Oct 29, 2026: a 33% gap to a record high
Glaukos reported after the close on Oct 28 and held its call at 4:30pm ET. The first premarket trades at 4am were at $206.00, up 13.5%, and the stock reached $213.10 by 6:50am. It opened the regular session at $211.00 and touched its low of $207.41 in the first minutes, then rose most of the morning, to $241.47 at 11:55am. At 12:04pm it was $240.76.
What happened:
- The quarter. Net sales were $211.0 million, up 58% and up 13.7% from the second quarter. US glaucoma sales rose 47% to $118.6 million, corneal health rose 154% to $59.0 million and international glaucoma rose 13% to $33.4 million. Non-GAAP EPS was $0.47 against an expected loss of about $0.10, and GAAP EPS was $0.03.
- The raise. The 2026 guide moved up $90 million at the midpoint, after a raise of about $62 million in July. COO Joe Gilliam said iDose TR alone should "reach into the low 280s" of millions this year, up from $275 million to $280 million.
- The 2027 number. CEO Tom Burns called the $1 billion target "highly preliminary." Gilliam said management modeled downside cases, including a final coverage rule close to the May draft, and that "we remain confident that we could still achieve that $1 billion."
- The Street. Wells Fargo, Needham, Piper Sandler, Stifel, Truist and BTIG all kept positive ratings on Oct 29.
The rest of eye care barely moved, so this was a company move, not a sector one. From the Oct 28 close, at 12:04pm:
| Stock or fund | Oct 28 close | Oct 29, 12:04pm | Change |
|---|---|---|---|
| Glaukos (GKOS) | $181.43 | $240.76 | +32.7% |
| STAAR Surgical (STAA) | $24.61 | $25.42 | +3.3% |
| iShares US Medical Devices (IHI) | $54.64 | $55.51 | +1.6% |
| Alcon (ALC) | $69.83 | $70.93 | +1.6% |
| Bausch + Lomb (BLCO) | $20.40 | $20.68 | +1.4% |
| Cooper Companies (COO) | $59.41 | $60.18 | +1.3% |
After the jump, RSI(14) stood at 87, the shares sat 40% above their 50-day average and 71% above their 200-day average, and the stock was at its 52-week high.
The numbers behind the raise
Glaukos has now posted four quarters in a row of faster growth, and each one beat the analyst average by a wider gap: $150.6 million in the first quarter against about $137 million expected, $185.6 million in the second against about $151 million, and $211.0 million in the third against about $168 million.
The margin moved with the mix. The non-GAAP gross margin was 87.7% against 83.9% a year earlier, and CFO Alex Thurman said the quarter was "really, really strong at almost 88%," with the two new products a growing share of sales. Non-GAAP operating income was $27.3 million and non-GAAP net income $28.5 million. Cash and short-term investments rose $50.5 million in the quarter to $339.8 million.
The guide is the part that moves estimates. Sales for the first nine months were $547.2 million, so $775 million to $785 million implies fourth-quarter sales of about $228 million to $238 million. Our explainers on why guidance changes move stocks and how estimate revisions follow cover why a raise this large tends to matter for longer than one day.
The bull case: two launches at once
- iDose TR is still growing. At about $76 million a quarter, it is most of US glaucoma sales. Gilliam pointed to fee-for-service Medicare patients in one large contractor region, Medicare Advantage and commercially insured patients as the sources.
- Epioxa has its billing code. Its product-specific J-code took effect July 1, and Gilliam said Glaukos exited the quarter with more than 200 established sites of care and contracts to reach more than 300. Access covers about 90% of US commercial lives, MarketBeat reported from the call.
- The balance sheet does not need help. With no debt and $339.8 million of cash, the launches are paid for out of operations.
The risks
- The iDose TR coverage rule. The May 2026 draft could limit Medicare coverage. Gilliam said the contractors' only statutory deadline is one year from the draft, and a final rule waits 45 days before taking effect. Analysts on the call asked whether a final rule would leave iDose flat in 2027; management declined to give a product-level 2027 figure.
- Spending. Thurman guided fourth-quarter operating expenses up 25% to 30%, with full-year expenses near $630 million.
- The price. At about 20 times trailing sales and above the average target, the stock needs the fourth quarter to land near the top of the range. Our guide to the price-to-sales ratio explains what that multiple assumes.
What comes next
The fourth-quarter report, expected around February 25, 2027, will show whether sales reach the implied $228 million to $238 million and should bring 2027 expense guidance. Before then, any final coverage decision on iDose TR is the event to watch, along with Epioxa site counts. Glaukos is also targeting FDA approval of iDose TRIO by the end of 2027. More of the day's swings are in today's biggest stock moves, and our guide to preparing for an earnings catalyst covers how to read the next report.