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DATE

Thursday, November 6, 2025 at 4:30 p.m. ET

CALL PARTICIPANTS

  • Co-Founder and Chief Executive Officer — Paul Badawi
  • Chief Financial Officer — Jim Rodberg
  • Chief Operating Officer — Ali Bauerlein

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RISKS

  • Surgical glaucoma gross margin remained flat at 87% for fiscal Q3 2025 (ended Sept. 30, 2025), as increased average selling prices were offset by $400,000 in tariff costs and higher overhead costs per unit.
  • Dry eye gross margin was 38%, compared to 48% for the period, primarily due to higher overhead cost per unit, as management stated.
  • The Surgical Glaucoma segment is expected to face $1 million to $1.5 million in tariff-related cost of goods sold for full year 2025, with management noting continued uncertainty in future tariff rates.
  • Management confirmed "we have not received any monetary damages awarded" related to the patent infringement case against Alcon, impacting potential cash inflows.

TAKEAWAYS

  • Total Revenue -- $19.9 million, a 1% decrease in total revenue; primarily resulted from lower dry eye revenue while surgical glaucoma grew.
  • Surgical Glaucoma Revenue -- Surgical glaucoma revenue was $19.7 million for fiscal Q3 2025 (ended Sept. 30, 2025), up 6% compared to the prior year period and up 3% sequentially compared to the previous quarter; driven by increased ordering accounts and average selling prices, partially offset by lower account utilization.
  • Dry Eye Revenue -- $200,000, a decrease from $1.5 million in the prior year; decrease aligns with the strategic refocus on reimbursed market access for TearCare.
  • Gross Margin -- 86%, up from 84%.
  • Surgical Glaucoma Gross Margin -- 87%, flat compared to the prior year; tariff-related costs and product mix offset increases in average selling price.
  • Dry Eye Gross Margin -- 38%, compared to 48% for the period; attributed to higher unit overhead, partially mitigated by improved average selling prices.
  • Total Operating Expenses -- $25.1 million total operating expenses for the quarter, decreased 11% from $28.1 million in the prior year; driven by lower stock-based compensation, personnel-related costs, and R&D spend.
  • Adjusted Operating Expenses -- Adjusted operating expenses were $19.8 million for the quarter, representing a 17% reduction from $23.8 million in the prior year; reflects restructuring and cost management.
  • Restructuring Costs -- $2.8 million in restructuring costs were incurred in connection with the August reduction in force, generating $12 million in expected annualized personnel savings.
  • Net Loss -- $8.2 million, or $0.16 per share for the quarter, versus $11.1 million, or $0.22 per share for the prior year period.
  • Cash and Debt -- $92.4 million in cash and cash equivalents as of quarter end; $40 million in debt outstanding (excluding adjustments).
  • Full-Year Revenue Guidance -- Raised to $76 million to $78 million from prior $72 million to $76 million for full year 2025; includes expected dry eye revenue of $500,000 to $1 million in Q4 2025.
  • Adjusted Operating Expense Guidance -- Lowered to $90 million to $92 million for 2025, representing a 9%-11% decrease compared to 2024.
  • TearCare Reimbursement Milestone -- First Coast Service Options and Novitas Solutions established $1,142 fee schedules for CPT code O563T, retroactive to January 1, 2025, covering 10.4 million Medicare beneficiaries in designated states within the areas covered by these two MACs.
  • Ordering Accounts (Surgical Glaucoma) -- Reached record high for the second consecutive quarter, up 2% sequentially and 8% year-over-year; driven by reengagement with dormant accounts and new account activation.
  • OmniEdge Utilization -- Product adoption increased, contributing to higher average selling prices and positive reception among surgeons.
  • UnitedHealthcare Coverage -- Inclusion of Omni in UnitedHealthcare's expanded surgical glaucoma treatment coverage effective October 1, 2025 was announced, with management expecting incremental growth beginning in Q4 2025.
  • Dry Eye Commercialization Strategy -- Focused on approximately 200 existing professional provider accounts in Medicare fee schedule regions, leveraging site access portals and targeted sales resources to drive adoption and utilization.
  • Executive Management Changes -- Ali Bauerlein promoted to Chief Operating Officer and Jim Rodberg to Chief Financial Officer, each cited by management as "critical members" aligned with strategic objectives.
  • New Manufacturing Sites -- Production for OmniEdge and SmartLid is expected to begin outside of China in 2026, mitigating tariff exposure and diversifying the supply chain.

SUMMARY

Sight Sciences (SGHT 0.60%) reported $19.9 million in revenue for fiscal Q3 2025 (ended Sept. 30, 2025), with a clear return to growth in its surgical glaucoma segment, driven by increased ordering accounts and higher average selling prices. The company achieved a pivotal reimbursement milestone as both First Coast Service Options and Novitas Solutions established permanent fee schedules for TearCare in October 2025, extending market access to 10.4 million Medicare beneficiaries. Management raised full-year 2025 revenue guidance and reduced expense outlook, reflecting improved cost discipline and anticipated new segment contributions. Coverage for Omni by UnitedHealthcare was cited as a catalyst for future growth in surgical glaucoma, with coverage effective Oct. 1, 2025, while continued investment in market access, provider engagement, and new manufacturing locations was confirmed.

  • CEO Badawi stated, "Our third quarter revenue of $19.9 million was driven primarily by adoption of our OmniSurgical Glaucoma Technology," directly linking growth to this product line.
  • COO Bauerlein expressed that provider interest in TearCare has increased rapidly since reimbursement rates were announced in October 2025, with claims now being paid at established rates.
  • CFO Rodberg confirmed, "We are raising our revenue guidance to $76 million to $78 million."
  • Management explained that the dry eye business will shift to a recurring revenue model supported by broadened reimbursement, targeting 6,500 eye care providers, and leveraging an installed base of 1,500 TearCare hubs.
  • Strategic commentary included an emphasis on leveraging tactical and disease synergies across glaucoma and dry eye segments, with overlapping surgeon and patient populations targeted for multi-segment growth.

INDUSTRY GLOSSARY

  • MIGS: Minimally Invasive Glaucoma Surgery; a set of procedures designed to lower intraocular pressure with reduced risk and recovery time compared to traditional glaucoma surgery.
  • MAC: Medicare Administrative Contractor; private entities that process Medicare claims and determine coverage policies for specific U.S. jurisdictions.
  • CPT code O563T: A procedural billing code specifically used to describe TearCare procedures for dry eye disease.
  • Pseudophakic: Clinical term referring to patients who have undergone cataract surgery and now possess an artificial intraocular lens.
  • PGAs: Prostaglandin analogs, widely prescribed medications for glaucoma management that can have ocular surface side effects.

Full Conference Call Transcript

Hannah Jeffries: Thank you for participating in today's call. Presenting today are Sight Sciences' Co-Founder and Chief Executive Officer, Paul Badawi, and Chief Financial Officer, Jim Rodberg. Also in attendance is Sight Sciences' Chief Operating Officer, Ali Bauerlein. Earlier today, Sight Sciences released financial results for the third quarter ended 09/30/2025, and raised its revenue guidance and lowered its adjusted operating expense guidance for the full year 2025. A copy of the press release is available on our website at investors.sightsciences.com. I would like to remind everyone that comments made by management today and answers to questions will include forward-looking statements within the meaning of the federal securities law.

These forward-looking statements include statements related to our 2025 revenue, adjusted operating expense guidance, and the primary factors impacting our ability to achieve our guidance. Our outlook for 2025 and into 2026, the impact of tariff costs on our cost of goods sold, our plans to expand our manufacturing lines to additional manufacturing locations, and the expected timelines and related costs. Our marketing, commercialization, and growth strategy, in particular for our tier care segment. Our ability to achieve our current and long-term strategic objectives and value drivers. The benefits we expect to realize from our recent executive management restructuring.

Our market opportunity and ability to compete and capture market share, the continued adoption of our products by surgeons, our product reimbursement coverage and strategy, including our ability to achieve broader positive reimbursement coverage, and or payment decisions for tier care. Expectations regarding commercial momentum, account utilization, and customer engagement. Our pipeline of interventional glaucoma and dry eye technologies, our clinical trial strategy and results, our investments in market development and research and development projects, and expectations regarding the relief that we may ultimately be awarded any potential impact of recently requested ex parte reexaminations on such relief in connection with our patent infringement case against Alcon.

Forward-looking statements are based on estimates and assumptions as of today and are neither promises nor guarantees and are subject to risks and uncertainties that may cause results to differ materially from those expressed or implied by these statements. A description of some of these risks and uncertainties can be found in our public filings with the Securities and Exchange Commission, including the risk factors section of our annual report on Form 10-K and quarterly reports on Form 10-Q. We undertake no obligation to publicly update or revise any forward-looking statements except as required by law.

On this call, management refers to certain financial measures that were not prepared in accordance with generally accepted accounting principles of the United States, including adjusted operating expenses. We believe these non-GAAP financial measures are important indicators of the company's operating performance because they exclude items that are unrelated to, and may not be indicative of its core operating results. See our earnings release for a reconciliation of these non-GAAP financial measures to the most directly comparable GAAP financial measures, as well as additional information about our reliance on non-GAAP financial measures. I will now turn the call over to Paul.

Paul Badawi: Thanks, Hannah. Our proven interventional technologies continue to have a profound impact, shaping the treatment landscapes for glaucoma and dry eye disease. Glaucoma remains the world's leading cause of irreversible blindness, and dry eye disease is one of the leading causes for a visit to an eye care provider. Both conditions are the result of obstructed anatomy in the anterior segment, where the standard of care topical prescription eye drops often fail to address the underlying cause of disease.

With two clinically proven, efficacious, and reimbursed interventional technologies for these two major anterior segment diseases, we believe that we have a unique opportunity to cross-functionally leverage team, market, and disease synergies to create proprietary value and build a leading interventional eye care company. Our strong third quarter results were driven by excellent performance by our surgical glaucoma team, where we returned to growth in the quarter, both versus the same period in the prior year and sequentially. Our third quarter revenue of $19.9 million was driven primarily by adoption of our OmniSurgical Glaucoma Technology. We continue to deliver operational excellence, achieving solid gross margins and improved expense management.

In addition, we anticipate that our recent achievement of the carrier price fee schedules established for tier care by First Coast Service Options and Novitas Solutions will allow us to pioneer the reimbursed market for interventional dry eye procedures and expand care for patients. Our momentum in surgical glaucoma and the new fee schedules established for tier care will be instrumental in driving sustained long-term growth. This progress further strengthens our outlook for 2025, and as a result, we are raising our full-year 2025 revenue guidance to $76 million to $78 million. I want to start with our dry eye business, where we have seen important advancements.

In October, Qmax, Novitas, and First Coast each established jurisdiction-wide pricing for CPT code O563T, which describes the procedure performed with our tier care system. The fee schedules were made retroactive for all dates of service on and after 01/01/2025. Within the areas covered by these two MACs, we estimate there are 10.4 million Medicare-covered lives. By securing appropriate fee schedule amounts for tier care in these two MAC regions, we are beginning to realize our vision of pioneering the reimbursed interventional dry eye treatment market.

We are seeing results from the deliberate phased approach that started with the development of best-in-class technology, demonstrated strong long-term clinical and health economic outcomes, and now we are focused on building customer advocacy, expanding market access, and commercialization. The payment rate established within these fee schedules is approximately $1,142 for participating providers in these areas and represents real value for all stakeholders, including Medicare, providers, patients, and Sight Sciences, when considering the clinical value of the procedure. These MAC fee schedules are an important benchmark as we pursue additional coverage and fee schedules with other MACs and commercial payers in the coming periods.

We estimate there are approximately 6,500 eye care providers nationwide, including both ophthalmologists and optometrists, identified as potential adopters of tier care procedures based on high utilization of alternative dry eye disease treatments. We estimate an existing footprint of approximately 200 professional eye care providers who have previously purchased Tiered Care Smart Hubs in these states with Medicare fee schedules established. With at least 15% dry eye disease prevalence estimated in the Medicare population and an established customer base in these regions, and a tenured sales team eager to support clinicians and patients, we are ramping targeted tier care commercialization efforts.

We are now focusing our commercial resources on supporting providers in these specific geographies and are expanding the use of our site access portal to streamline insurance authorizations and reimbursement. Our strategy is focused on facilitating provider adoption through the foundation of our experienced sales, marketing, and customer support teams, already dedicated to the dry eye market. We will also target new eye care providers in these states based on their current treatment of dry eye disease and focus on our surgical glaucoma customers in these states who may also benefit from adding Tiered Care to their treatment offerings.

While it has been just three weeks since receiving confirmation that fee schedules were established, we have seen strong new customer interest in learning more about tier care and good reengagement with existing accounts. We are pleased with this enthusiastic customer engagement early on and expect this activity to continue to increase through the rest of 2025 and into 2026. There is significant patient need that we believe will lead to substantial revenue growth over time as the pioneer of reimbursed interventional dry eye treatments.

Turning to our surgical glaucoma segment, we have now completed the third full quarter operating within the new MIGS environment, where Medicare coverage in most states restricts performing multiple MIGS procedures in combination with cataract surgery, and we are very pleased with our execution. Our performance this year demonstrates that Omni is a foundational component of many MIG surgeons' treatment algorithms. In 2025, our surgical glaucoma revenue was $19.7 million, up 6% compared to 2024, and up 3% sequentially. Importantly, the sequential growth comes off the typically seasonally high second quarter. Our strategic priorities include reinforcing our competitive position, making focused commercial investments, accelerating adoption of OmniEdge, and expanding the standalone Omni opportunity in pseudophakic patients.

Throughout the third quarter, we made meaningful progress across each of these initiatives, which was reflected in ordering accounts, utilization, and average selling prices. For the second quarter in a row, we reached a record high for ordering accounts. In the third quarter, ordering accounts were up 2% sequentially, and 8% versus the same period in the prior year. This was driven by both reengagement efforts with accounts who had ordered previously but had gone dormant and also new accounts ordering for the first time. Utilization was also strong, delivering a flat sequential performance versus typical seasonal declines from the second quarter to the third quarter.

In addition, our average selling price increased versus the same period in the prior year, with increased OmniEdge utilization, which continues to be well received by surgeons. These metrics represent our core growth drivers and main focus of our commercial team, and we are very pleased that we continue to see strong progress. Additionally, we believe there are market and tactical synergies across our surgical glaucoma and dry eye segments. There is customer overlap, as most glaucoma surgeons treat dry eye disease and have many glaucoma patients talking to them about their ocular surface disease symptoms.

There is also disease overlap because some glaucoma eye drops can cause or exacerbate dry eye and damage the ocular surface, including prostaglandin analogs, or PGAs, the most frequently prescribed medication for glaucoma. Long-term PGA use has been associated with obstructive meibomian gland disease. We expect our surgical glaucoma team to be a partner to our ocular surface sales team as they create awareness for the benefits of tear care treatments. As discussed before, we believe there is a significant unmet need among pseudophakic patients and that this patient population is well suited for a standalone procedure with Omni.

We believe that our efforts to grow this segment with a targeted approach that prioritizes education efforts aimed at surgeons and their staff are yielding positive results, and that by targeting this segment, we will drive Omni adoption that can be a meaningful growth driver for us. The strength of the third quarter highlights the progress we are making, and we recently hit another milestone that we believe will further drive growth within our Surgical Glaucoma segment. In September, it was announced that Omni was included in UnitedHealthcare's expanded coverage of glaucoma surgical treatments, effective 10/01/2025. We believe that this will be a growth driver starting in the fourth quarter and beyond.

Lastly, I want to comment on the management changes that we announced today. I'm very excited for the latest evolution of the Sight Sciences management team, with the promotion of Ali Bauerlein to Chief Operating Officer and Jim Rodberg to Chief Financial Officer. Both Ali and Jim have been critical members of the team for multiple years, and they have each made many contributions over their tenure at Sight Sciences. We have all been working very closely together in that time to advance our strategic priorities and drive our results. I'm confident that their unique skill sets directly align with our vision of the future of eye care and the needs of the organization.

As Chief Operating Officer, Ali will have direct responsibility for the successful scale-up of our Tiered Care franchise and increased oversight over our day-to-day operations. Ali has a proven track record of leading a rapidly growing medtech through multiple phases of growth. As we achieve more tier care market access wins over the coming quarters and years, we are poised to create a new standard of care and significant new category in eye care: reimbursed procedural dry eye.

We are confident that Ali's promotion to a COO role right now is a timely one, helping to ensure that our company maintains its daily cross-functional execution discipline and that our Tiered Care business scales reliably and predictably and achieves its fullest potential. Jim is also a great fit for our CFO role as Ali transitions to COO. Like Ali, Jim has also been a top performer at Sight for many years, and we are very pleased to recognize his demonstrated impact, leadership abilities, and significant potential with his promotion to CFO.

Having served as our Interim CFO in 2023 and having worked closely with Ali and me for the past two years, Jim brings a strong finance background from a leading medtech organization that will be critical to our continued execution and predictable growth in the coming years. We expect our ability to drive growth while maintaining operational discipline to continue under Jim's leadership, and we are very pleased to welcome him to our executive leadership team. We believe this will be a seamless transition as our cohesive management team continues to execute against our priorities.

As we look ahead, our strategy is focused on several key priorities, which include securing additional reimbursement coverage and or payment decisions for tier care, accelerating commercial momentum in MIGS and dry eye, deepening customer engagement through ongoing education initiatives, generating new clinical and economic evidence to support broader adoption of our technologies, and progressing our robust product pipeline. We believe that we are well positioned to finish the year strongly and thereby set ourselves up nicely for a return to growth in both business segments in 2026.

We intend to continue to elevate our market leadership position in MIGS and drive momentum in surgical glaucoma with Omni, and to begin to scale the reimbursed interventional dry eye category we are creating with TearCare. It's an exciting time at Sight Sciences, given the significant patient impact we are positioned to make over the coming years by enabling our customers to treat two major obstructive ophthalmic diseases with proven procedural interventions. I will now turn the call over to Jim to discuss our third quarter financial results and updated guidance for 2025.

Jim Rodberg: Thanks, Paul. I'm thrilled to be stepping into an expanded role at Sight Sciences, especially at such an exciting time for the company. During my time here, I've been able to work alongside the management team and see firsthand the growth and progress that we have made. As CFO, I look forward to continuing to build from our strong foundation and deliver on our strategic goals. Turning to our results. Unless noted, results are for 2025, and all comparisons are to the same period in the prior year. In the third quarter, total revenue was $19.9 million, a 1% decrease. Surgical glaucoma revenue was $19.7 million, an increase of 6%.

Surgical glaucoma growth was due to an increase in both ordering accounts and average selling prices, partially offset by lower account utilization. Our dry eye revenue was $200,000, a decrease from $1.5 million, in line with our expectations due to fewer SmartLid sales as we focused primarily on achieving reimbursed market access for tier care procedures. Gross margin was 86%, up from 84%. Surgical glaucoma gross margin was 87%, flat compared to 87%, primarily due to tariff costs, higher overhead costs per unit, and product sales mix offset by higher average selling prices. We incurred $400,000 in surgical glaucoma cost of goods sold associated with tariffs.

Dry eye gross margin was 38%, compared to 48%, primarily due to higher overhead cost per unit partially offset by higher average selling prices. Total operating expenses were $25.1 million, a decrease of 11% compared to $28.1 million, primarily due to lower stock-based compensation, personnel-related expenses, and research and development expenses. As part of the reduction in force announced in August, we incurred $2.8 million in restructuring costs and a reduction in stock-based compensation of $600,000. Adjusted operating expenses were $19.8 million, a decrease of 17% compared to $23.8 million. Our net loss was $8.2 million or $0.16 per share, compared to a net loss of $11.1 million or $0.22 per share.

We ended the quarter with $92.4 million of cash and cash equivalents and $40 million of debt, excluding unamortized discount and debt issuance costs. Cash used was $9.1 million, including $1.5 million of restructuring costs. As a reminder, we have not received any monetary damages awarded in our successful jury trial verdict in our patent infringement case against Alcon. Moving to our revenue outlook for full year 2025. We are raising our revenue guidance to $76 million to $78 million, compared to our prior guidance of $72 million to $76 million. Our revenue guidance includes revenue for our dry eye segment of $500,000 to $1 million for the fourth quarter.

This revenue guidance range implies fourth-quarter revenue growth from our surgical glaucoma of low single digits at the midpoint of the range versus 2024. We still expect the Surgical Glaucoma segment's tariff exposure to be between $1 million to $1.5 million for full year 2025, although we acknowledge this is a very dynamic environment with uncertainty on future tariff rates. As a reminder, we have been working on additional third-party manufacturing locations outside of China, and we expect these facilities will begin producing a portion of our volumes starting with our OmniEdge and Tiered Care SmartLid product lines in 2026. We expect dry eye gross margin in the fourth quarter to be higher than the gross margins seen in 2025.

We expect our dry eye gross margin to expand significantly with higher volumes associated with broader reimbursed market access as we ramp commercialization, partially offset by import tariffs. We are also reducing our adjusted operating expense guidance for full year 2025 to $90 million to $92 million, representing a decrease of 9% to 11% compared to 2024. This guidance still includes investments in pseudophakic standalone market development, tier care market access and commercialization, as well as focused research and development projects, and also reflects reductions in spend associated with the August reduction in force. We still expect the reduction in force to generate approximately $12 million in annualized personnel-related savings.

We're pleased with the operational and strategic progress achieved this quarter and remain focused on deepening our presence in the surgical glaucoma and dry eye markets. As we continue to execute against our long-term objectives, we're laying a strong foundation for sustained growth and future success. Operator, please open the line for questions.

Operator: Yes. Thank you. At this time, we'll conduct a question and answer session. As a reminder, to ask a question, you'll need to press 11 on your telephone. Wait for your name to be announced. To withdraw your question, please press 11 again. Your first question comes from the line of Danielle Antalffy with UBS. Your line is now open.

Danielle Antalffy: Hey. Good afternoon, guys. Thanks so much for taking the question. Congrats on a really good quarter and congrats on the tier care news on coverage. I was at AAO, and it was really fun to see the excitement around it and also get my tear care procedure. That was very exciting as well, and I loved it. My question is for Ali, actually. Congratulations on the new role. I guess, at a high level, as Chief Operating Officer, what's going to be your primary focus over the next six to twelve months? And, you know, where do you think you see the most potential for near-term change to drive improving performance?

I guess, where are you going to be spending most of your time, and what do you think are areas you think you can really have a near-term impact? Thanks so much.

Ali Bauerlein: Yeah. Thanks, Danielle. And we're really excited about where we are from a development perspective here at Sight Sciences. I will really be focused on accelerating our growth, increasing the oversight on the day-to-day operation, but most importantly, really working with the team to drive the successful scale-up of the Tier Care franchise. And I am very excited about the tier care potential. This is a new category of reimbursed interventional dry eye that we are establishing, and now having our first payer pricing established at appropriate rates really allows us to go approach the market. And we have a very unique value proposition here. This is something that is great for payers, great for providers, great for patients.

And all of that leads to a great opportunity to drive this market over time. And it's a large market. We have a product that has great clinical efficacy. This is a recurring revenue business. And we're very excited about establishing Tier Care as a leading interventional dry eye treatment company and category. So that's really what I'll be focused on, primarily. And, you know, really excited to be taking on this new role at Sight Sciences.

Danielle Antalffy: Thank you.

Ali Bauerlein: Thank you.

Operator: Your next question comes from the line of David Saxon with Needham and Company. Your line is now open.

David Saxon: Great. Good afternoon, guys. Thanks for taking my questions. Congrats on the quarter. And Ali and Jim, congrats on the new roles. I got two, one on glaucoma, one on dry eye. Starting with glaucoma. So it looks like one of your competitors has kind of repositioned their products in a different Salesforce. So wanted to get your thoughts on kind of how you see that opportunity. Have you seen any benefit from that yet, or what are your thoughts on kind of what you could do with that opportunity in 2026?

Paul Badawi: Yeah, David. Hi. This is Paul. I'll take that one. We've been focused since the LCDs went into effect over the past year, we're finally about to lap those headwinds. But as surgeons, we're forced to choose one MIGS procedure because of the restrictions that prevented surgeons from doing two MIGS procedures in a single surgical setting. Our team has done a great job working with their surgeon customers and reminding them of the comprehensive efficacy of Omni, the durable clinical outcomes, the consistent clinical outcomes have been proven time and time again with lots of clinical studies. So they've done a great job winning that business as it converts from two MIGS to one MIGS.

We were seeing the results of that this year. We're going to continue focusing on selling the benefits of Omni and winning as much of that business as we can. As we head into 2026, the MIGS market will return to growth. We've been focusing internally with our team on doing as well as we could commercially. I think we've done a great job. The team's done a great job this year to position ourselves as strongly as possible entering 2026 to capture as much of that growth as possible. So does some disruption at competitors allow for further opportunity for us? It should. But I think we're doing a great job regardless.

We're looking forward to the MIGS market getting back to growth in '26 and Sight Sciences and Omni capturing as much of that growth as possible.

David Saxon: Okay. Yes. Thanks for that, Paul. And then on dry eye, the tear care opportunity, obviously, congrats on that news there. So you've got 200 accounts in those two jurisdictions. Can you talk about the initiatives you have going on to kind of build engagement and utilization? And then I know that happened post the quarter, but out of the 50 active accounts in the third quarter, can you talk about how many of those are in those jurisdictions? And could kind of see some quick ramp? Thanks so much.

Ali Bauerlein: Yeah, sure. So I'll take that. And we obviously got this news in October. We're able to share this with the industry at AAO and really generated a significant amount of excitement and engagement around this new reimbursed category. And so we have continued to leverage those initial communications and have additional follow-up communications with customers as they explore how they want to use Tier Care in their treatment paradigm. So mostly right now, we've been primarily focused on education, identification, and then activation of accounts. I will say that it's still early.

It's been about three weeks from the time that we got that announcement, but we've seen heavy engagement both from existing accounts wanting to learn about how they can activate this new payer payment rates and also new interest from new customers and, of course, interest outside of the First Coast and Novitas region. This also is something, as we look to expand our coverage, we are engaging with customers in other jurisdictions as well to show the need and the interest in tier care. I will say that we also have had now successful claims processed at these repayment rates.

So it's good to get confirmation, not only have the fee schedules been published, but we also are now seeing claims activities being paid, which is important for customers. So all of that is great and kind of built into our opportunity here. Of course, in the fourth quarter, we do expect to continue those activities, but this is a very large market opportunity. Basically, we included modest contributions in the fourth quarter associated with these activities, but we do expect that to ramp substantially going into 2026 as we continue to work with these accounts and broaden both the coverage as well as customers.

In terms of the accounts that we already had engaged with, we are going to provide specifics around how many of them are in the First Coast and Novitas region. But we do have a base of customers that we are engaging with, and as we said, there's kind of 200 within this group of accounts that have ordered over the last few years that we are in communication about reengaging on tier care in this new reimbursed environment.

David Saxon: Okay. Great. Thanks so much for that, Ali, and congrats, everyone, on the quarter.

Ali Bauerlein: Thanks. Thanks, David.

Operator: Thank you. Your next question comes from the line of Tom Stephan with Stifel. Your line is now open.

Tom Stephan: Great. Hey, guys. Thanks for taking the questions and congrats on the progress and the new roles as well. I'll start with guidance. I think the midpoint implies for 4Q flat quarter-over-quarter revenue growth. And I believe slightly down sequentially in surgical glaucoma given, Jim, I think you said tier care is expected to step up sequentially. So I guess thinking about surgical glaucoma specifically in Q4, anything to call out that might keep you from growing sequentially despite what I think should be some seasonality benefits from 3Q to 4Q?

Jim Rodberg: Yeah. Appreciate that, Tom. No. Nothing specific to call out. I would say Q3 was a really strong quarter for Surgical growing 6% year over year. And on the heels of a record number of active accounts, increased ASPs, and utilization from Q2 to Q3 being flat, the team performed really well. And in setting up our Q4 guidance, at the midpoint, there still is some year-over-year growth there. And our objective and our practice in setting guidance is to set prudent and achievable guidance. So we feel really good about where we're at in the surgical business and feel good about Q4.

Tom Stephan: That's great. Thanks for that, Jim. And then follow-up just on Tiered Care. Appreciate all the color on the different initiatives and sort of the ramp-up. But, you know, Ali or Jim, any help on sort of how to model or at least think about tier care contribution next year either quantitatively would be great, but qualitatively certainly would suffice as well. Thanks for taking the questions.

Ali Bauerlein: Yeah, I can take that. And Jim, feel free to jump in as well. Obviously, we're not going to provide 2026 guidance today. As we said in the prepared remarks, we do expect to get back to growth in both segments next year. So we do see growth in both areas. In terms of tier care, obviously, we will be coming off of a very small base of revenue. So I would expect the growth rate in tier care to be significantly larger than the growth rate on our surgical glaucoma business just because of the small base that we're coming from.

We do see a large opportunity on Tier Care as we activate these accounts and we work with accounts to identify patients that need the procedure. There's also this recurring revenue as patients return and need additional treatment. So we see that as a very large growth driver for us next year. Obviously, we won't provide details today on the specifics.

Paul Badawi: Tom, I'll just add in terms of the model. Tear Care is a unique business model. First of all, it's an interventional procedure that addresses the root underlying cause of disease for millions of patients. But it's not done in the OR. It's done in the office. The office typically has a much higher throughput profile, number one, that's theoretically. Number two, we're not starting from a standstill like many new reimbursed launches. We've been in the market for several years now, which means, a, we have an established base of customers who have already demonstrated a strong product market fit and high throughput. So high volume procedure, reimbursement helps to unlock the scale of this market opportunity.

And so, and to Ali's point before, what prevents companies from realizing significant TAMs? Usually, it's one of the key stakeholders along the way. Doesn't benefit. Or isn't completely happy. In this case, beyond it having high throughput kind of in-office profile, with lots of patients lining up at doctor's ophthalmologists and optometrists, everybody benefits. Value accrues to all stakeholders. Patients first and foremost, they get immediate improvements, and those improvements last. As the Sahara study says. It's a durable improvement in signs and symptoms of disease. Eye care providers benefit. Number one, they get to offer their patients a better treatment. So they have happier patients. Number two, because it's a procedure, there's work and RVU associated with that.

So some of the economics accrue, and that economic value accrues to the provider. And lastly, and very importantly, payers see value. Because as we scale this business, and there's more scrutiny on a scale business, payers gonna look and say, what's the value for us? And so the Sahara two-year RCT and the budget impact model and the clinical cost utility analysis that we performed and now published tell payers also that adoption of tier care at scale is still economically beneficial to you. And so we think this is a tremendous opportunity for those reasons. In terms of the business model.

Tom Stephan: That's great. Thanks, everyone.

Jim Rodberg: Thanks, Tom. Thanks.

Operator: Thank you. Your next question comes from the line of Joanne Wuensch with Citi. Your line is now open.

Anthony: Hi. This is Anthony on for Joanne. Thanks for taking our questions. Another on tier care coverage, how should we think about timing on commercial and MA contracts? Will those be after you sort of get the rest of the MACs? Or should we expect those to layer in along with the other MACs?

Ali Bauerlein: Yeah, thanks for the question. And we are actively engaging with both other MACs as well as commercial payers. We can't speculate on exactly when we will get any of the other coverage policies or payment schedules set up, but we are having good conversations. Those are continuing, and with both First Coast and Novitas establishing fee schedules and being the first mover there for establishing them, that certainly helps our conversation with other payers. So it's hard for me to say which will come next. I do think that all of them are progressing appropriately.

I will say that the next easy target are the Medicare Advantage plans in the same states as the two MACs because there is a requirement for them to cover and match the traditional Medicare plan. So we are engaging with those Medicare Advantage plans. That could also improve our coverage for those beneficiaries as well.

Anthony: Got it. That's helpful. And then in surgical glaucoma, you mentioned some dormant accounts reengaging. Any idea why those have started reengaging this past quarter?

Ali Bauerlein: Really, those accounts have been engaging over the last year. So this is something that is not necessarily new, but as we had the LCD uncertainty period where people weren't sure of coverage of Omni and where that would come out, we did have accounts that went dormant during those periods. So we have been actively engaging with those additional accounts over the last year as we gained clarity on the new policies put into effect, and we've just continued to see progress throughout the year to reengage those accounts and bring them back into an active status.

Paul Badawi: Another thing to keep in mind, I think just want to call attention to the focus of our surgical glaucoma team. We've been in the MIGS market for a long time. We have very tenured professionals. We've maintained our focus on this market opportunity at a time when some of the others are losing focus. Right? We had a question about one of the disrupted sales forces from one of the players. Other companies might be prioritizing other products with the same sales reps. We have a proven surgical glaucoma team with proven long-term relationships with MIG surgeons, and I think you're starting to see the results of that focus over the long term come through in 2025.

And we obviously expect that to continue and translate into real growth in 2026.

Anthony: Thanks for taking the questions.

Operator: Thank you. Your next question comes from the line of Adam Meter with Piper Sandler. Your line is now open.

Adam Meter: Hi, good afternoon. Thank you for taking the questions, and congrats on the progress and welcome Jim and Ali. Congrats on the new role. Two from me. I guess the first one on the P&L. You all have done a really nice job with expense management this year. And you further, I think, recently announced the plan to reduce OpEx by $12 million on an annual basis. So really, I guess, the question is how do we think about the OpEx line in our model next year? Just any qualitative or quantitative color would be appreciated. And then I had a follow-up. Thanks.

Jim Rodberg: Yeah. Thanks for the questions. At this time, we're not going to give any 2026 guidance, but we are really proud of the work we've done on OpEx. The team has been extremely disciplined over the last year to two years here and really have driven a lot of OpEx savings throughout the P&L. And you could see in the reduction here in guidance, it's impressive. The OpEx adjustments and improvements we've made. And one thing I'll call out about the reduction in force is that a lot of those costs were general and administrative costs and not commercial and sales impacting costs. So that's important to note too, I think.

Adam Meter: Okay. Understood. That's helpful. We'll stay tuned for more color there. And I guess for the follow-up, I think this is for Ali. But it's on tier care. And just trying to, I guess, better understand the strategy to kind of build, I would say, more awareness around the tier care therapy. Are you at a point now where it really kind of makes sense to make those market development investments? Do you wait for additional payers to come on board? Clearly, it's a big opportunity to go after, but would love to hear about the strategy to get those patients into the funnel. Thank you.

Ali Bauerlein: Happy to take that question, and it's a great one. So first, I would highlight the fact that we've been in the market with Tiered Care for multiple years now. We've sold 1,500 hubs into accounts that are trained on tier care and we've done over 70,000 procedures in the model. So already, we do have a good base of awareness on the tear care procedure and the benefits of the Tier Care procedure to patients. Of course, we do need to continue to expand that knowledge base, expand the customer base, as we've said there are, you know, 6,500 optometrists and ophthalmologists that we will be targeting as part of our overall approach to the market.

And of those, a large subset of them, you know, are in these areas that we can go target and work with to really start seeing increased utilization of the technology. So that is our high-level plan. We do have a small sales team in place. We have been starting to grow that team as we look to as we've had these fee schedules established. And that will continue in 2026 in a targeted manner. We are now, from a commercial perspective, trying to increase density in the states that we already have these fee schedules established. So payers that would be complementary to those states so we can increase density with those customers.

But we are also looking at expanding into other MAC jurisdictions as well. So really, the focus is both increasing the payer coverage and payment schedules at the same time as really driving customer engagement in these markets. I will say that naturally, this is one of the most common reasons that somebody goes to their eye care provider is because they're experiencing dry eye symptoms. So the problem is well understood by our customers and they are seeking better treatment options.

And Tier Care has been proven effective in the Sahara study versus Restasis, and we are really hoping to continue to educate providers on the benefits of tier care and how this can fit into their overall dry eye treatment paradigm. So we're very excited about that, as are our providers who have expressed strong interest in learning more.

Adam Meter: Perfect. Thanks for all the color.

Operator: Thank you. Your next question comes from the line of Justin Wang with Morgan Stanley. Your line is now open.

Justin Wang: Hey, everybody. I'm filling in for Patrick. Thanks for the questions. I just like to touch a little bit more on the momentum of achieving coverage density on Tiered Care. I mean with Novitas and First Coast setting the precedent for Medicare fee for service and how exactly has this influenced the tone of conversations with other payers, both commercial and government? And I appreciate that some payers just didn't want to be the first out there, but now that's out of the way, how should we be thinking about the cadence for future decisions going forward?

Ali Bauerlein: Yeah. Great question, Justin. And we are continuing to have those conversations. I will say that it is important for somebody to step up and be the one to establish these first payment schedules at these appropriate fee schedule amounts. And so we were very happy to get across the finish line with First Coast and Novitas. The conversations have continued with payers, I will say, in the world of payer discussions, three weeks is a very short time frame. But we have had engagement with both commercial and MACs within this time.

And there has been strong interest to understand how First Coast and Novitas came to these decisions and what their next steps should be in understanding the clinical value of the tier care procedure and also the health economic value. So I will say that interest has continued to strengthen as we've gotten past those publications. And, you know, we do feel good that this First Coast and Novitas will be the first of many, not just the first.

Justin Wang: Amazing. Thank you.

Operator: Thank you. I'm showing no further questions at this time. I would now like to hand the call back to Paul Badawi for closing remarks.

Paul Badawi: Thank you for attending today's call. We appreciate your interest in Sight Sciences, and we look forward to updating you on our progress in the future. Thank you.

Operator: Thank you. This does conclude the program. You may now disconnect.