Sight Sciences’ 2026 Earnings Call: Payer Coverage Excluded from Guidance Despite Confidence, OmniUltra Launch Staged with 2027 Expansion

Date of Call: Aug 5, 2026

Financials Results

• Revenue: $23.4M, up 20% YOY
• EPS: Net loss per share $0.08, improved from $0.23 in the second quarter of 2025
• Gross Margin: 91%, up from 85% in the prior year period (includes 1.4M one-time tariff refund benefit)
• Operating Margin: Operating expenses $25.3M, down 11% YOY; Adjusted operating expenses $22.3M, down 8% YOY

Guidance:

• Total revenue guidance raised to $88-$92M for 2026, up from prior $83-$89M, representing growth of 14%-19%.
• Interventional glaucoma revenue guidance narrowed to high end of range: $79-$81M.
• Interventional dry eye revenue guidance raised to $9-$11M, up from prior $6-$8M.
• Adjusted operating expense guidance lowered to $92-$94M for 2026, reflecting 5%-7% increase vs. 2025.

Business Commentary:

Strong Revenue Growth:

• Site Sciences reported a 20% increase in revenue for the second quarter, reaching $23.4 million, marking the highest growth rate since 2023.
• The growth was driven by record revenue in both interventional dry eye and interventional glaucoma segments.

Interventional Dry Eye Expansion:

• The company's interventional dry eye revenue reached a record $2.7 million, nearly doubling from the first quarter.
• This increase was supported by a significant rise in active accounts and increased utilization, along with additional payer coverage.

Interventional Glaucoma Growth:

• Interventional glaucoma revenue was $20.7 million, reflecting an 8% year-over-year increase, with ordering accounts reaching an all-time high.
• Growth was attributed to increased Omni volume, broader market access, and strong utilization.

Operational Efficiency and Cash Flow Improvement:

• Total operating expenses decreased by 11%, and adjusted operating expenses dropped by 8%, reflecting improved operational efficiency.
• The company achieved a reduction in cash usage, underscoring progress toward cash flow break-even.

Market Access and Payer Engagement:

• Site Sciences added approximately 4.1 million patient lives in the second quarter, expanding coverage with major insurers like Aetna.
• The expansion of market access is anticipated to drive further growth in the interventional dry eye segment.

Sentiment Analysis:

Overall Tone: Positive

• "We delivered a strong second quarter, with revenue growing 20% year over year, our highest growth rate since 2023." "We are raising our full-year 2026 revenue guidance and reducing our adjusted operating expense guidance." "We are encouraged by the progress in the first half of the year, and the underlying trends support our expectation for continued interventional glaucoma growth in the second half of 2026."

Q&A:

• Question from Adam Mader (Piper Sandler): Could you discuss the underlying market trends and health of the interventional glaucoma market?
  Response: Management agrees the market is stable and in growth mode, mid-single digits, with a growing interventional mindset, and expects stability to continue into 2027.

• Question from Adam Mader (Piper Sandler): Regarding the 4 million additional covered lives in dry eye from Q2 payers, when did they come online and impact Q2? What is embedded in the updated dry eye guidance for payer coverage?
  Response: Impact in Q2 was minimal as providers tested billing; growing impact is expected in the back half. Revenue guidance does not assume new payer wins, though a pathway exists.

• Question from Nelson Cox (Lake Street Capital Markets): With dry eye active accounts nearly doubling, is volume spreading across new accounts or still concentrated in top accounts?
  Response: Utilization is durable across the board, though top accounts still drive higher volumes; overall account base is growing with integration into workflow.

• Question from Nelson Cox (Lake Street Capital Markets): What is the rollout plan and pricing for OmniUltra, and is any contribution baked into 2026 guidance?
  Response: OmniUltra launch targeted for AAO in 2026, with early feedback sessions first; no revenue contribution is assumed in 2026 guidance, full launch expected in 2027.

• Question from Steve Lichtman (William Blair): Can you give confidence in positive MAC movement for dry eye by year-end?
  Response: Confidence is based on strong clinical and health economic data, ongoing payer engagement, and a pathway to establish fee schedules or coverage policies, though timing is outside control.

• Question from Steve Lichtman (William Blair): How did standalone vs. combo cataract contribute to glaucoma growth, and what is standalone's current mix?
  Response: Standalone market share is growing faster than the overall market, with mix shifting towards standalone; company's standalone mix is also growing faster than market.

• Question from Tom Steven (Stifel): Do you feel current OPEX plans support spending discipline while supporting growth initiatives?
  Response: Yes, a good balance is struck between growth investment and discipline, honed during past cost-efficiency efforts, now with two strong growth engines.

• Question from Tom Steven (Stifel): What gives confidence in mid-single-digit YOY growth for glaucoma in Q3 despite typical seasonal decline?
  Response: Confidence comes from record active accounts, four consecutive quarters of growth, and momentum offsetting potential seasonality.

• Question from David Saxon (Needham and Company): Have you seen competitive response in dry eye, and how is tier care utilization in existing Omni accounts?
  Response: No competitive response seen; tier care is in a class with RCT support. Utilization is strong, with about two-thirds of volume from accounts that also have interventional glaucoma engagement.

• Question from David Saxon (Needham and Company): When will manufacturing transition outside China be complete, and what is the benefit?
  Response: Transition expected to complete in second half of 2026; it was not a primary cost-reduction play, so no significant margin impact expected.

• Question from Joanne Wench (Citi): Was the surge in new active customers in Q2 due to specific factors like reimbursement or promotions?
  Response: Attributed to good execution and a stable, growing market, not specific promotions or abnormal factors.

• Question from Joanne Wench (Citi): Should the expense management trend continue, and are you at a steady state?
  Response: Will see an uptick in SG&A for investments in dry eye market access and glaucoma standalone, but will remain disciplined and focused on high-return opportunities towards cash flow breakeven.

Contradiction Point 1

Financial Guidance Inclusion of New Payer Coverage

Contradiction on whether new payer wins are included in H2 financial guidance, impacting revenue expectations.

Adam Mader (Piper Sandler) - Adam Mader (Piper Sandler)

2026Q2: The updated H2 dry eye guidance assumes continued modest growth from existing coverage but does not include revenue from anticipated new payer decisions expected in H2. - Paul Badawi(CEO), Allie Bauerlein(COO)

Can you discuss the underlying market trends in interventional glaucoma and your outlook, as well as the effectiveness date, Q2 impact, and assumptions in updated H2 guidance for the 4.1 million additional dry eye covered lives? - Adam Maeder (Piper Sandler)

2026Q2: Revenue guidance for TearCare does not assume any incremental market access wins in H2 2026. - Paul Badawi(CEO), Allie Bauerlein(COO)

Contradiction Point 2

Commercial Launch Timeline and Revenue Contribution for OmniUltra

Contradiction on the expected contribution of the OmniUltra launch to 2026 financials.

Nelson Cox (Lake Street Capital Markets) - Nelson Cox (Lake Street Capital Markets)

2026Q2: No revenue contribution from OmniUltra is baked into the 2026 guidance. - Paul Badawi(CEO)

Are the volume increases in dry eye due to expansion into new accounts or concentration in existing ones, and what is the rollout plan for OmniUltra and its expected contribution to 2026 guidance? - Nelson Cox (Lake Street Capital Markets)

2026Q2: The launch will occur in stages: early feedback with select surgeons before the American Academy of Ophthalmology (AAO) meeting, a broader launch at AAO, with full market expansion planned for 2027. - Paul Badawi(CEO)

Contradiction Point 3

Nature of Dry Eye Market Growth and Utilization Trends

Contradicts the characterization of customer account growth and utilization maturity, affecting understanding of market penetration.

What are your thoughts on the recent earnings report? - Nelson Cox (Lake Street Capital Markets)

2026Q2: While there are a few high-volume accounts, utilization is now more consistent across a broader base of accounts, showing durable repeat performance... - Paul Badawi(CEO)

Is the increase in active accounts and dry eye utilization leading to volume spread across new accounts or remaining concentrated? - Nelson (on behalf of Frank Takkinen, Lake Street Capital Markets)

2026Q1: Customer adoption is still early across all accounts. Even the largest accounts are not fully activating TearCare across their entire Medicare patient population. - Alison Bauerlein(COO)

Contradiction Point 4

Dry Eye Payer Engagement and Outlook

Contradiction between guidance prudence and expressed confidence in securing additional 2026 payer coverage.

Can you discuss the drivers of revenue growth in the latest quarter? - Steve Lichtman (William Blair)

2026Q2: The company believes there is a pathway to secure more fee schedules or coverage policies from payers in 2026, though timing is outside their control. - Allie Bauerlein(COO), Paul Badawi(CEO)

Can you provide an update on payer dialogue for TierCare and confidence in further MAC movement by year-end, as well as disaggregate interventional glaucoma growth between standalone and combo cataract and share the standalone mix? - Frank Takkinen (Lake Street Capital Markets)

20260305-2025 Q4: The interventional dry eye guidance is early, prudent, and does not assume additional market access wins beyond the two established MACs (Novitas and First Coast). - Paul Badawi(CEO), Jim Rodberg(CFO)

Contradiction Point 5

Glaucoma Market Growth Outlook

Market growth outlook shifts from low-single digits to mid-single digits, impacting strategic and financial planning.

Adam Mader (Piper Sandler) - Adam Mader (Piper Sandler)

2026Q2: The interventional glaucoma market is stable and returning to growth, estimated in the mid-single digits. - Paul Badawi(CEO), Allie Bauerlein(COO)

Can you discuss the underlying market trends in interventional glaucoma and your outlook, as well as the timing and impact of the 4.1 million additional covered lives in dry eye on Q2 and the assumptions in the updated guidance for H2? - Frank Takkinen (Lake Street Capital Markets)

20260305-2025 Q4: The underlying interventional glaucoma market is expected to grow in the low to mid-single digits. - Paul Badawi(CEO), Jim Rodberg(CFO)