Glaukos (GKOS) Q1 2026 earnings review
iDose TR Propels Accelerating Growth While Operating Losses Persist
Glaukos delivered a massive 41% YoY revenue jump in Q1 2026, driven entirely by the explosive adoption of its iDose TR implant. U.S. Glaucoma sales skyrocketed 58% as the company successfully established the 'Interventional Glaucoma' paradigm. Despite record revenues and Non-GAAP gross margins expanding to an impressive ~84%, the bottom line remains mired in red ink. Non-GAAP net loss registered at $10.4 million, constrained by heavy ongoing investments in commercial infrastructure and R&D. Buoyed by top-line momentum and the commercial launch of its novel Epioxa therapy, management raised FY26 revenue guidance, cementing the narrative of a high-growth, high-burn phase.
🐂 Bull Case
With $54 million in Q1 sales, iDose TR is scaling rapidly. It confirms physician appetite for stand-alone, dropless interventional therapies and is successfully driving U.S. Glaucoma sales up nearly 60% YoY.
The long-awaited Epioxa (epi-on corneal cross-linking) therapy is now commercially available. With a permanent J-code effective July 2026, it offers a less invasive alternative to Photrexa, poising the Corneal Health segment for substantial long-term growth.
🐻 Bear Case
Despite 41% top-line growth and stellar 84% gross margins, heavy commercialization and R&D costs generated a $19.9 million GAAP operating loss. Operating leverage remains elusive.
The switch from Photrexa to Epioxa is likely to cause near-term volatility. Patients and providers may 'warehouse' (delay) procedures until the new Epioxa J-code fully kicks in by Q3.
⚖️ Verdict: 🟢
Bullish. Glaukos is successfully executing a massive paradigm shift in glaucoma treatment. While profitability remains elusive, the 41% revenue growth and rapidly expanding iDose TR adoption prove the company's aggressive investments are paying off on the top line.
Key Themes
iDose TR Adoption is Accelerating
The iDose TR launch is the undisputed growth engine for Glaukos. Sales reached approximately $54 million in Q1 2026, marking a clear acceleration from $45 million in 25Q4 and $31 million in 25Q2. This product alone is single-handedly driving the 58% surge in U.S. Glaucoma revenue. Broadening market access, unlimited re-administration label updates, and increasing surgeon utilization confirm that the shift toward 'Interventional Glaucoma' is working.
Epioxa Launch Revives Corneal Health
Reversing the stagnant performance seen in 2025, Corneal Health revenue grew 15% YoY to $21.3 million. This marks the beginning of the Epioxa era, which became commercially available in March 2026. Management has already secured access pathways for >100 million commercial lives and expects a permanent J-code (J2789) to activate in July 2026, which should streamline reimbursement and accelerate adoption.
Operating Expenses Remain Elevated
Stable, but problematic. Glaukos continues to burn cash to fuel its growth. SG&A expenses spiked 32% YoY to $92.9 million to support global commercial expansion and new product launches, while R&D expenses jumped 36% YoY to $44.1 million. The pace of spending is almost matching revenue growth, keeping the company firmly in unprofitable territory (-$19.8M GAAP Net Loss) despite an incredible 84% Non-GAAP gross margin.
Corneal Health Transition Disruption
Management explicitly warned of potential transient headwinds within the U.S. Corneal Health franchise due to the Photrexa-to-Epioxa transition. In prior quarters, they noted a 'warehousing effect' where patients delay their Photrexa procedures to wait for the less invasive Epioxa therapy. This poses a near-term execution risk until the permanent J-code takes full effect in Q3 2026.
International Competition Pressures
While International Glaucoma sales grew a healthy 23% YoY, management baked 'combo-cataract MIGS competition globally' into their 2026 guidance as a distinct headwind. As Glaukos shifts focus to stand-alone therapies, legacy combination MIGS devices are facing fierce market share battles overseas.
International Glaucoma Expansion
Accelerating from a 13% constant currency growth rate in Q4 2025 to 16% in Q1 2026, the International Glaucoma segment hit a record $35.8 million. The rollout of iStent infinite in Europe (following EU MDR clearance last year) is helping scale the international infrastructure and establish MIGS as the global standard of care.
Other KPIs
Stable and exceptional. The Non-GAAP gross margin improved by 120 basis points YoY (from 82.4% in 25Q1). High-margin products like iDose TR and a shift toward higher-priced therapies continue to yield software-like gross margins, providing the raw capital to fund massive commercial investments.
Stable. Total liquidity remains healthy, down only slightly from $282.6 million at the end of FY25. With zero debt on the balance sheet, Glaukos has ample runway to navigate its current operating losses while waiting for its newly launched products to reach peak revenue generation.
Accelerating dramatically. Growth surged to 58% YoY compared to 41% YoY a year ago. This segment accounts for 62% of total revenue and is the primary beneficiary of the iDose TR commercial rollout.
Guidance
Accelerating. Management raised the full-year guidance from the previous range of $600-$620 million. The new midpoint ($627.5M) implies roughly 23.6% YoY growth against FY25's $507.4M. This reflects high confidence in the continued adoption of iDose TR and early contributions from the Epioxa launch.
Key Questions
Timeline to Profitability
With Non-GAAP gross margins nearing 84% and revenue growing at 41%, what revenue threshold is required to achieve operating leverage and reach cash-flow breakeven, considering the continued 30%+ growth in SG&A and R&D?
Epioxa Warehousing Effect
Given the commercial availability of Epioxa in March but the permanent J-code not taking effect until July, how severe do you expect the 'warehousing' of keratoconus patients to be in Q2, and what is the strategy to bridge this gap?
iDose TR Combo vs Stand-Alone
With the rapid rise to $54 million in quarterly iDose TR sales, what is the current breakdown between stand-alone procedures versus those performed in combination with cataract surgery, and how is the mix evolving?