SGHT

Day. Thank you for standing by. Welcome to the Sight Sciences first quarter 2026 earnings results conference call. At this time, all participants are in a listen-only mode. After the speaker's presentation, there will be a question-and-answer session. To ask a question during the session, you will need to press star 11 on your telephone. You will then hear an automated message advising your hand is raised. To withdraw your question, please press star 11 again. Please be advised that today's conference is being recorded. I would now like to hand the conference over to your first speaker today, Hannah Jeffrey, Investor Relations. Please go ahead.

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, James Rodberg. Also in attendance is Sight Sciences Chief Operating Officer, Alison Bauerlein. Earlier today, Sight Sciences released financial results for the first quarter ended March 31, 2026, and raised its revenue guidance and maintained its adjusted operating expense guidance for full year 2026. 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, including statements about material business considerations, 2026 outlook, and financial guidance. These statements are based on plans and expectations as of today, which may change over time. In addition, actual results could differ materially from projected results due to a number of risks and uncertainties.

For a discussion of factors that may affect the company's future financial results and business, please refer to the earnings release issued prior to this call and the company's most recent SEC filings. We undertake no obligation to publicly update or revise any forward-looking statements except as required by law. Also on this call, management refers to certain financial measures that were not prepared in accordance with generally accepted accounting principles in 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.

Thanks, Hannah. Good afternoon, and thank you for joining us. We delivered a strong start to 2026 with 1st quarter results that demonstrated a return to double-digit revenue growth, continued strength in gross margin, and disciplined operating expense and cash management. We drove solid execution across both segments, interventional glaucoma and interventional dry eye. This included a 3rd quarter in a row of revenue growth in interventional glaucoma and continued positive commercial traction in interventional dry eye, where revenue nearly doubled from the 4th quarter, representing early validation of our procedural in-office recurring revenue business model. Based on our performance and outlook, we are raising our full year 2026 revenue guidance while maintaining our adjusted operating expense guidance.

We are continuing to build an interventional eye care company focused on two significant anterior segment diseases, glaucoma and dry eye disease, where we believe procedural options can play a larger role in the treatment paradigm. Our two flagship technologies, OMNI and TearCare, are designed to address the root underlying causes of disease and can efficiently integrate into established practice workflows. They each support our focus on earlier procedure-based care while helping providers deliver consistent clinical outcomes for patients. We believe there is meaningful customer and patient overlap in our two business units, particularly in high volume cataract and MIGS practices, where ocular surface disease is common and where physicians are increasingly incorporating procedural options in their treatment algorithm. Glaucoma and dry eye disease are often present in the same patient, and eye care providers often want to address both as part of the patient's treatment plan.

We're already seeing this overlap where we are driving new TearCare adopters from our existing glaucoma customer base. As we continue to drive earlier procedure-based care across these two significant market opportunities, OMNI and TearCare can fit naturally along the same patient journey, supporting consistent clinical outcomes for patients as well as practice efficiency for providers. Over time, that broader portfolio participation can help deepen account penetration and support our efforts to scale both of these businesses and drive sustainable growth long term. Our strategy is to help advance interventional care earlier in the treatment paradigm of both glaucoma and dry eye disease and to accelerate these efforts by leveraging the overlap of our two interventional business segments that we call the intersection of intervention. We began to drive momentum from this unique intersection in the first quarter.

As we build on this progress, we remain focused on delivering sustainable growth and creating long-term value for our stakeholders. Now, turning to our segments, I'll begin with Interventional Dry Eye. In our first full quarter following initial market access, we drove expanded traction in our reimbursed dry eye business and increased customer adoption of our TearCare technology. We are increasing our Interventional Dry Eye revenue guidance by $1 million at the midpoint based on our strong results ahead of expectations and our confidence moving forward. We are very pleased by the commercial traction we generated with our dry eye customers in the first quarter, where we delivered revenue of $1.4 million, nearly doubling our fourth quarter revenue.

The majority of this revenue was from our disposable SmartLids, and we sold approximately 1,500 in the first quarter, up from approximately 700 in the fourth quarter of 2025. More than doubling the volume. This includes sales to 96 accounts made up of a balanced mix of new accounts and reordering accounts. Average SmartLids utilization increased from approximately 9 per active account in the fourth quarter to approximately 16 per active account in the first quarter. Our strong dry eye performance is primarily in the First Coast and Novitas regions, where fee schedules were recently established. We are pleased with the early validation of our reimbursed business model and solid customer engagement with TearCare.

In addition, we are driving encouraging cross-selling dynamics with approximately half of all active accounts coming from our existing glaucoma customer base and with higher utilization in those accounts versus the interventional dry eye only customers. These early indicators demonstrate the depth and value of our established relationships and the synergies that exist between our 2 business segments. Importantly, early utilization trends are improving, with a growing number of accounts reordering and increasing procedure volumes. For accounts that reordered in the first quarter, utilization more than doubled from fourth quarter volumes. In addition, new accounts onboarded in the first quarter are ramping at higher initial levels than those in the prior quarter. Together, these dynamics point to improved customer targeting and enhanced office workflow training, strengthening adoption and early momentum for scaling this business. We are also focused on supporting practices as they incorporate TearCare into their workflow.

A growing number of accounts have successfully completed reimbursed procedures and reordered SmartLids, which we view as a positive early indicator of repeat utilization. This adoption reflects the effectiveness of our targeted commercial approach, prioritizing high volume dry eye practices with significant Medicare patient volumes. These efforts are translating into meaningful traction with increasing interest from both new and existing accounts, supporting the broader shift towards interventional dry eye care. To build on this foundation, we have continued to expand our commercial team in the first quarter, adding resources in both our sales rep and clinic support functions to enhance execution and deepen provider engagement. Our focus remains on scaling efficiently within established reimbursed markets while positioning the organization to drive meaningful growth as we move through 2026. In parallel, we are also focused on expanding market access through engagement with additional MACs as well as commercial payers.

We are actively engaged in discussions with multiple MACs, including detailed reviews of our clinical and economic data and submitted TearCare claims reviews. Based on these activities and discussions, we expect additional payers to establish fee schedules this year. We are encouraged by our continued progress and view expanding TearCare market access as an important catalyst to support long-term growth. Building on a foundation of clinically differentiated technology, initial reimbursement in select markets, ongoing reimbursement discussions, and strong commercial traction, we are excited about our opportunity to drive the development of this large and under-penetrated reimbursed interventional dry eye market. Turning to interventional glaucoma, our OMNI technology continues to demonstrate its clinical value within the evolving glaucoma treatment paradigm and its increasing importance as a differentiated technology and durable growth driver in the expanding field of interventional glaucoma.

In the first quarter, we delivered strong performance and generated the third consecutive quarter of year-over-year growth. Revenue was $18.3 million, up 7% versus the prior year period. Ordering accounts increased 6% compared to the prior year period, driven primarily by reactivating dormant accounts and adding new accounts. The revenue growth was primarily driven by increased volume and price, and partially offset by slightly lower utilization per account. We finished the first quarter with a strong March, with procedure volumes increasing from a slower than typical start in January and February. Additionally, we drove continued strong adoption of Omni Edge, which helped in reactivating accounts and adding new accounts. Omni Edge includes a higher capacity viscoelastic delivery feature while maintaining the trusted safety, efficacy, and usability of the OMNI technology platform.

For 2026, our interventional glaucoma strategy is anchored in consistent execution as we work to expand the combo cataract market and capture additional share, as well as further unlock the standalone market opportunity. In the combo cataract market, we are focused on adding accounts through training new surgeons, capturing share in existing accounts, expanding adoption and penetration with MIGS naive surgeons, and increasing combo cataract volumes through interventional glaucoma activations. In standalone, we have hired a dedicated market development team and are encouraged by the early progress they are making in activating standalone glaucoma interventions. Together with our differentiated technology and experienced commercial organization, we are in a strong position to deliver our growth targets in 2026 in interventional glaucoma.

Looking closer at the standalone opportunity, as the shift toward earlier interventional treatment continues to shape the glaucoma treatment landscape, our effective market development team has been instrumental in partnering with surgeons and their staff to help them introduce a streamlined and actionable interventional glaucoma patient workflow that is modeled after the well-known and proven cataract patient workflow. This differentiated approach is helping practices identify patients and support increased procedural interventions in those practices adopting this workflow. We believe this new interventional glaucoma patient workflow partnership with our customers represents an important driver of market development and a growing contributor to long-term revenue growth. Before turning the call over to Jim, I want to briefly touch on the latest regarding our patent infringement case against Alcon.

In April, the court issued its final judgment, which upheld the jury's finding of willful infringement by Alcon and confirmed past damages and interest totaling approximately $55 million, as well as ongoing royalties of 10% of Hydrus revenue through patent expiration. This ruling is subject to appeal, and no cash has been received to date. To close, we delivered a strong start to 2026 in both our interventional glaucoma and interventional dry eye business segments, and the progress we made in the first quarter reinforces our confidence in the year ahead, including our decision to raise revenue guidance while maintaining our adjusted operating expense guidance. In interventional glaucoma, we generated our third consecutive quarter of year-over-year growth and remain focused on expanding our leadership position in the combo cataract segment while continuing to activate standalone intervention.

In interventional dry eye, we are encouraged by increasing customer adoption and utilization, and we remain focused on scaling efficiently in markets where reimbursement is in place while working to expand market access over time. We are also excited about the increasing recognition within the eye care community that there is strong patient overlap between interventional glaucoma and interventional dry eye. We are uniquely positioned to leverage this synergy with two leading interventions for these two large and overlapping disease categories as we build something bigger, a leading interventional eye care company. Across the company, we are investing to support growth while maintaining the operating and financial discipline needed to improve cash usage and advance our path toward cash flow breakeven. With that, I'll turn the call over to Jim to walk through the financials.

Thanks, Paul. Before discussing the first quarter results, I want to underscore that we are executing against our strategic goals from a position of strength. With the operating discipline and cost structure we need to support growth, and we believe this positions us to achieve cash flow breakeven without the need to raise additional equity capital. Unless otherwise noted, my comments reflect results for the first quarter of 2026, and comparisons are to the same period in the prior year. In the first quarter, total revenue was $19.7 million, a 13% increase driven by growth in each of our two Interventional segments. Interventional Glaucoma revenue was $18.3 million, an increase of 7%, driven by increases in ordering accounts and average selling prices, and partially offset by lower utilization per account.

Ordering accounts grew 6% from the prior year, as well as 1% sequentially from the fourth quarter. Interventional dry eye revenue was $1.4 million, up from $0.4 million, and nearly doubling from the fourth quarter of 2025. Dry eye results were driven by increases in average selling prices, utilization, and ordering accounts, reflecting strong momentum in our reimbursed interventional dry eye business model. Gross margin was 86%, flat compared to the prior year. Interventional glaucoma gross margin remained strong at 87%, in line with the prior year period on higher average selling prices and product mix, slightly offset by tariff costs.

Interventional dry eye gross margin was 72%, up from 71% in the same period in the prior year, primarily due to higher average selling prices and increased SmartLids sold, mostly offset by a one-time inventory overhead adjustment in the prior year. Over time, we expect our dry eye margins to continue to improve as we scale our reimbursed business model and offset absorption and overhead costs. Total operating expenses were $29.4 million, an increase of 2% compared to $29 million, primarily due to a $5.4 million one-time fee earned upon a successful final judgment in the Alcon litigation case described above. Excluding this fee, operating expenses were down 17%, driven primarily by lower personnel related expenses and stock-based compensation.

As a reminder, we conducted a reduction in force in the third quarter of 2025, and this past quarter was the second full quarter of our lower cost structure. Adjusted operating expenses were $21.2 million, down 14% compared to $24.7 million. Net loss was $13 million or $0.24 per share, compared to a net loss of $14.2 million or $0.28 per share. We ended the quarter with $85 million of cash and cash equivalents compared to $92 million at the end of 2025. Cash used was $7 million in the quarter, which was down significantly from $11.6 million in the first quarter of 2025. We ended the quarter with $40 million of debt, excluding unamortized discount and debt issuance costs. Moving to our revenue outlook for full year 2026.

We are raising revenue guidance to $83 million-$89 million, which reflects growth of 7%-15% compared to 2025, versus the prior guidance of $82 million-$88 million. This includes revenue for our interventional glaucoma segment of $77 million-$81 million, representing growth of 2%-7%, and our interventional dry eye segment of $6 million-$8 million, compared to $1.6 million in the prior year. This guidance reflects our philosophy of setting achievable targets and our focus on disciplined execution and the growth we believe we can deliver. Looking closer at the second quarter, we expect total revenue to grow low double digits compared to the second quarter of 2025. We expect interventional glaucoma to grow mid-single digits compared to the second quarter of 2025.

Interventional dry eye revenue is expected to be in the range of $1.5 million-$2 million in the second quarter, and we expect that revenue to continue to scale throughout the year. We are reaffirming our full year 2026 adjusted operating expense guidance of $93 million-$96 million, representing an increase of 6%-9% compared to 2025. The increased spend compared to the prior year is driven by targeted commercial investments to capture growth opportunities in both interventional dry eye and interventional glaucoma while we continue to manage the business with operating discipline. We are pleased with our return to double-digit revenue growth in the first quarter. Looking ahead, we are excited to continue pioneering the interventional glaucoma and interventional dry eye markets, and we are laying a strong foundation for sustainable growth and continued success. Operator, please open the line for questions.

Thank you. At this time, we will conduct the question and answer session. As a reminder, to ask a question, you will need to press star one one on your telephone and wait for your name to be announced. To withdraw your question, please press star one one again. Please stand by while we compile the Q&A roster. Our first question comes from the line of Frank Takkinen of Lake Street Capital Markets. Your line is now open.

Hey, this is Nelson on for Frank. Thanks for all the color and congrats on the solid progress. Maybe just to start, want to start on the SmartLids utilization stepping from 9 to 16 in the quarter per active account, which was a strong read there. For your most mature kind of fully reimbursed accounts, can you talk about that steady state utilization and how we should think about that trajectory for the broader kind of installed base moving forward?

Thanks, Nelson, it's a great question. All of our accounts are still relatively early in their usage of TearCare across their Medicare, traditional Medicare fee for service population. I think even our largest accounts are not yet fully activating this across their patient population. Of course, once we can also get additional coverage, that will also allow our customers to treat more and more patients across their patient pool. I will say, you know, when we look at our customer mix, there are a handful of accounts, you know, probably 10% of the accounts that are driving a larger portion of the total volume here.

Those are accounts that have really figured out the workflow, how to put this into their overall practice. Frankly, we're really proud of the progress that we had in the first quarter, almost 100 active accounts. These accounts are really like the true early adopters of TearCare, the true believers in the future of procedural dry eye intervention. We really see all of our customers are still very early in their utilization curves, which is really just a testament to how large this market is and how many patients could benefit from a procedural dry eye intervention.

Got it. That's very helpful. Just quickly, you called out adding sales reps and clinical support resources during the quarter. Can you maybe size the interventional dry eye team today and where we should see that going just throughout the year?

Yeah. We're not going to provide a detailed sales force headcount every quarter, but we did incrementally add in the quarter. I know we reported at the end of 2025, we had about ten between our direct sales force as well as clinical specialists. That team is still very small and growing. We are investing in the team, really focused on those First Coast and Novitas areas where we have Medicare fee schedules established, and we would expect to continue to grow that team throughout the year.

Understand. Thank you, guys, and congrats.

Thanks.

Thank you. Our next question comes from the line of Adam Maeder of Piper Sandler. Your line is now open.

Hi. Good afternoon. Thank you for taking the questions and congrats on a good start to the year. Two from me. I guess the first one, I wanted to start on interventional glaucoma.

And I really was hoping you could kind of double-click and contextualize, you know, the good result there, the +7% year-over-year. You know, curious to get your view on kind of underlying market trends, competitive dynamics. I think one competitor may have had a little bit of a supply issue, you know, pricing, and then, you know, you obviously talked about some inclement weather. Did you recapture those patients in the quarter? Just maybe kind of bring that all together for us, and then I had a follow-up. Thanks.

Yeah. Hi, Adam. We're excited to be back in growth mode in IG, in interventional glaucoma. The glaucoma community recognizes now that intervening earlier is better long-term for patients. There's this real tailwind in the ophthalmic community. You can feel it. We were just at ASCRS, A-S-C-R-S, American Society of Cataract and Refractive Surgery meeting last month. There's just so much talk around earlier intervention, both IG, interventional glaucoma, as well as IDE, interventional dry eye. On the glaucoma side, we all know there's millions of glaucoma patients that are currently on medications and could benefit from an earlier intervention. That market is growing. We're excited to be a leader. We're the leading implant-free, micro-invasive glaucoma surgical option in the market.

Over time, as this category grows, we expect to continue to innovate and lead the category we've created. We've got new technology coming out. We're trying to stay ahead of the market with Omni Ultra later this year. It's our third straight quarter of year-over-year growth. We're excited about that. Excited about the tailwind of interventional glaucoma and continuing to lead as the, you know, implant-free market leader in IG.

Hey, Adam, this is Jim. On the Q1 dynamics, we closed the quarter very strongly. As you can imagine, March tends to be a pretty significant part of the first quarter, and team executed really well, and we leave the first quarter feeling really, really good about where we're at. We had strength in March. We expect that strength and momentum to continue into Q2 and the balance of the year, and overall, confident about our path forward.

Okay, fantastic. Very helpful color and great to hear the comments on the market. Then maybe switching over to dry eye, you know, congratulations, Ali, on the progress there. Wanted to push a little bit, you know, in terms of market access and try and better understand the expectations for new payer adds, you know, whether it's on the commercial or the MACs side. Not sure if you can be any more specific in terms of potential timing there. I guess really one of the questions I have is can you hit the updated $6 million-$8 million without any additional payer wins? Thank you for taking the questions.

Yeah. Thanks. Thanks for the follow-up here. Of course, we are also very focused on increasing reimbursed access to TearCare with both Medicare payers as well as commercial payers. We're having continued good conversations across the payer mix, really focused on the SAHARA data, the health economic data, and also showing claims utilization and interest in the procedure. We are, of course, building a category here. It does take time. We still expect to have additional payer wins in 2026. It is hard to predict exact timing there, but we fundamentally don't feel any different about our ability to get payer wins over time here to get access to this technology for our patients and our ECP provider partners.

I will say that we do have some, you know, incremental positive movement. There are some commercial payers that are paying regularly while they haven't established coverage policies. You know, there are payers that are moving towards those types of activities, and, you know, we feel good about it. In terms of guidance, yes, we still feel extremely confident. The guidance is put in place that only takes into account First Coast and Novitas fee schedules in place for 2026. Really that market potential alone is still very large for us. We're still a very small fraction of the patients that have moderate to severe dry eye disease with MGD, even within that traditional Medicare fee for service population.

Very much early stages, and it's a large market, and we feel very good that we've set appropriate guidance, taking into account all of those factors for the areas where we currently have fee schedules established.

That's great color. I'll jump back in the queue. Thank you.

Thank you. Our next question comes from the line of Steve Lichtman of William Blair. Your line is now open.

Thank you. Evening, guys, and congratulations on the progress. Wondering, Ali, if you could talk about customer accounts for dry eye in the regions that you are approved with reimbursement. What's your latest view on sort of the denominator, the number of viable centers that you think are target sets for you within the regions that you're currently in?

I'm gonna shift that question a little bit and talk about ECPs, Eye Care Providers, because that's an easier way of thinking about this opportunity. When we talk about across the U.S., really the targeted payers or targeted providers that do a lot of prescription eye drops, do procedural interventions for dry eye, have strong populations of patients here. We've talked about historically about 6,500 ECPs fall into that bucket as kind of that initial target population. Within First Coast and Novitas, there's 2,000 ECPs that would meet that same criteria. We are still very small. Obviously, active accounts is a little different than Eye Care Provider counts.

Even with, you know, there being a couple ECPs per active account, we're still very much in the early penetration days of the opportunity within First Coast and Novitas.

Great. Just to follow up on the patent suit. Obviously, you know, a decent amount of cash, you know, pending here for you guys. Either Paul or Jim, can you talk about the next steps here? I think Alcon has an opportunity to potentially appeal, but within the next couple weeks if that or there could be a settlement. You know, what's the next steps? Remind us of the interest accrual if it does go to appeal.

I can give an update on at least the amounts. In April of this year, final judgment was issued, and that preserved the jury verdict from 2024. That awarded us updated damages, interest, and royalties of approximately $55 million, as well as ongoing royalties of 10% of future Hydrus sales through the patent expiration. We have not received any cash to date, and we will not book anything, obviously, until such time, when appeals would be exhausted and cash would change hands, for example. The final judgment is subject to appeal. Beyond that, we won't comment further on pending litigation. We feel we are in a very strong position in this case.

Okay, great. Thanks, Jim. Thanks, everyone.

Thanks.

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

Great. Hey, guys. Thanks for taking the questions. First one on dry eye. Nice to see the guidance raise already really strong sequential growth in utilization. Maybe I'll just ask sort of a big picture question. Like, what have been, call it the top one or two upside surprises or learnings, amidst kind of this relaunch, if you will? Part two to that, how do you feel about the playbook you're developing for when different markets and patient populations hopefully unlock and sort of your ability to deploy that quickly? I'll leave it there. Thanks.

One to two areas of -- We've had a lot of learnings since launch, and most of them have been very positive, both about how large of an opportunity this is, how many patients really are looking for a better treatment, but also the synergies with our IG business. That's probably the largest benefit that we've seen, is that those accounts are a large part of the accounts that have activated in these early stages. They have larger traditional Medicare fee-for-service populations, and they are looking for ways to help their patients who also experience a significant amount of dry eye. That is a very large part of our initial launch here, initial success. We also see that those accounts are having higher utilization than the non-IG synergistic accounts.

Really positive momentum there and good synergies across the team. In terms of the playbook and what we see as we move forward here, there is still a lot of workflow activation that needs to occur when account decides that they want to implement procedural dry eye. We do think that this is involved with people really being in accounts and helping the clinic set up their workflow, identify the patients, and identify how best to put them into a dry eye treatment workflow. Because of that, we do think that as we have additional market access wins, particularly in new geographies, that will involve additional commercial investments as we grow the team and, of course, work with the accounts that we already have in those areas as well.

As we have additional density happening with additional payers coming on in already markets where we have Medicare fee schedules, those are easier to activate because those accounts, it's just adding new payers that can process and add those patients into that same workflow. Over time, that may also shift the accounts that we're targeting. As you know, we are targeting right now a lot of those higher volume ophthalmology practices that do have a lot of Medicare patients, which is, you know, where we're seeing the synergies with IG. Over time, that population may shift where we know that there is when we look at the dry eye disease market, 70% of patients are covered by commercial plans, and 30% are being covered by Medicare or Medicare Advantage plans. Right now we're targeting a subset of a subset there.

As we get the commercial plans, that can really shift our strategy in terms of account targeting and where we look to really partner with people. We're really happy with the progress we've seen in terms of creating a workflow within accounts, and it is being replicated very efficiently across accounts so they can work TearCare into their procedure flow, whether that's I'm going to have a TearCare day or I'm going to have multiple TearCare afternoons or TearCare mornings. They tend to stack them up in the day to be efficient. All of that is being worked through, we're having the assessments upfront to identify those patients that may benefit from a procedural dry eye intervention and working that into the workflow.

A lot of different things coming together right now, but we do think we're in a good spot to continue to execute across this new area.

Tom, I just want to add a few thoughts to Ali's comments around the intersection. As Sight Sciences has started, you know, we were born interventional. We started with OMNI, and then we developed TearCare. These are two very strong interventions for two of the leading diseases in eye care. While that's been our philosophy, I think what we've seen and we've been pleasantly surprised by is the rate at which our customers, and specifically surgeons, as Ali mentioned, have recognized the overlap of these two disease categories and the possibilities of offering these same patients multiple interventions. The alignment between the ophthalmic community and our philosophy of building an interventional eye care company has come faster, I'd say, than even we expected.

When we go out in the field and we meet with our, you know, our happy OMNI surgeons and we're working with our dedicated commercial team, it's amazing how many of our glaucoma surgeons talk about how many of their glaucoma patients have dry eye disease, and they're complaining about their dry eye disease because you can feel that. They're not complaining about their glaucoma because it's a silent disease, unfortunately. So the, you know, us being able to show up as their interventional partner, having an intervention for their glaucoma patient, having an intervention for their glaucoma patient who also has dry eye disease, it's a very powerful partnership. I think we're just surprised and very happy about how fast the community is acknowledging that. We're calling it, again, internally IX. It's the intersection of intervention.

It's this proprietary angle we have. We're looking forward to, like, driving the benefits and the synergies of these interventional platforms to reach more patients with better interventions, offering better care more quickly.

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

Hey, good afternoon, and thanks for taking the question. You seem to be making a fair amount of progress on expense management, cash management, and everything else that goes along with it. Can you sort of give us a view on your philosophy of how do you balance everything that you're doing in terms of penetrating the MACs and educating the physicians and ramping them with the other metrics that, you know, we come to view and love in on the side of Wall Street? Thank you.

Hey, Joanne. Thanks for the question. I'll take that one, Paul and Ali can add as needed here. We're in a really good spot with a really healthy balance sheet and a strong pathway to cash flow break even, while at the same time having the ability to go invest in these 2 significant opportunities. As we look at 2026, the most important investments for us this year are on the dry eye side, both in market access resources as well as commercial resources to scale up that business in markets where we already have reimbursement. On the glaucoma side, continuing to invest in the standalone opportunity there.

The balance for us is we want to make disciplined, high return investments, and we're fortunate, I think, to have the flexibility to go faster on some of those investments where there's outsized opportunity for growth.

The only thing I would add to that, Joanne, on the R&D front. Look, we have a history of developing cost-effectively developing clinically differentiated interventions that can elevate the standard of care. I think we've done that well with OMNI. We've done that well with TearCare. We've got a number of, you know, selective R&D programs that we're investing in that we're gonna be very excited about, you know, all within this interventional category as we build, you know, a focused interventional eye care company. We've got very interesting pipeline that we're developing cost-effectively, and in due course, we're looking forward to sharing more about that, hopefully later this year.

Wonderful. Thank you.

Thank you. Our next question comes from the line of David Saxon of Needham & Company. Your line is now open.

Great. Good afternoon, Paul, Ali, and Jim. Thanks for taking my questions. I wanted to ask a similar question to Adam's, but from a slightly different angle. I think you're only in 4 of the 13 states in First Coast and Novitas, those two regions or jurisdictions, I should say. Does the guide assume you get into any more of those states, or is the 6 to 8 really just reflective of presence in like a fraction of the total, immediate opportunity?

Yeah. To your point, we have sales really across first of all, most of the 13 states, we have some level of sales. We do have some sales support across them. You are right, we do have density within 4 or 5 main states that have the majority of the sales resources in them. We do expect to continue to expand the resources there, whether we expand them within those specific 4 to 5 states, as there are still opportunities. As you can imagine, you know, 1 rep in Florida would not be sufficient to cover the entire state of Florida, for example. We are looking at where we invest those resources. The plan does take into account that we do have incremental investments in commercial resources in those areas.

We aren't gonna get into specific territories or how we're going to break that out. All of that is accounted for in our operating expense guidance. We have already adjusted for that appropriately.

Okay. Thanks for that. On the IG side, Paul or Ali, would love to get an update on Omni Ultra, you know, timing of that clearance. Is that embedded in the IG revenue guidance, or would that be upside, you know, when that comes out? Thanks so much.

Yeah. David, this is Paul. We are in discussions with the FDA on Omni Ultra. Well, you know, nothing is definitive, as everybody knows, with 510(k) clearance pathways. We feel confident that we should have a clearance, hopefully within the coming months, certainly by the end of the year. We're very excited to launch Ultra again, hopefully by the end of the year, it'll be out in the market. It's got a number of great features. Surgeon informed. We're obviously partner very closely all the time with our surgeons and take their feedback to continue to innovate in IG and move the OMNI platform forward and stay ahead. It's got, you know, single path, single incision, single path 360.

It's got viscoelastic delivery on both advancement and retraction, which is a really nice feature. It's got markings on the catheter to tell the surgeon how far they've advanced. It's got, you know, better ergonomics. The handle has better ergonomics. It's got a number of features that we think will help elevate this category even further. Hopefully it's getting released by the end of the year. We don't know when ultimately can't predict with specificity when the clearance will come. I can say this: we've put out guidance that we are very confident we can deliver regardless of when Ultra arrives. Hopefully it arrives sooner rather than later, we can do even better.

Great. Thanks so much.

Thank you. This concludes the question and answer session. I would now like to turn it back to Paul Badawi for closing remarks.

Thank you all 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 for your participation in today's conference. This does conclude the program. You may now disconnect.

Good day, everyone, and welcome to Sight Sciences Fourth Quarter 2025 Earnings Results. [Operator Instructions] Please note, this conference is being recorded. Now it's my pleasure to turn the call over to Trip Taylor with Investor Relations. Please proceed.

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 its financial results for the fourth quarter ended December 31, 2025, and initiated its revenue guidance and adjusted operating expense guidance for full year 2026. 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, including statements about material business considerations, 2026 outlook and financial guidance. These statements are based on plans and expectations as of today, which may change over time. In addition, actual results could differ materially from projected results due to a number of risks and uncertainties. For a discussion of factors that may affect the company's future financial results and business, please refer to the earnings release issued prior to this call and the company's most recent SEC filings. We undertake no obligation to publicly update or revise any forward-looking statements, except as required by law. Also on this call, management refers to certain financial measures that were not prepared in accordance with generally accepted accounting principles in the United States, including adjusted operating expenses. We believe that 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.

Thanks, Trip. We ended 2025 with solid execution across our business, highlighted by fourth quarter revenue growth in both segments, strong gross margins and continued operating expense discipline and cash management. In 2026, we're building on this momentum with a clear strategy to return to double-digit growth while maintaining our operational rigor and financial discipline. Before reviewing the quarter, I want to frame our discussion around the size and significance of the markets we serve and why we're confident in our long-term opportunity. Our flagship interventional technologies, OMNI and TearCare, address 2 of the most prevalent anterior segment diseases, glaucoma and dry eye disease. Glaucoma remains the leading cause of irreversible blindness globally and dry eye disease continues to be one of the most common reasons patients seek care from eye care providers. With proprietary minimally invasive technologies designed to comprehensively address the root underlying causes of disease, we are expanding both the role of interventional solutions in the markets we serve and the markets themselves. Together, these 2 increasingly interventional categories offer substantial runway for continued growth in the years ahead. Consistent with that strategy, we've updated the way we describe our businesses. What we previously referred to as surgical glaucoma and dry eye, we now call Interventional Glaucoma and Interventional Dry Eye, reflecting our focus on elevating the standards of care with earlier procedure-based interventions. We believe this interventional focus positions us to participate in an important part of the treatment continuum and over time, creates multiple durable growth drivers across both glaucoma and dry eye. We believe there is significant customer and patient overlap in these 2 categories that can unlock synergistic commercial value. Many patients who suffer from glaucoma also suffer from dry eye disease and meibomian gland dysfunction, which can be exacerbated by continued use of glaucoma medications, a known cause of ocular surface disease. In addition, many practices have dedicated eye care providers managing patients with both diseases, creating a natural synergy in care pathway and treatment. With strong collaboration between our Interventional Glaucoma and Interventional Dry Eye teams, we have the potential to enhance our customer engagement, support adoption across both businesses and strengthen the scalability of our interventional eye care strategy. With proven technologies, experienced teams, strong customer relationships and a track record of execution, we believe we are well positioned to drive meaningful value as we continue building a leading interventional eye care company. Now turning to our segments. I'll begin with Interventional Dry Eye, where we recently achieved a very important reimbursement milestone. In the fourth quarter, 2 MAC, Novitas Solutions and First Coast Service Options, established pricing for CPT code 0563T, the code associated with our TearCare procedure. This marks a turning point for our TearCare business model, and we are now executing our strategy with the goal of pioneering the reimbursed Interventional Dry Eye treatment market. We were very encouraged by the commercial traction we generated with a variety of dry eye customers in the fourth quarter. As preannounced in January, Interventional Dry Eye revenue in the fourth quarter was $0.7 million, up both sequentially and compared to the prior year. Revenues were driven by the sale of approximately 700 SmartLids to approximately 80 accounts, roughly 30 of which were new account engagements. The sequential and year-over-year revenue growth in the quarter was largely driven by sales in the Novitas and First Coast regions, where customer engagement with TearCare has been strong and reflects positive momentum in the reimbursed business model. A portion of new customers are existing glaucoma customers of ours who are excited to partner further on the TearCare treatment opportunity. The increasing engagement across accounts as they establish their Interventional Dry Eye practices and validate successful processing and payment of their first claims is promising. This progress is particularly notable, given our small but growing sales team and the limited time since our reimbursed launch. As part of our commercialization strategy, we are focused on high-volume dry eye prescribers where TearCare presents a clear and compelling clinical and economic value proposition. In parallel, we are engaging new eye care providers in states where fee schedules have been newly established based on existing dry eye treatment activity. And we continue to expand our outreach to glaucoma customers in these markets, where TearCare is a natural complement to their current practice offerings. Early interest from new providers and renewed engagement from existing providers underscore growing demand for tier care and Interventional Dry Eye procedures. In order to scale this business in fuel growth, we are making additional investments in our Interventional Dry Eye commercial organization. These investments are intended to strengthen provider engagement and expand commercialization in markets with established reimbursement. We added resources in the fourth quarter, and we'll continue building out our commercial infrastructure to drive growth in 2026. Expanding market access also remains a critical pillar of our growth strategy. As we deepen our engagement with additional max and commercial payers throughout 2026, we believe we can accelerate adoption and expand access for patients. We have built a strong foundation on clinically differentiated technology, initial market access fee schedules and early commercial validation, positioning us to pioneer the reimbursed Interventional Dry Eye market for years to come. Turning to Interventional Glaucoma. The fourth quarter marked an important milestone in 2025 as we fully lap the LCD changes, restricting multiple mix procedures in combination with cataract surgery. These LCDs reduce the number of devices used and caused meaningful headwinds to market growth in 2025. Despite these headwinds, our OMNI technology once again demonstrated its importance in the glaucoma treatment paradigm in this single MIGS environment. In the fourth quarter, we built on our strong third quarter performance and generated another quarter of growth compared to the prior year. Revenue was $19.7 million, up 5% year-over-year and flat sequentially. And at the top end of our preannounced revenue range provided in January. Ordering accounts increased 2% compared to the prior year, driven by a combination of reactivating accounts and adding new accounts. Utilization remained healthy, down only slightly after a particularly strong third quarter. Additionally, we saw continued benefit from higher Omni Edge utilization, which drove higher average selling prices in the quarter. With the interventional mindset increasingly impacting the glaucoma treatment algorithm, we are focused on developing the stand-alone market with OMNI. We are investing in targeted commercial resources to drive pseudophakic education and activation with surgeons and clinic staff. With similarities to the office-based cataract evaluation workflow, that is familiar to most ophthalmic and optometric practices. We have designed an Interventional Glaucoma evaluation workflow that we believe represents a significant opportunity to expand omni adoption and stand-alone interventions, and support a meaningful source of revenue growth over time. In 2026, our Interventional Glaucoma strategy focuses on disciplined execution to drive share gains, expansion of the combo cataract segment and further development of the underpenetrated stand-alone market, driven by our experienced commercial team, clinically differentiated technology, our investments in our dedicated psuedophakic market development team, we are positioned for a return to sustainable growth in Interventional Glaucoma. In closing, our strong fourth quarter performance reflects consistent execution across the organization and reinforces the momentum we are carrying into 2026. We believe we are well positioned to return to durable revenue growth in both segments as we leverage our differentiated technologies, experienced teams and the synergies of these 2 opportunities to continue building a leading interventional eye care company. I will now turn the call over to Jim to discuss our financial results.

Thanks, Paul. Before I turn to the results, I want to emphasize that we're entering 2026 and from a position of strength. With the operating discipline and cost structure we need to support growth, and over time, we believe this positions us to achieve cash flow breakeven without the need to raise additional equity capital. Unless otherwise noted, my comments reflect results for the fourth quarter of 2025 and comparisons are to the same period in the prior year. In the fourth quarter, total revenue was $20.4 million, a 7% increase. Interventional Glaucoma revenue was $19.7 million, an increase of 5%, driven by increases in ordering accounts and average selling prices. Interventional Dry Eye revenue was $0.7 million up from $0.3 million, reflecting positive traction in our reimbursed Interventional Dry Eye business model. Gross margin was 87%, consistent with the prior year. Interventional Glaucoma gross margin remained strong at 88% compared to 87% with the increase primarily due to higher average selling prices and product mix, slightly offset by tariff costs. Interventional Dry Eye gross margin improved to 68% compared to 51%, primarily due to higher average selling prices. Total operating expenses were $21.5 million, a decrease of 25% compared to $28.5 million primarily due to lower personnel-related expenses and stock-based compensation. As a reminder, we conducted a reduction in force in August 2025 and the fourth quarter was the first full quarter of our lower cost structure. Adjusted operating expenses were $18.9 million, a decrease of 23% compared to $24.4 million. Net loss was $4.2 million or $0.08 per share compared to a net loss of $11.8 million or $0.23 per share. We ended the quarter with $92 million of cash and cash equivalents compared to $120.4 million at the end of 2024. Cash usage was $0.4 million in the quarter the lowest cash usage quarter of the year, reflecting continued operational discipline. We ended the year with $40 million of debt, excluding unamortized discount and debt issuance costs from our 2024 year-end balance. Moving to our revenue outlook for full year 2026. We are initiating revenue guidance of $82 million to $88 million, which reflects growth of 6% to 14% compared to 2025. This guidance includes revenue for our Interventional Glaucoma segment of $77 million to $81 million, representing growth of 2% to 7%. And our Interventional Dry Eye segment of $5 million to $7 million compared to $1.6 million in the prior year. This guidance reflects our philosophy of setting prudent targets and our focus on disciplined execution and the growth we believe we can deliver. Looking closer at the first quarter, we expect Interventional Glaucoma to grow low single digits compared to the first quarter of 2025. We expect the first quarter revenue to be the lowest quarter of the year in this segment. and expect the second half of 2026 to be higher than the first half. Interventional dry high revenue is expected to be approximately $1 million in the first quarter. And as we expand and scale our reimbursed TearCare care launch, we expect revenue to ramp throughout the year. We are also initiating our guidance expectations for full year 2026, adjusted operating expenses of $93 million to $96 million. representing an increase of 6% to 9% compared to 2025. The expected increase is driven primarily by targeted market access and commercial investments in both Interventional Dry Eye and Interventional Glaucoma. We're pleased with the operational and strategic progress achieved in the fourth quarter and throughout 2025. We remain focused on pioneering 2 significant categories in the Interventional Stand-alone Glaucoma and reimbursed Interventional Dry Eye markets. As we continue to execute against our long-term objectives, we're laying a strong foundation for sustainable growth and future success. Operator, please open the line for questions.

[Operator Instructions] Our first question comes from the line of Frank Takkinen with Lake Street Capital Markets.

Great. Congrats on a strong finish to the year. I was hoping to start with one on guidance. Just curious if you could provide some color on kind of low-end versus high-end assumptions and it'd be helpful to talk about Interventional Glaucoma and Interventional Dry Eye disease separately.

Yes. Thanks, Frank. I can take that one. On Interventional Glaucoma, we're in a much more stable market and reimbursement environment than we saw a year ago. And we've got a couple of areas that we talked about in the prepared remarks, where we're focused on there, expanding the combo cataract segment as well as taking share there and expanding the stand-alone market opportunity. So on the guidance there in a much more stable market and stable environment. It's an area where we've been a leader in implant-free MIGS and we've got a team that's had a proven track record of execution. And in a one MIGS world, OMNI performs quite well. So we feel good about getting back to growth here in 2026. On IDE, baked into that guidance, we're early. Q4 was a really critical milestone for us with the MAC fee schedules established. And you saw $0.7 million of revenue in the fourth quarter. As we look ahead to 2026, our initial guidance here we want to step prudent guidance. And then really within that, we haven't assumed additional market access wins within our guidance, but the team is certainly heavily focused on market access initiatives and moving that forward here in 2026. So overall, I think we're excited about getting back to growth with both of our segments here getting to growth in 2026 and looking forward to executing here in 2026.

Perfect. And then a follow-up on kind of both of those factors. What are you assuming for underlying market growth in Interventional Glaucoma? And then saw the ASP a little bit over 1,000 for dry eye. Does that feel like a sustainable ASP rate? Or is that maybe a little bit high for how we should be thinking about it?

Yes. On the glaucoma market, Frank, we think it's in the low to mid-single-digit market growth there. And then Ali?

Yes. Happy to take the ASP question. So remember, when you look at the IDE revenue, that includes a mix of Smart Lids sold as well as Smart Hub sold. So that the ASP would be reflective of that mix within those segments. And we don't provide specific ASP information of our products but that is certainly a factor that you should think about when you're building out your IDE model and considering the different components of revenue.

Our next question is from Danielle Antalffy with UBS.

Sorry for my voice. I'm a little sick. Just a question on the standalone glaucoma market. I'm just curious what you see or how you see this evolving in the near term. I was at AO back in October, it seems to be very much a focus. And I'm a big believer in the standalone glaucoma market. But from a percentage penetration perspective, like how quickly can this ramp? And the second part of the question, what are the obstacles to getting there? And what are you guys doing to help break down some of those obstacles?

Danielle, this is Paul. Happy to take that one. Yes, it's an exciting time in Interventional Glaucoma for the past several years, Sight Science, as well as a handful of other industry players, have been spending a lot of time working with our eye care provider partners in educating the field on the benefits of earlier intervention with minimally invasive procedural-based solutions for glaucoma. I think we're moving, we're excited to be making some targeted investments in activating the stand-alone market so moving beyond an interventional mindset, moving beyond education. I think most glaucoma surgeons today do genuinely believe that intervening earlier with proven procedural interventions, whether that's pharmaceutical or medical device, pure procedure is better for patients over the long term. And now the goal is how to activate, how to turn that understanding of interventions being better earlier into actual cases. And we spent the last year at Sight Sciences really trying to understand how to activate the stand-alone opportunity. I talked about it a bit in the prepared remarks. We're modeling our stand-alone activation after something that's so well understood in ophthalmology, that's cataract surgery. Cataract surgery is a wonderful procedure. It's the #1 procedure by volume in all of medicine. And there's a well understood patient workflow for cataract surgery. So a patient understands that they need to get cataract surgery, what happens next, they come back to their eye care provider for a dedicated visit to really understand what are the available cataract options. And then from there, they get a surgery schedule. And we're finding in 2025 when we do that with a handful of accounts when we bring, when we work with our providers to help them follow this workflow where they bring back an Interventional Glaucoma patient candidate for an Interventional Glaucoma dedicated consult. That consult results in a much higher level of procedural activation. That activation might be OMNI. It might be some other interventional procedure. But if we do that well and our industry partners do that well, and we convert this market from eye drops to intervention, whether that's omni or other procedures. It's good for patients. It's good for providers and ultimately, it will be great for Sight Sciences as well. In terms of percentages, I think, Danielle, your other question, we believe we estimate that the current MIGS market is approximately like in terms of revenue cases, maybe 90% combo cataract stand-alone. We believe we have a slightly higher percentage of mix of stand-alone. We estimate mid-80s combo cataract, mid-teens stand-alone. And we believe that mix for us is going to shift. Again, we've made some dedicated pseudophakic market development commercial investments, about half a dozen market development focused professionals at Sight Sciences right now, who are working across the country with our eye care providers and customers to activate the stand-alone market to follow that Interventional Glaucoma console playbook that we arrived at in 2025 and actually implementing it to drive stand-alone case volume. So we're excited about it. It takes time to develop significant markets, but we believe that this will continue to be an area of growth for us over the years ahead.

Our next question comes from the line of Steve Lichtman with William Blair.

Apologies for any background noise, I'm in the car. Congrats on the progress. I wanted to ask first actually on the operating expenses. 4Q performance and the 2026 outlook were both better than our thinking. So as you think about this year, how are you balancing the opportunity you see on both sides of your business, but in particular, on dry eye with keeping the level of spend in check. Are you focusing really on the 2 MAC areas for now in dry eye? Any color there would be helpful.

Yes. Thanks, Steve. It's Jim. So as we look at investments in 2026, yes, the bulk of them are on commercial infrastructure, and you nailed it on our Interventional Dry Eye we're going to be placing investments in that space and both on the market access side and driving market access progress and then also on the commercial infrastructure side. So if and when we get additional market access wins, we're ready on the commercial side to drive traction. Our thinking is we want to have a mind -- we have an eye on breakeven and financial discipline, like we've done over the past couple of years, we've proven we can really manage OpEx and manage spend. And now we're in a position with a strong balance sheet to go fuel that growth. And we're going to invest -- we're going to learn a lot and invest and potentially pivot quickly, but invest where it makes sense to go fuel that growth. in both dry eye as well as on the Interventional Glaucoma, particularly the stand-alone opportunity.

Yes. Just to add to that, I mean we see the Interventional Dry Eye opportunity as such a compelling large market opportunity and the early traction that we're seeing with accounts has validated that with us. So the investments that we already have in commercial infrastructure appear to be seeing good returns on those investments. and we do expect to grow that team as we move forward, both in the areas where we already have fee schedules established and then also over time as we have additional reimbursement wins. So we are very excited about that, and that was something that we wanted to make sure we accounted for when putting out our operating expenses guidance.

Great. And then just double-clicking on that. In terms of the dry eye revenue for this year, it sounds like you're really laying out guidance essentially in those 2 MACs predominantly. And can you remind us, obviously, you're looking to get more wins, but just in those 2 MACs alone, what you see the revenue opportunity is for dry eye?

Yes, sure. So it's still an incredible opportunity just with those 2 MACs. They have 10.4 million covered lives our estimate because there is a higher prevalence of dry eye disease in a Medicare age population that there's about 700,000 patients in those markets with moderate to severe MGE. So still a very large market opportunity when you think about in Q4, we sold 700-ish smart lids, we're still at 0.1% of the market. So very early in terms of adoption curve here. And when we think about guidance, even the revenue opportunity in those areas is quite significant. Our bigger constraint is our own commercial infrastructure and resources to go activate those accounts and work with customers to set up their Interventional Dry Eye practices. So we do have a small team that is growing, but we also wanted to be careful to that prudent guidance, even taking into account the 2 states. So we won't be providing today kind of what's the full revenue opportunity of those markets, but it is quite compelling, and we think we've put guidance in a very prudent and reasonable place to start the year. And as we learn more and as we expand the team, we will provide updates as we go.

Our next question is from Tom Stephan with Stifel.

Great. First one on TearCare. I know it's early and this may be a difficult question. But as coverage and reimbursement starts to take hold, can you talk to us a bit about sort of how you think about the peak sales potential of TearCare, the inputs, the framework, et cetera, and as a figure, I'll take a stab here, is the figure of at least $100 million a reasonable starting point as we think about TearCare peak sales? And then I have a follow-up.

Yes. Thanks, Tom. I'll take that. So first of all, obviously, dry eye disease is a prevalent problem here in the United States. And if you look at the people who have moderate to severe MGD, there are 7 million to 8 million people who suffer from dry eye disease. Obviously, TearCare Care is a procedure that has been proven through the Hera data to show real benefits to signs and symptoms of those patients with dry eye disease. And so we think it's a compelling opportunity for patients who need procedural intervention and want procedural intervention versus regular daily or multiple times a day drop. And so in terms of the opportunity from a market potential, it's obviously very large. What is critical in that is our ability to gain market access to patients being able to get interventional procedures using their insurance benefits. And obviously, we are still very early in the curve of adoption there with $10.4 million covered lives, and we do look to expand that over time to be able to really make procedural intervention a standard of care. In terms of your question of peak sales, we see this as a very large market opportunity. We aren't going to quantify that today. But you can very quickly do some math that shows this is an incredible opportunity for us from a revenue perspective. But more importantly, this is also an opportunity that is better for patients in terms of having a procedural intervention versus regular eye drops with proven clinical results. It's also better for the eye care providers because the eye care providers get to participate in the economics since they are doing a procedural intervention versus drops where there's no incremental reimbursement for them. And we've also proven that it's better for the payers with our budget impact and cost utility analysis that shows that this is a better economic outcome for the payers as well. So we really think that this is a win for all we're very, very early in terms of market adoption and penetration. So we aren't going to get out ahead of that today. But to us, this is one of the most compelling opportunities in eye care today.

And Tom, I would just add to that. Obviously, we've spent a lot of time together in the MIGS category where you've got several thousand MIGS trained surgeons, several thousand surgeons who are trained on OMNI, in particular, when you think about procedural dry eye opportunity, not only are there more patients suffering from dry eye disease but there's also many more eye care providers and customers that will be our customers for TearCare across the country. That includes, obviously, in surgery, it's just ophthalmology. In Interventional Dry Eye, we have both the ophthalmic customers as well as the optometric customers. So there's thousands of ophthalmologists who can be customers for TearCare and there's many, many more optometrists who can be and will be customers for TearCare. So that's another way to think about the TAM. We'll obviously prove it as we go. We're excited to prove it commercially and generate the traction and deliver the results quarter after quarter. But I think you're going to see a different kind of business model, one, because there's so many more patients. Two, there are so many more eye care providers. And lastly, the model the model becomes more interesting over time because unlike surgery and unlike MIGS, where the goal is a single treatment and hopefully, that treatment keeps pressure under control. for as many years as humanly possible. We know that's not the case with dry eye treatments drop or procedure and in this model patients should stay in the model, getting 1 to 2 treatments per year. So we think that the TAM is super interesting for all of those reasons.

Got it. Really appreciate the color. And then maybe to pivot to glaucoma, and just on the first quarter outlook, up low single digit year-over-year. I would presume maybe is a bit below market and it's against an easy comp. So can you talk a bit about just what you're seeing in the first quarter that supports that near-term view, anything we should be cognizant of from maybe a headwind standpoint that's driving that outlook?

Tom, it's Jim. I'll take that one. I would say the only thing to really call out that's impacted us here in the first quarter as well as many others are the storms across the U.S. in January and February. So that's one piece. Otherwise, we don't see any other meaningful things to call out here in the first quarter.

Our next question comes from Adam Maeder with Piper Sandler.

Two for me, one on dry eye and one on international glaucoma. On dry eye, I was hoping just to get some additional color around your conversations that you're having with the other MACs as well as commercial payers. Just trying to get a sense for when we could start to see some of those other payer domino's fall and would love just to better understand what exactly is -- are they pushing back on anything? Maybe it's just a matter of time and bureaucracy, but you have 24-month randomized controlled trial data. So what do we kind of need to get those additional payers over the goal line? And then I had an additional question.

Yes, I'll take that one. And we've continued to be very active engaging with the other MACs having great conversations discussing their own review processes of the clinical and economic data as well as establishing pricing. And I will say that those conversations are continuing to progress. We do expect to have more MACs join and have more MACs established fee seals, and we would expect that to happen this year. So that's kind of our expectation. More granularity, it's always hard to predict exact timing with MACs. But I will say that, as you pointed out, there is very strong clinical evidence and economic data and we are showing demand and interest from constituents in their market. They are ECPs and patients are wanting access to this technology. And because we do have fee schedules already established in First Coast and Novitas, that is creating tightened pressure on other MACs to also allow access to their Medicare beneficiaries to have a fee schedule established. So we are happy with the progress there. Again, we won't speculate on exact exactly who will be the next one to establish a fee schedule or when that will be. But I will say that those conversations have continued to move forward, and that's really what we expected at this point.

Okay. Fantastic. And for the follow-up, I actually wanted to ask a reimbursement question on the glaucoma side. And I saw recently that AMA elected to move forward with the new goniotomy codes with an effective date of January 2028. So I guess what is Sight's expectation for kind of where reimbursement ultimately shakes out with those new codes. Can you level set us on the percentage of revenue tied to goniotomy for your business? And how are you thinking about any potential impact either positive or negative?

Adam, yes, we are aware of the potential read rock of goniotomy. We believe it's going to be -- the code will be split into an adult goniotomy code and a pediatric goniotomy code. Pediatric goniotomy, as you might expect, is more intensive procedurally and has more follow-up requirements. And so we would expect that the pediatric goniotomy economics might be maintained, but the adult goniotomy when it's revalued everyone, all experts in this area are saying they would expect it to be unfortunately reduced. If and when that happens, it would be in effect January 2028. A fee reduction would obviously put pressure on the utilization of that procedure. OMNI, our flagship Interventional Glaucoma technology, it performs canaloplasty followed by trabeculotomy, or AKA goniotomy. It's built either 2 canaloplasty or 2 goniotomy. We would expect if there's pressure on goniotomy alone as a procedure from an OMNI perspective as the leader in implant-free Mig, and the leader in ab interno canaloplasty that, that could actually be a tailwind at that time. Obviously, we believe, hopefully, the valuation of goniotomy is fair and reasonable. It's an important procedure in glaucoma. We hope that the assessment is acceptable to all stakeholders, mainly eye care providers.

Our next question comes from the line of David Saxon with Needham & Company.

Two for me, one on both of the businesses. First, just on Interventional Dry Eye I think you talked about in the script, you're selling to some omni customers. And I think in the past, you've talked about something like 200 OMNI accounts in those 2 MAC regions. So just wanted to get an understanding, like is the selling approach to ophthalmologists, any different than what you would do with optometrists either in terms of the length of the sales cycle or clinical education or any other dynamics like that?

Yes, I'll take that. So first of all, I'd say we're still very much in early days with this. So the accounts that we're engaging with now truly are the early visionaries. They're the ones that are seeing procedural dry eye as real opportunity for them, an important part of their procedure practices and are looking to be leaders in this area. And so I do think that, that profile of account is already different than what we'll see kind of at scale, especially with coverage density. Obviously, right now, it's a very targeted density associated with those accounts that have traditional fee-for-service Medicare beneficiaries. And so that also influences the accounts that are primary targets right now. So right now, we are seeing a lot of synergies with ophthalmology practices that are existing Interventional Glaucoma accounts because they do have a high mix of Medicare beneficiaries already, and they have a lot of experience with parts with Sights Sciences. That said, when we look at kind of our revenue mix, we are continuing to see new -- both a mix of new accounts and existing accounts order. So both accounts that already believed in the benefits of procedural dry eye and had adopted the product without reimbursement and then those that are now coming on board. So I think it's too early for us to call out specific trends or dynamics here just because it is a unique market environment, but we are very encouraged that our OMNI customers also have a serious problem with dry eye within their patient population, and they're looking for options to treat those. So that has been a great synergy for us and one that we expect to continue to grow on in 2026.

Okay. And then on the IG business, it looks like ordering facility count was down sequentially. Any color there? And then since you rolled out on the edge, you've been seeing a benefit from some pricing. I think you have Ultra the next iteration coming out shortly. So like anything baked into the guide around kind of additional pricing up a fair?

Thanks, David. On the utilization or account question, utilization has been fairly strong and from Q3 to Q4, relatively flat. On the account side, we did have year-over-year growth Q3 to Q4 down slightly, but Q3 was particularly strong in 2025. So as we look ahead, we continue to have a balance of reengaging accounts as well as adding new accounts. So our growth will come from a balance of accounts and adding new accounts as well as reengaging existing accounts and utilization at those. In terms of pricing, we did have some favorable pricing from Edge in 2025. And as we look ahead to launching Ultra here at some time in 2 we don't have specific uplift baked in for ultra ASPs into the guidance.

And this concludes our Q&A session. I will pass it back to Paul Badawi for his closing comments.

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.

And with that, we conclude our conference. Thank you for participating, and you may now disconnect.