversations. We have great clinical data, and we have strong health economic data on how this saves payers' money. On top of that, we have high patient demand for this type of procedure. All of that really works to our benefit. We have had great engagement with the key opinion leaders in our space to really help us work through this process with the payers.
Got it. Got it. That's great. Sort of taking a step back, Ali, you mentioned this earlier. I think in 2023 at peak, you sold roughly 20,000 SmartLids. How quickly do you think you can get back to that?
It's a great question. Obviously, we're not going to provide any guidance today on specific timing of getting back to that level, but it is natural to assume that the market of a cash pay market versus the market for a reimbursed market, the reimbursed market is much larger than the cash pay market. Again, we were limited in our resources in 2023 and still were able to sell over 20,000 SmartLids, which is a testament to the end consumer demand for this type of procedure. We are very excited about the potential here. To us, it's more a matter of time. This is a very large market. Even 20,000 is a small fraction of the actual people who have dry eye disease and MGD in particular.
Got it. Maybe to wrap up here, I think that's a good segue sort of into my last question, but how does the company sort of think about peak sales for TearCare in the U.S.? Some industry sources, I think, have noted there's roughly 1-2 million patients in the U.S. on a prescription eye drop. Is that the right denominator here? Help us frame sort of how Sight Sciences views peak sales here for TearCare.
Yeah. Obviously, we see this as a large opportunity to help these patients who suffer from dry eye disease and MGD in particular. When we think about the market potential, we actually think about the 19 million people that have dry eye disease. If you break that down into the people who have MGD and are moderate to severe, you're still in the six to eight million patients that are sufferers of dry eye disease and have MGD in moderate to severe. That is a huge patient population. As you mentioned, there are a couple of million, 1-2 million of patients that are on eye drops.
To us, that discrepancy really shows that there is both an issue with adherence of using drops even when you are experiencing dry eye symptoms, because if you're doing that one time, two times, four times a day, it can be very hard to stick to a regimen like that. Also, efficacy. There are a lot of patients that try drops and they are treated with this aqueous deficiency, but really their issue is that they have blockages in their meibomian glands. Because of that, they do not experience the relief that they were expecting when they do these topical eye drops. As a result, we actually see the addressable market here to be much larger. Again, as a reminder to what Paul said earlier, this is a model where patients stay in the model. They would be coming back every six to twelve months for retreatment.
Certainly helps the TAM as well.
I actually think of it as categories, major new categories. Obviously, we're in the eye care space, so within ophthalmology, probably like once a decade, a big new category is created if you look back. MIGS, anti-VEGF. I think this is the beginning of a significant new category creation that comes along every once in a while.
Obviously, I didn't answer your question on peak sales. I think it's too early to say peak sales, but this is a huge TAM that, again, as Paul said earlier, provides value to all the stakeholders. We believe we're really positioned to execute well here.
That's great. Maybe in the last 10 minutes or so, we can pivot to MIGS and OMNI. Maybe I'll just jump right in. When we compare your 3Q 2025 surgical glaucoma revenue to Glaukos's U.S. glaucoma excisional revenue, we see that Sight gained share sequentially. That's the second straight quarter that Sight has gained share sequentially from Glaukos. Maybe if you can talk to kind of the share dynamics in the current kind of unstacked MIGS environment, what's driving the share gains in your view? Are the relative economics maybe at play here? Curious if you can just elaborate on share dynamics.
Yeah, I'll start off and then pick it up. A couple of things, Tom. One, I'd say our team's execution, our surgical glaucoma commercial team is as tenured and focused on MIGS, as tenured as any. Probably more focused on MIGS in 2025 than anyone else. I think that's showing up in the results. Well-established relationships with the leading ophthalmic surgeons. Commercial execution and excellence is very important and focus. Number two, in a one MIGS environment, with the elimination of multiple MIGS that has been a headwind to the entire MIGS industry this year. In a way, while it's a headwind to all of us, including Sight and OMNI, relatively speaking, you could see it as a tailwind to OMNI. Meaning a surgeon now has to choose one MIGS procedure, they're going to likely prioritize the one that on its own is most comprehensive and clinically efficacious.
That is kind of OMNI's kind of brand and position in the market. It was designed to offer per its label, per its design. It offers multiple mechanisms of action. It is indicated for canaloplasty followed by trabeculotomy in both combo cataract cases as well as standalone cases. It is kind of like multiple MIGS in one device already. In a MIGS environment that only allows you to choose one, it is relatively stronger. I think the combination of OMNI and its clinical position coupled with commercial excellence, look, the other, we are the number two player in MIGS overall. We are the number one player in implant-free MIGS by a long shot. We are surrounded by the two stent players. The number one stent player has obviously been very busy with sustained release.
The number three stent player we've been focused on is a lot of our product and their product was being used together. We're trying to win as much of that business as we can. I think we've been doing a good job of it this year.
That's great. Jim, I'll pull you in here. I have a question on guidance. So when we look at 4Q 2025 implied guidance at the midpoint, I think it suggests glaucoma is down slightly sequentially, but typically it's up in the fourth quarter just given seasonality. Anything we should be cognizant of, or I guess is this maybe just more of the company's kind of typical approach to guidance?
Yeah, so appreciate it. We do take a prudent and achievable guidance strategy as we set that. We feel really good about the glaucoma business and how we performed in the third quarter, getting back to growth earlier than expected and record number of ordering accounts, a number of really, really good things happening there. The team's executed really well. As we look ahead to Q4, we feel really good about it. Our guidance ranged from flattish to high single-digit growth year over year. We feel good about that. As we get into 2026, returning to growth there.
Got it. That's great. You mentioned 2026, and this is for anyone, but on surgical glaucoma, how should we be thinking about long-term growth for the company's surgical glaucoma segment? We have a low to mid-single-digit combo cataract MIGS market growth that's maybe somewhat maturing. We have standalone, which is early emerging. OMNI should be a beneficiary of that. Longer term, how do we think about sort of the algorithm for Sight's glaucoma business?
Yeah, I'd say all of the above at a high level, continuing to grow, take share in combination cataract as we've been doing, expand the combo cataract market. It's less than 50% penetrated today. Getting more cataract surgeons who are treating patients who have glaucoma, who are doing cataract surgery on patients who have glaucoma, getting them to adopt MIGS more regularly. Expanding the combo cataract MIGS market. Tom, as you mentioned, the standalone market, we've got the interventional glaucoma mindset is here. Frankly, the interventional mindset in eye care, which then feeds into the overall Sight story of building a leading interventional eye care company with our two flagship technologies, OMNI for glaucoma and TearCare for dry eye disease. The interventional glaucoma mindset is here. It's now moving from that mindset to operationalizing standalone cases.
We have been very prescriptive with a growing number of accounts to educate them. It is almost like the cataract model where we bring in interventional glaucoma candidates. We are helping our practices, our customers understand that they need to bring these patients in for interventional glaucoma consultations, just like you would a cataract consultation where you sit and you talk about that and you put a game plan together and you choose an interventional procedure, and then the patient comes back for surgery. We have been working with that model with a number of accounts, and it is showing very good increases in interventional glaucoma cases. Lots of those are OMNI. We are going to start to expand that in 2026. That is the other growth driver for us in surgical glaucoma, expanding the pseudophakic standalone market. Obviously pipeline. We are an innovative company, clearly.
OMNI and TearCare were both homegrown, and we have a number of other exciting interventional innovations that are coming down the pipeline.
That's great. I'll push a little more here just to wrap it up on surgical glaucoma. If combo cataract, low to mid-single-digit market growth, Sight is a share gainer, maybe at least mid-single-digit growth for OMNI in combo cataract, then you have the incremental contribution from standalone where it seems like early efforts are bearing some fruit. Can surgical glaucoma be durably high single-digit growth in the intermediate term? I'll take a shot at this.
I mean, clearly we're not going to give 2026 guidance today, but I think you understand the factors that are at play in the market, and we think we are performing better than market.
Got it. That's great. Last 38 seconds here. I'll try to squeeze in a couple more. Profitability, Jim or Ali, what's the latest messaging in regards to the company's break-even targets? Talk about just the health of the balance sheet, and then I'll try to squeeze in more.
Yeah, we feel good about the balance sheet as well, over $90 million in cash and confident in our ability to be on a pathway to break even without the need for additional equity capital. Not giving any timelines on that at this point, but we're in a good spot there.
That's great. Then last one on OpEx, adjusted OpEx $20 million in 3Q at the midpoint for full year guidance being guided to $22 million, I think is implied for 4Q. For 2026, do we think about that kind of low $20 million range as the right quarterly run rate, or will we maybe see a step up as, I guess, notably TearCare commercial efforts pick up?
Yeah, so no specific guidance on 2026. What I'll say is we're set up to scale this business and invest appropriately. We're going to make very informed, measured investments. You've seen over the last couple of years, we've had really, really strong financial discipline and have done a really good job on the P&L. We'll take that same approach. Ali and Paul and I have worked very closely over the last couple of years to manage the P&L. As we turn to growth, we'll use that same philosophy on investing, be disciplined, and scale these businesses.
That's great. Team, thanks so much.
All right. Thanks a lot.