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Transcript Summary

Sight Sciences reported a robust first quarter for 2026, with total revenue rising 13% to $19.7 million. The growth was led by a 7% increase in Interventional Glaucoma revenue ($18.3 million) and a significant jump in Interventional Dry Eye revenue to $1.4 million. The company's Interventional Dry Eye segment saw a doubling of revenue from the previous quarter, driven by the successful rollout of the TearCare reimbursed model in specific MAC regions. Management raised the 2026 revenue guidance to $83–$89 million while maintaining its operating expense targets. A key highlight was the 'intersection of intervention' strategy, which capitalizes on the clinical overlap between glaucoma and dry eye patients to drive cross-selling. Additionally, the company secured a favorable $55 million final judgment in its patent infringement case against Alcon, including future royalties. With $85 million in cash and a reduced cost structure, Sight Sciences reaffirmed its path to cash flow breakeven without additional equity funding. The company also anticipates the launch of its OMNI Ultra technology later this year, further strengthening its leadership in the implant-free MIGS market.

5-year share-count history (top 10 holders by peak, incl. exited) + price

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Sight Sciences: Buying Growth with Dilution and Betting the Farm on Patent Litigation

Full Earnings Call Transcript — Q1 • 2026-05-07

Operator: Good day, and thank you for standing by. Welcome to the Sight Sciences First Quarter 2026 Earnings Results Conference Call. [Operator Instructions] 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.
Hannah Jeffrey: 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 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 materials 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.
Paul Badawi: Thanks, Hannah. Good afternoon, and thank you for joining us. We delivered a strong start to 2026 with first 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 third 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 fourth 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 2 significant anterior segment diseases, glaucoma and dry eye disease, where we believe procedural options can play a larger role in the treatment paradigm. Our 2 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 2 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 2 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 2 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 underpenetrated 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 stand-alone 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 stand-alone, we have hired a dedicated market development team and are encouraged by the early progress they are making in activating stand-alone 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 stand-alone 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 stand-alone 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 2 leading interventions for these 2 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.
Jim Rodberg: 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 2 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 onetime 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 to $89 million, which reflects growth of 7% to 15% compared to 2025 versus the prior guidance of $82 million to $88 million. This 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 $6 million to $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 to $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 to $96 million, representing an increase of 6% to 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.
Operator: [Operator Instructions] Our first question comes from the line of Frank Takkinen of Lake Street Capital Markets.
Nelson Cox: This is Nelson on for Frank. Congrats on the solid progress. Maybe just to start, I want to start on the SmartLids utilization stepping from 9 to 16 in the quarter per active account. So, 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?
Alison Bauerlein: Yes. Thanks, Nelson. And it's a great question. And the good news is I don't think we're anywhere close to a steady state yet. All of our accounts are still relatively early in their usage of TearCare across their Medicare -- traditional Medicare fee-for-service population. And so, I think even our largest accounts are not yet fully activating this across their patient population. And then, 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 when we look at our customer mix, there are a handful of accounts, probably 10% of the accounts that are driving a larger portion of the total volume here. And that's -- those are accounts that have really figured out the workflow, how to put this into their overall practice. And 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 interventions. And 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.
Nelson Cox: That's very helpful. And then 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?
Alison Bauerlein: Yes. So, 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 10 between our direct sales force as well as clinical specialists. So that team is still very small and growing. So, 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.
Operator: Our next question comes from the line of Adam Maeder of Piper Sandler.
Adam Maeder: Congrats on a good start to the year. Two for me. And 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 the good result there, the plus 7% year-over-year. 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, pricing. And then you obviously talked about some increment weather. So did you recapture those patients in the quarter. So just maybe kind of bring that all together for us? And then I have a follow-up.
Paul Badawi: Yes. 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. So, 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, and 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 microinvasive glaucoma surgical option in the market. And 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. So, we're excited about that, excited about the tailwind of Interventional Glaucoma and continuing to lead as the implant-free market leader in IG.
Jim Rodberg: 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 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.
Adam Maeder: Okay. Fantastic. Very helpful color and great to hear the comments on the market. And then maybe switching over to dry eye. Congratulations, Ali, on the progress there. I wanted to push a little bit in terms of market access and try and better understand the expectations for new payer adds, whether it's on the commercial or the MAC side. I'm not sure if you can be any more specific in terms of potential timing there. And I guess, really, the -- one of the questions I have is, can you hit the updated $6 million to $8 million without any additional payer wins?
Alison Bauerlein: Yes. Thanks for the follow-up here. And 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. And so 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 incremental positive movement with -- there are some commercial payers that are paying regularly, while they haven't established coverage policies. There are payers that are moving towards those types of activities, and 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. And 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. So very much early stages, and it's a large market, and we feel very good that we set appropriate guidance, taking into account all those factors for the areas where we currently have fee schedules established.
Operator: Our next question comes from the line of Steve Lichtman of William Blair.
Steven Lichtman: Congratulations on the progress. Wondering 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?
Alison Bauerlein: Yes. I'm going to 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 -- 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. So, we are still very small. Obviously, active accounts is a little different than eye care provider counts. But even with there being a couple of ECPs per active account, we're still very much in the early penetration days of the opportunity within First Cost and Novitas.
Steven Lichtman: Great. And then just a follow-up on the patent suit. Obviously, a decent amount of cash 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 of weeks, if that -- or there could be a settlement. What's the next steps and remind us of the interest accrual if it does go to appeal?
Jim Rodberg: Yes. So, I can give an update on at least the amount. So, 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. And beyond that, we won't comment further on pending litigation, but we feel we are in a very strong position in this case.
Operator: Our next question comes from the line of Tom Stephan of Stifel.
Thomas Stephan: 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? And 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.
Alison Bauerlein: Yes. So, one to two areas, 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. And so that is a very large part of our initial launch here, initial success. And we also see that those accounts are having higher utilization than the non-IG synergistic accounts. So 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. So, we do think that this is involved with people, people really being in accounts and helping the clinics set up their workflow, identify the patients and identify how best to put them into a dry eye treatment workflow. And so, 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. And then 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 is 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 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. And so 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. But we're really happy with the progress we've seen in terms of creating 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 morning. They tend to stack them up in the day to be efficient. But all of that is being worked through and then we're having the assessment upfront to identify those patients that may benefit from a procedural dry eye intervention and working that into the workflow. So, 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.
Paul Badawi: And Tom, I just want to add a few thoughts to Ali's comments around the intersection. Sight Sciences started -- we were born interventional. We started with OMNI and then we developed TearCare. These are 2 very strong interventions for 2 of the leading diseases in eye care. So, 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 2 disease categories and the possibilities of offering these same patients multiple interventions. So, 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 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. And so, the -- us being able to show up as their interventional partner having an intervention for their glaucoma patients, having an intervention for their glaucoma patient who also has dry eye disease. It's a very powerful partnership. And I think we're just -- we're 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, and 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.
Operator: Our next question comes from the line of Joanne Wuensch of Citi.
Joanne Wuensch: 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 MAC and educating the physicians and ramping them with the other metrics that we come to view and love on the side of Wall Street.
Jim Rodberg: Joanne, thanks for the question. I'll take that one, and Paul and Ali can add as needed here. But we're in a really good spot with a really healthy balance sheet and a strong pathway to cash flow breakeven, 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 in -- 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. And then on the glaucoma side, continuing to invest in the stand-alone opportunity there. So, 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.
Paul Badawi: And 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're making very selective -- we've got a number of selective R&D programs that we're investing in that we're going to be very excited about, all within this interventional category as we build a focused interventional eye care company. But 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.
Operator: Our next question comes from the line of David Saxon of Needham & Company.
David Saxon: So, I wanted to ask a similar question to Adams, but from a slightly different angle. So, I think you're only in 4 of the 13 states in First Coast and Novitas, those 2 regions or jurisdictions, I should say. So, 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?
Alison Bauerlein: Yes. So, to your point, we have sales really across -- first of all, most of the 13 states, we have some level of sales. So, we do have some sales support across them. But 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. One rep in Florida would not be sufficient to cover the entire state of Florida, for example. So, 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 going to get into specific territories or how we're going to break that out. But all of that is accounted for in our operating expense guidance. So, we have already adjusted for that appropriately.
David Saxon: Okay. And then on the IG side, Paul or Ali, would love to get an update on Omni Ultra timing of that clearance. And is that embedded in the IG revenue guidance? Or would that be upside when that comes out?
Paul Badawi: Yes, David, this is Paul. We are in discussions with the FDA on OMNI Ultra. While 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. So, we're very excited to launch Ultra, again, hopefully, by the end of the year it will be out in the market. It's got a number of great features, surgeon informed. We 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 single pass, single incision, single pass 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 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, we 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, and we can do even better.
Operator: This concludes the question-and-answer session. I would now like to turn it back to Paul Badawi for closing remarks.
Paul Badawi: 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.
Operator: Thank you for your participation in today's conference. This does conclude the program. You may now disconnect.