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| So to summarize, the response we received from surgeons in the broader ophthalmic community since we announced FDA approval for iDose TR has been overwhelmingly positive and reaffirms our view that with the launch of iDose TR, we are pioneering a brand new category of procedural pharmaceuticals that has the potential to reshape glaucoma management as we know it today |
| So I can't ask the second part of your question, but I can tell you that we're excited about iLution both with Travoprost and then you've seen the data as well of iLution and the use of dry eye where we saw substantial changes in visual acuity as well as substantial improvements in tear film stability |
| You ended the year with a stronger than expected quarter |
| Glaukos reported today record fourth quarter consolidated net sales of $82.4 million up 16% on a reported basis and 15% on a constant currency basis versus the year ago quarter |
| And so for all those reasons, we're excited and moving forward |
| These record results, which further exceeded our preliminary pre-announcement from early January were driven by broad-based double-digit growth across our Glaucoma and Corneal Health franchises globally |
| Our strong fourth quarter performance caps-off a successful year of execution, both from a commercial and development perspective, leaving us ideally positioned as we enter into what should be a transformative period for our company in the years to come |
| From a commercial perspective, strong execution of key strategies within each of our core franchises drove this out performance |
| So I think as you put all that together and maybe most importantly, it points out accelerating trends within our overall franchises and what we think, is a pretty strong exit loss, if you will, when you think about coming out of 2024 and into 2025, particularly within that US glaucoma business |
| Market receptivity and adoption of iStent infinite remains strong with surgeon feedback most commonly highlighting the benefits of its three stent solution favorable safety profile and streamlined injector system |
| And we are getting positive signals across the board |
| And so, why do I say that? Because iStent infinite is showing a strong ability to re-establish physiologic outflow through the trabecular meshwork |
| I think as we get these get the approvals, I think there’ll be a strong initiative as we move forward with interventional glaucoma where people will start to feel strong confidence in using this in standalone cases |
| And so we feel like we're in a confident position targeting approval at the tail end of this clinical trial given the demonstrable performance we’ve had with the product up-to-date |
| And finally, our Corneal Health franchise delivered record sales of $21.8 million, a 19% year-over-year growth, including Photrexa record sales of $19.2 million on a year-over-year growth of 26%, as our key initiatives continue to take hold in support of this important business |
| I feel good about our path forward |
| And, I think that the guidance we established overall really implies another year of accelerating growth as we focus on putting in place really the foundational building blocks that we believe will enable the next really decade of growth for our company |
| We’re happy to report all of these cases went extremely well and early feedback from the small group of surgeons has been very positive |
| We are in a powerful position to leverage our established best-in-class glaucoma sales force and commercial organization to drive the iDose launch |
| It was evident throughout the productive meeting that our glaucoma sales force is excited and prepared to execute our plan |
| I mean, obviously, we were pleased to see the business continue to deliver and the momentum as we exited 2023, we’re entering 2024 |
| Our foundation is strong and we’re ideally positioned to continue transforming vision for the benefit of patients worldwide |
| Beyond iDose, we continue to prudently invest in and successfully advance our robust pipeline of novel promising platform technologies that we believe have the abilities to significantly expand our addressable markets and fundamentally transform our company over time |
| More recently, another TR manuscript published in ophthalmology and therapy highlighted favorable Phase 3 12-month results |
| Moving on, our international glaucoma franchise delivered sales of $21.9 million on strong year-over-year growth of 25% on a reported basis and 23% on a constant currency basis |
| The strong growth was once again broad-based as we continue to scale our international infrastructure and execute our plans to drive MIGS forward as a standard of care in each region and every major market in the world |
| And so, that’s very encouraging |
| And so, let me first say that we’re poised for success today given the current label |
| So, as you can see, we have a lot to be excited about when it comes to the significant potential value that we believe our pipeline programs may create |
| And so, using these products in combination should provide a very robust combinatorial care and procedure therapy for surgeons as they move forward |
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| And we'll probably also see some continued device related selling headwinds as the efficacy gets increasingly in focus for both our customers and our sales force |
| You started covering all this, but in what you're just saying, but I mean that's a dramatic slowdown in the US glaucoma business excluding whatever revenues would come up before iDose and then kind of same thing OUS |
| It certainly is painful for the patient |
| In parallel, we expect to see continued efforts by competition in those markets and probably even a little bit of currency headwind as we sit here today going into the year |
| But despite the continued growth tailed off a little bit from an absolute basis in the second half probably as procedures started to normalize a bit, on a global basis in the second half |
| And certainly, our upgrade to 5493 on the APC side doesn’t hurt us as a financial incentive for surgeons to be doing the right therapy for their patients |
| Some of the headwinds that you'd feared might have been a little better than expected |
| Combine that with what is a relatively difficult first half comp, if you go back and look at our international business, it was pretty clear that we were running at elevated levels in the first half of last year |
| And not surprisingly, we do expect those patterns to be pretty disrupted this year, by the combination of both the growing infinite business as we continue to turn on the market access side of that equation as well as most materially the iDose launch over the course of 2024 |
| And to your second point, for now we caution you with some conservatism as there could be some modest volatility in the margin as we ramp up iDose and go through a new product launch and the associated scaling that happens from a manufacturing standpoint |
| Love to hear from you the reaction from any payers or physicians and your confidence that you’ve priced this right? And just secondly, your confidence that the surgeon fee is going to be adequate? And I have one follow-up |
| And because of the extra time for visual rehabilitation, a lot of times it's incongruent with the young patients that are having this procedure, which sometimes have to defer the procedures until spring break or summer until they have a little bit more time to spend at home and heal |
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