Sight Sciences (SGHT) 2026 年第三季法說會：營收創新高，上修財測指引

重點摘要

• Sight Sciences 公布 2026 年第三季營收達創紀錄的 2,490 萬美元，年增 25%，連續第三季實現雙位數成長。
• 介入性乾眼症 (IDE) 業務營收創下 390 萬美元的新高，季增 45%，下單客戶數增至 222 家，每家客戶平均使用量升至 21 套 SmartLid。
• 介入性青光眼 (IG) 業務營收年增 7% 至 2,100 萬美元，受惠於手術量增加、活躍客戶數創新高以及使用率提升。
• 毛利率維持在 86%。淨虧損改善 17% 至 680 萬美元，單季現金消耗量年減 74% 至 240 萬美元。
• 管理階層將 2026 全年營收財測上調至 9,200 萬至 9,300 萬美元，同時維持經調整營業費用 9,200 萬至 9,400 萬美元的財測不變。
• 管理階層表示，公司仍有望在不籌集額外股權資本的情況下實現現金流損益兩平，但未提供具體時間表。

核心財務業績

今年以來營收成長 19%，經調整營業費用則下降 2%。今年以來現金消耗改善 48% 至 1,460 萬美元，顯示儘管持續進行商業化投資，營運槓桿效益仍有所提升。

業務與營運表現

TearCare 推動 IDE 業務加速成長

IDE 的成長得益於客戶採用率和使用率的雙重提升。下單客戶數從第二季的 176 家增至 222 家，SmartLid 採購量從約 3,100 套增至約 4,600 套。每家下單客戶的平均使用量從 18 套升至 21 套 SmartLid。

管理階層表示，即使在新增客戶的情況下使用率仍有提升，不過各客戶的採用情況仍不均衡。部分成熟客戶的使用量遠高於公布的平均值，而新進診所則仍在建立工作流程並測試請款申報。

FDA 在本季擴大了 TearCare 的適應症標籤，目前核准用於改善乾眼症患者的瞼板腺功能。管理階層預期擴大的標籤將有助於客戶教育、治療定位以及與保險給付機構的溝通。

商業推廣活動仍集中在已建立保險給付與收費標準的地區，特別是擁有大量傳統聯邦醫療保險 (Medicare) 病患群體的診所。該公司也鎖定聯合照護診所；管理階層表示，目前約有一半的 TearCare 客戶同時也是 IG 客戶。

IG 連續第五季實現成長

受益於手術量增加、使用率提高以及活躍客戶數創新高，IG 營收達 2,100 萬美元。這是該業務部門連續第五個季度實現成長。

繼初步有限度推廣後，Sight Sciences 於 10 月的美國眼科學會 (AAO) 年會上在美國正式商業化推出 OMNI Ultra。這款次世代系統具備單次通過管成形術、透過 TruSync Plus 實現的自動化黏稠擴張術，以及更優異的導管視覺化功能。管理階層預期該產品的推出將為 2027 年的 IG 成長動能提供支撐。

Aetna 亦擴大了對 OMNI 和 SION 的承保範圍，新增約 2,500 萬名納保人口。

針對單純青光眼手術，該公司正與醫療機構合作，建立可重複的病患篩檢、諮詢與手術流程。管理階層認為該市場滲透率仍低，其發展階段早於合併白內障手術。

透過 IX 平台進行交叉銷售

Sight Sciences 透過其「介入交會點」（Intersection of Intervention，簡稱 IX）策略，將 OMNI 與 TearCare 定位為互補產品。管理階層表示，青光眼領域的既有合作關係有助於加速 TearCare 的推廣採用，尤其是在治療同時患有白內障、青光眼和乾眼症的白內障及微創青光眼手術 (MIGS) 醫師群體中。

該公司也觀察到，在白內障手術前需要先治療乾眼症的病患中，TearCare 已開始在術前被採用。

管理階層財測

更新後的營收預期代表全年成長約 20%。管理階層將此上調歸功於 IG 的持續動能以及 IDE 更大的貢獻。

Sight Sciences 計劃持續針對 IDE 的商業資源和市場准入進行精準投資，同時力求營收成長快於費用成長。該公司將其債務的只付利息寬限期延長六個月至 2027 年 8 月，並稱此項調整為可提供額外彈性的資本管理措施。

管理階層未提供具體的 2027 年財測。管理階層表示，創紀錄的 IG 活躍客戶數、OMNI Ultra 的上市，以及 TearCare 客戶數和使用率的持續成長，為邁入該年度提供了動能。

風險與關注事項

• TearCare 仍處於納入保險給付之商業推廣的初期階段，使得使用趨勢與季節性難以預測。
• 目前 IDE 的成長來自有限的保險給付覆蓋範圍。更廣泛的採用在一定程度上取決於聯邦醫療保險行政承包商 (MAC) 及商業保險機構制定更多收費標準與承保政策。
• 管理階層表示，儘管溝通持續進行且請款申報活動增加，但公司無法掌控保險機構做出決定的時間點。
• 較新的 TearCare 客戶在建立工作流程與測試請款申報期間，使用率通常較低。
• Sight Sciences 在仍處於淨虧損和負現金流的情況下，持續投資於商業資源與市場准入。

分析師問答精華

第四季財測：分析師詢問為何更新後的全年預期意味著季增長較為溫和。管理階層指出兩項業務持續強勁，但表示 IDE 仍處於市場開拓曲線的早期階段。因此，公司在財測中納入了季節性與採用率的不確定性。

TearCare 使用率：管理階層婉拒提供長期使用率目標。管理階層表示，成熟客戶的使用量可遠高於目前平均值，而新客戶則需要時間建立處置流程。隨著商業保險覆蓋範圍擴大，使用密度可望隨著時間推移而提升。

TearCare 保險給付准入：公司在與保險機構的協商中運用臨床實證、衛生經濟學數據、請款申報活動、專業指南以及擴大的 FDA 適應症標籤。管理階層預期未來幾季將有更多收費標準或承保政策推出，但無法預測確切時間點。

2027 年成長：管理階層並未背書具體的外部預估。管理階層將 IG 描述為穩定且持久的成長引擎，並強調 OMNI Ultra 為潛在的順風推力。對於 IDE，首要任務包括增加客戶、提高現有已給付地區的使用率，以及擴大市場准入。

營運槓桿與流動性：管理階層計劃在維持費用紀律的同時，為最具吸引力的成長機會提供資金。管理階層重申在不籌集額外股權資本的情況下實現現金流損益兩平的目標，而債務寬限期延長至 2027 年 8 月則提供了更多彈性。

完整法說會逐字稿

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完整財報電話會議逐字稿

管理層陳述

Operator

Good day, and thank you for standing by. Welcome to the Sight Sciences Third Quarter 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.

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 third quarter ended September 30, 2026, raised its revenue guidance and maintained its adjusted operating expense guidance for the 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 within the meaning of federal securities laws. 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 risks and other 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 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 are 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'll now turn the call over to Paul.

Paul Badawi

Thanks, Hannah. Good afternoon, and thank you for joining us. We are extremely proud of our results again this quarter, where we reported record revenue of $24.9 million, growing 25% year-over-year. This marks our third consecutive quarter of double-digit growth and second consecutive quarter of 20% growth or greater. IDE revenue continues to scale rapidly and reached another record quarter with revenue of $3.9 million, and IG continued its momentum and grew 7% to $21 million. Notably, we delivered this high growth performance while both investing in our growth drivers and significantly improving our cash burn, highlighting the operating leverage in our commercial model.

Based on our strong results and outlook, we are raising our full year 2026 revenue guidance while maintaining our adjusted operating expense guidance. At Sight Sciences, we are focused on delivering minimally invasive technologies that address the underlying cause of two of the most common anterior segment diseases, glaucoma and dry eye disease. As the pioneer and creator of two interventional eye care categories within glaucoma and dry eye disease, Sight Sciences has taken an important leadership position in interventional eye care. To date, our products have now been used in over 500,000 procedures.

As the treatment paradigm continues to shift toward earlier procedure-based care, we are well positioned to drive expanded adoption of our technologies and improve access to earlier intervention for the patients we serve. This opportunity is particularly compelling because glaucoma and dry eye disease are increasingly seen within the same patients, practices and treatment pathways, reinforcing our conviction that OMNI and TearCare are synergistic interventional growth drivers.

Within our company, we have created a third area of focus beyond IG and IDE called the Intersection of Intervention, or IX. IX is where Sight Sciences becomes more than a portfolio of products. It creates a scalable interventional eye care platform with common customers, overlapping patients and a shared procedure-based model that can create commercial leverage across glaucoma and dry eye. At last month's American Academy of Ophthalmology's Annual Meeting in New Orleans, we had the privilege of celebrating the IX partners who have adopted both OMNI and TearCare into their practices and have been instrumental in leading the advancement of interventional patient care. Importantly, our established relationships in glaucoma are helping accelerate adoption of TearCare, creating a powerful connection between our two technologies. We believe this synergy represents a durable growth driver and reinforces our position as a leader in interventional eye care.

Now turning to our segments, beginning with IDE, where we delivered another record quarter and generated third quarter revenue of $3.9 million, an increase of 45% from the second quarter. This continued traction reflects growing TearCare adoption in the reimbursed market and further progress in building a durable recurring procedural revenue model. Based on this momentum, we are increasing our full year IDE revenue outlook to approximately $12 million, up from the previous range of $9 million to $11 million.

Looking closer at this quarter's results, the underlying metrics of our IDE business continued to strengthen with increases in both ordering accounts and utilization. Ordering accounts rose to 222, up from 176 in the second quarter, and those accounts purchased approximately 4,600 SmartLids, up from approximately 3,100 in the second quarter. Average utilization climbed to 21 SmartLids per ordering account compared to 18 in the second quarter. Notably, utilization increased as we added new ordering accounts, reflecting deeper adoption of TearCare across our customer base. Growth in both ordering accounts and utilization is the foundation of a durable recurring procedural revenue model and continued progress on both remains central to scaling our IDE business.

The early adoption metrics highlight the significant opportunity ahead for the more than 7 million patients suffering from moderate-to-severe MGD. We continue to sharpen our go-to-market strategy as we learn from the commercial adoption of TearCare in areas with market access. We are focused on practices that already manage a high volume of dry eye patients and have embraced a procedural approach, and we are adding targeted sales and clinic support capacity to help practices quickly establish workflows and build a consistent patient flow. This disciplined focused model allows us to grow efficiently today while positioning us to scale rapidly as market access expands.

Earlier in the quarter, we announced an FDA label expansion for TearCare, making it the first and only treatment for MGD indicated to improve meibomian gland function in patients suffering from dry eye disease. This updated label marks an important milestone for TearCare. While the benefits of the procedure already resonate with our customers and their patients, this label expansion recognizes TearCare's ability to improve physiological function and ultimately address the underlying cause of disease, enabling our team to strengthen the message around the benefits of the procedure for patients.

Expanding equitable market access to the only reimbursed procedural intervention for the millions of patients suffering from MGD remains a top priority. We continue to advance this priority through productive dialog with multiple payers and anticipate that they will establish fee schedules and/or coverage policies in the coming quarters. To this end, we continue to invest in our team to drive the expansion of market access for TearCare through heightened engagement with MACs and commercial payers. In our conversations, we continue to highlight TearCare's robust clinical evidence, favorable health economic profile and increasing adoption in everyday clinical practice. At the same time, we remain focused on commercially executing within the serviceable market already in front of us. We believe continued execution in these regions can drive meaningful growth with additional positive payer decisions serving as important accelerators.

Overall, IDE delivered another record quarter with growth in both ordering accounts and utilization and an expanded FDA label that better reflects TearCare's full value. Our results to date have come from a focused commercial team operating in a limited reimbursed footprint, and we believe they demonstrate the significance of this opportunity when patients have access to it. As market access expands, we believe our commercial model can scale efficiently into new regions, positioning us to pioneer and lead this category and drive significant growth in the years ahead.

Moving to IG. Third quarter revenue was $21 million, an increase of 7% compared with the prior year period. This was our fifth consecutive quarter of growth and importantly, active accounts reached another all-time high in the quarter. Based on this performance, we now expect increased full year IG revenue of $80 million to $81 million compared to our prior range of $79 million to $81 million.

Our strategic priorities remain unchanged as we continue to focus on training new surgeons, driving deeper utilization across our existing customer base and capturing a larger share of combo cataract cases while also continuing to activate the stand-alone opportunity. We were also encouraged by the expansion of OMNI and SION coverage through Aetna earlier in the quarter, adding approximately 25 million additional covered lives. Together, these efforts are strengthening our implant-free glaucoma franchise, deepening our customer relationships, and creating a solid foundation for our leading interventional eye care platform.

Shortly before our last earnings call, we announced FDA 510(k) clearance of OMNI Ultra, the next-generation technology in our OMNI product line. Following an initial limited rollout, we launched Ultra commercially in the U.S. at the AAO Annual Meeting in New Orleans in October. We are excited about the launch and believe Ultra can support sustained growth in our IG business by appealing to a broad range of surgeons and deepening engagement across our customer base. Developed with direct input from surgeon customers, Ultra includes single-pass canaloplasty, TruSync Plus for automated viscodilation and improved catheter visualization. Early users have responded very positively to its versatility, ease of use and meaningful improvements over the prior generation of OMNI. Ultra builds on our legacy as the pioneer of ab interno canaloplasty and demonstrates our continued commitment to innovation, further strengthening our leadership position in implant-free MIGS.

In stand-alone, our market development work continues to focus on helping practices implement a repeatable interventional glaucoma activation workflow. This workflow was designed with the cataract workflow in mind, a familiar and effective model for practices and is intended to help move the stand-alone opportunity from physician education to practical activation. We believe this helps providers identify appropriate patients, integrate the procedure into clinic operations and build more consistent adoption. The stand-alone market is growing, and it remains a large underpenetrated opportunity. We believe the work we have done is beginning to contribute to growth today and is an important step toward expanding the role of interventional glaucoma in the treatment algorithm.

In summary, we are proud of the performance across both of our interventional segments in the third quarter. In IDE, we are driving significant growth with a concentrated commercial team as we prepare to scale efficiently upon achieving broader market access. In IG, we are looking forward to the full launch of OMNI Ultra over the coming quarters and sustaining our growth trajectory. Finally, the unique overlap between our 2 businesses serves as an important growth driver, and we are excited to be leading the intersection of intervention as it further evolves into a compelling catalyst for Sight Sciences.

With that, I'll turn the call over to Jim to discuss our third quarter financial results and updated 2026 guidance.

Jim Rodberg

Thanks, Paul. Third quarter revenue was a record $24.9 million, an increase of 25% year-over-year and our third consecutive quarter of double-digit growth. IG revenue was $21 million, up 7% compared to the prior year period, driven primarily by higher volumes, a record number of active accounts and stronger utilization than the prior year period. IDE revenue reached a record $3.9 million, increasing 45% sequentially from the second quarter, driven by growth in both ordering accounts and utilization as the business continues to scale.

Gross margin was 86%, in line with the prior year period. IG gross margin was 87%, consistent with the prior year period. IDE gross margin was 79%, up significantly from 38% in the same period in the prior year, primarily due to higher average selling prices. Total operating expenses were $27.5 million in the third quarter, representing a 10% increase compared to $25.1 million in the prior year period. The increase was largely due to higher personnel-related expenses from additional commercial investments to drive revenue growth. Adjusted operating expenses were $24 million, up 21% compared to $19.8 million in the same period in the prior year. The increase year-over-year reflects a lower expense base in 2025 following last year's realignment of our cost structure as well as investments we have made in 2026 for growth in both segments. These investments were most significant in resources to scale the IDE business, and we expect to continue those investments through the end of the year.

Year-to-date, revenue grew 19%, while adjusted operating expenses declined 2% compared to the prior year period. Net loss was $6.8 million, a 17% improvement from $8.2 million in the prior year period. Net loss per share was $0.12 compared to $0.16 in the third quarter of 2025. We ended the quarter with $77.4 million of cash and cash equivalents compared to $79.8 million at the end of the second quarter. Cash used in the quarter was $2.4 million, an improvement of 74% from $9.1 million in the third quarter of 2025. Year-to-date cash usage improved 48% to $14.6 million. Importantly, we achieved this improvement in cash burn while continuing to invest in revenue growth across both businesses, underscoring the operating leverage in our model. We ended the quarter with $40 million of debt, excluding unamortized discount and debt issuance costs. And in October, we extended the interest-only period on our debt by 6 months to August 2027. We remain well positioned to achieve cash flow breakeven without the need to raise additional equity capital.

Moving to our full year 2026 outlook. We are raising total revenue guidance to $92 million to $93 million, up from $88 million to $92 million. This includes IDE revenue of approximately $12 million, up from $9 million to $11 million and IG revenue of $80 million to $81 million, up compared to $79 million to $81 million previously. Our updated outlook represents approximately 20% full year revenue growth, driven by continued momentum in IG and a meaningfully higher contribution from IDE. We are maintaining adjusted operating expense guidance of $92 million to $94 million, representing full year growth of 5% to 7% compared to prior year.

In closing, the third quarter demonstrated the strength and momentum of our business. Record revenue growing 25%, sustained growth in IG, continued acceleration of our IDE business and significant improvement in cash burn. We are raising our revenue outlook while maintaining adjusted operating expense guidance, reinforcing our confidence in the growth trajectory and operating leverage of the business. We remain focused on investing to drive strong revenue growth while simultaneously improving profitability and cash flow.

Operator, please open the line for questions.

Operator

Our first question, we're going to be taken from Frank Takkinen from Lake Street Capital Markets.

分析師問答

Frank Takkinen

Congrats on another really solid quarter. I was hoping to start with one on the 2026 guidance. Obviously, all metrics are pointing to a lot of momentum in the business. I think if you look at the guide, it's implying slightly down quarter-over-quarter or flat quarter-over-quarter at the high end of the range. Why might this be? And maybe speak a little bit to each of the businesses and if there's conservatism baked in or if there's anything else going on with those businesses that might support that?

Jim Rodberg

Yes. Thanks, Frank. This is Jim. I can start here and others chime in as needed. Look, I think for the full year revenue guide here, we're really proud of getting back to high growth now at almost 20% for the full year. And both interventional businesses here performing ahead of expectations and another raise here for the end of the year.

Now first, in IG, the underlying strength of that business, the fundamentals, we're really excited about that and have had excellent execution all year long. So we exit Q3 with record active accounts, strong utilization, stable pricing and excited about the Ultra launch here in Q4 that will be a tailwind as we head into 2027. So on the glaucoma business, really strong fundamentals, have performed really well year-to-date. Expect that momentum to continue into Q4 and carry into 2027 with momentum.

On the IDE side, we're continuing to scale that business rapidly, and the team has done an exceptional job with revenue reaching record amounts each quarter, a couple of doubles in there early in the year. And the confidence we have in that business, we continue to outperform and raise with revenue accelerating active accounts now up to 222 and utilization improving. So we look forward to executing well here in Q4 as we've done all year and exiting the year here with strength and entering 2027 with a lot of momentum.

Frank Takkinen

Maybe for my follow-up just on that last point you made around ramping accounts relatively quickly and utilization outperforming. Can you maybe parse out like what some higher-level sites are doing from a utilization standpoint and trying to give us a feel for where this utilization level can go over time. It feels like there's a lot of room to go on still, and it's obviously outpacing even a pretty good clip of new accounts. Maybe talk to where that utilization metric can go over time?

Alison Bauerlein

Yes, Frank, I'll take that one. This is Ali. And we are really proud of the fact that we're seeing growing utilization across our customer base and that's while we're also adding new accounts, and obviously, newer accounts typically have lower utilization than accounts who have been doing this for a couple of quarters and have really been building out their IDE business.

We aren't going to provide specifics of levels of utilization. But I think with any type of early stage, early adopters, you see a wider range of utilization, and we do have some accounts doing significantly more utilization than that average metric that we provide. And then we have others that are still very early in their adoption curves and are more cautious in the amount of procedures that they're doing, while they're still building out their workflow and testing claims. But we do think that there is a lot of room for us to continue to grow utilization over time. As you know, right now, we really are focused on customers that have a larger base of traditional Medicare patients because that's where fee schedules are established. But the larger portion of the market is patients that are on more traditional commercial plans. And so those are opportunities over time to also increase density with our customer base as we expand market access. So hopefully, that little bit of color helps.

Operator

Our next question comes from Tom Stephan from Stifel.

Thomas Stephan

I'll start out on 2027, and I'll take a stab here. Not looking for guidance, but I look at consensus, and I think I'm seeing low double-digit percent revenue growth next year. Maybe just your level of confidence in that being the right starting point for Street models heading into next year. And then what does glaucoma look like within that? I think the 2-year CAGR for '26 on glaucoma revs might shake out at around 3%. But Street has, I want to say, mid- to high single-digit percent growth next year. So maybe if you can comment even directionally on those consensus numbers and your level of confidence both for total revs and glaucoma as well.

Jim Rodberg

Thanks, Tom. I'll take that one. This is Jim. So you're right. We're not going to get into specifics around 2027 guidance today. But I would emphasize, we're very proud to be back in growth mode in both of these businesses. And as we mentioned in our prepared remarks, revenue now growing 20% at the midpoint in our updated guide. We exit '26 with a lot of strength and momentum heading into 2027.

In IG, our fifth consecutive quarter of growth, record number of active accounts and Ultra providing hopefully a tailwind here heading into next year. We're very excited about the launch of that. So on the IG side, growing this year 6% to 7% in the updated guide is a really great performance by our team. It's a healthier growing market. And we would expect that momentum to continue here into Q4 and that to be a stable, durable growth engine for us in the future.

On IDE, very early, as we said on -- in that business and scaling it up, and like Ali said, very proud of the progress we've made there in delivering record revenue each quarter. So I think as we look at that business, we're focused on a couple of things in 2027. One, scaling up within First Coast and Novitas, adding active accounts, increasing utilization. And at the same time, working on expanding market access for additional growth opportunities. So we'll get into more specifics on the 2027 guide in an upcoming call. And I just want to say, I think we feel very confident in where the business has performed this year and looking to continue it here in Q4 and into 2027.

Paul Badawi

And Tom, I would just add, as you think about Sight Sciences and look out into the future, there's -- the world of ophthalmology is becoming more interventional every day. I think the term interventional glaucoma or IG has become a household name within the ophthalmic community. We're pioneering the reimbursed procedural IDE category and now even go to trade shows and IDE is becoming a term, it is becoming better understood. So as the world of ophthalmology and optometry becomes more interventional over time, we're in a very unique position with 2 proven interventional technologies in OMNI and TearCare that both address the root underlying cause of disease, very consistently clinically effective.

We have data that helps us educate our customers that intervening earlier is clinically better over the long term. We've got dedicated commercial teams focused on these 2 businesses and focused on these 2 categories driving intervention. We're in practices around the country, educating surgeons, office-based ophthalmologists, optometrists and all of their staff, administrators and staff on the benefits of intervention -- of earlier intervention. And so as we continue to execute on that, and we continue to build a leading interventional eye care company, obviously, very attractive growth is going to follow from that over the years to come.

Thomas Stephan

And then my follow-up, just to zero in on TearCare, I'll ask a utilization question in maybe a little bit of a different way. But for the current ordering accounts today or in the third quarter, where the utilization was, I believe, about at around 21% in 3Q, how does that compare to what these same accounts were doing, call it, 2, 3 years back prior to reimbursement being part of the equation here for all practices. I guess I'm just curious how volumes at the current installed base, how those volumes look and are ramping back up now versus maybe these same accounts' previous run rates. Hopefully, that makes sense.

Alison Bauerlein

Yes. Thanks, Tom. I'll take that one. And I think it's a great question because, first of all, I would say a lot of account makeup is very different than it was 2 years ago. Two years ago, it was really focused on the cash pay market that was driven primarily by optometry practices. Now the majority of our accounts are collaborative care practices, about half of them are also IG accounts, and so we see a lot of synergies there. And in general, these are higher quality, more durable relationships that we have where those practices are ordering on a regular frequency because they're using products in that everyday practice environment, where with the cash pay situation, those patient interactions were much less frequent.

And so you had ordering patterns that were very variable by account, and there was a lot of lost accounts where they would start and then maybe wouldn't necessarily see the traction on the cash pay and the volume would fall off. And so the quality of those interactions is much higher. We're seeing great patient outcomes and patient feedback that continues on the value of TearCare and being able to just have something that is a reimbursed procedural option is very attractive to providers who are looking for a better solution versus just telling their patients to use more daily eye drops. So it really is something that we're proud of in terms of that utilization. And again, as I said earlier, we still believe we are really early stage in terms of those utilization. And as we can increase access, that should continue to grow over time as well.

Operator

Our next question comes from Steve Lichtman from William Blair.

Steven Lichtman

Congratulations on the quarter and progress. I wanted to ask about the label expansion from August. Given the differentiation there, wondering what feedback you've gotten from the field on this, how the education of that label expansion is going? And is it opening up some eyes in terms of accounts that may have been resistant before?

Paul Badawi

Yes. I'll start and then, Ali, you want to add thoughts as well, that would be great. Steve, this is Paul. We're very proud of the label. It's very consistent with our mission in interventional eye care. It's consistent with how we approach developing technologies that can elevate the standard of care. Our goal is to equip eye care providers with best-in-class technologies that address the root underlying cause of disease. And we believe that if we can offer those technologies that are either minimally invasive or noninvasive and do address that underlying cause of disease, do so in a comprehensive user-friendly manner, then we can differentiate ourselves from a safety, efficacy and usability perspective. We believe that's the right way to develop technologies and to hopefully ultimately elevate the standard of care.

So getting this label expansion for TearCare is extremely consistent with that. It validates our approach being the first and only MGD technology indicated by the FDA to improve meibomian gland function. Over the past few decades, dry eye disease has been thought of as a problem of aqueous deficiency, when in reality, far more patients suffer from accelerated tear evaporation. And so the meibomian glands as an anatomy have been overlooked. We thought that -- we wanted to challenge that. That wasn't okay. There are so many patients, millions of patients out there who have diseased meibomian glands, they're obstructed, they need a targeted treatment that targets that underlying cause. And so that's what we've been doing over the past decade with TearCare finally culminating in this label expansion. I think it just validates how we approach the markets that we serve and how we expect to partner with our customers and help them elevate the standard of care for patients. But with that, Ali, do you want to add?

Alison Bauerlein

Yes. Just to build on that, the field reaction has been positive to the label expansion. I think for the customers that we already have, frankly, it was intuitive for them. It was something that they already believed about the value of TearCare because it makes sense when you think about the technology and the benefits that it provides to the patients, naturally you can draw the parallel between that and improving signs and symptoms of MGD. So that is great.

I do think that it's important for any of the customers who may be on the sidelines and want more clinical data and are focused on that building both the clinical and the label expansion of the technology. But I think a lot of the clinicians do understand that and believe that to be true even without the label expansion. I do think it is really important when we think longer term about society support and where TearCare fits into the dry eye disease treatment paradigm and how payers think about the value of the technology. So all of those things are also benefits in addition to providing the benefits to our customers to show the value of the technology.

Paul Badawi

And the last thing I'll add to that, Steve, just one final thought, just reminded me of -- our Head of TearCare Marketing, who's phenomenal, has been with us for a long time. He's recently done significant market research into messaging for TearCare, where they'll test 10 different potential messages for TearCare. And I don't know if it was #1 or #2, I think it was actually #1, but the message that resonated with both customers and patients the most was that TearCare addresses this root cause or the underlying cause of disease. So from a market research and messaging research perspective, you want to test these messages before you roll it out in a meaningful way. And I believe it was #1 in terms of impact. If it wasn't #1, it was #2, but it was at the top. So we believe it's going to resonate very nicely with the market when we roll out more focus on this label expansion.

Steven Lichtman

And my follow-up on the label is something that Ali you just alluded to, which is in what way can you now utilize that in your discussions with other MACs and payers to really leverage the label expansion?

Alison Bauerlein

Yes. Great question. And it's one of many things that we bring to the attention of any of the payers. Obviously, we focus on the clinical data, the label expansion, the health economic data, the claims data. We also focus on AAO practice patterns and TSOF DEWS guidelines and where we fit into that overall treatment paradigm. So all of that just continues to be building blocks to establishing the appropriate access to the technology over time. So I don't think there is one building block that makes the difference, but each one continues to build our case for the support for access to TearCare.

Paul Badawi

And I'd add, if you're a payer, would you rather pay for a treatment that addresses the underlying cause of disease or for a treatment that just simply temporarily treats a symptom of the disease? I think payers do appreciate solutions that are getting really just at the heart of the problem. And as we've seen from our SAHARA RCT, when you do treat the underlying cause of disease comprehensively, consistently, you're often able to deliver in the case of dry eye, very consistent improvement, statistically significant improvements in all signs and all symptoms of disease and in SAHARA's case at all time points measured.

Operator

Our next question comes from the line of Adam Maeder from Piper Sandler.

Kyle Edward Winborne

This is Kyle on for Adam. Maybe I'll start with one for Jim. Just given some of these strong opportunities ahead for top line growth with Ultra and TearCare, how should we think about OpEx spend in the subsequent quarters and into 2027 given the commitment to driving P&L leverage?

Jim Rodberg

Yes, it's a great question. Thanks. So I think the overarching theme here and what we've shown year-to-date is that we're going to invest behind the highest, most attractive growth opportunities. We've done that this year in getting back to growth in IDE and continuing to drive growth in IG. Year-to-date, revenue up 19%, adjusted OpEx down 2%, so we have demonstrated significant operating leverage as the business has accelerated this year.

As we look ahead for the full year now, our guide, top line approximately 20% and adjusted OpEx growing 6% at the midpoint. So continuing to drive that leverage for the full year here. And as we look ahead, we're going to make -- we're going to continue making targeted investments behind the growth opportunities that are most attractive. And in the near term, IDE scale-up, commercial resources, market access there are top of mind. And we want to make sure that we're maintaining the fiscal discipline that we've shown, but go after growth and invest behind attractive opportunities. But over time, driving the revenue growth ahead of expense growth and having an eye on cash flow breakeven all the while.

Kyle Edward Winborne

And then for my follow-up, maybe if I could just push a little bit on the implied Q4 guidance, specifically around TearCare. The updated guidance for 2026 of $12 million, I think, implies a sequential decel, I think, to about 6% growth from Q4 versus Q3, if I'm doing that math right. I understand it's obviously still early in the launch. But could you just maybe talk through what exactly this would be? Is it just some conservatism baked in here?

Alison Bauerlein

Yes. I think we've taken a similar approach throughout the year on our IDE guidance. We are very early in the overall market development of this opportunity. And so we don't want to get out ahead of that from a market perspective and understanding seasonality and trends. I will say we are extremely proud of what we've created, and we think we are building a durable business. So we have great people, great rep productivity, great durability on accounts and a growing account base. And that's really what we're focused on. We just want to make sure that the guidance that we put out there takes into account just the fact that we're very early in this overall curve and that we set the bar appropriately as a result.

Operator

Our next question comes from Joanne Wuensch from Citi.

Anthony Occhiogrosso

This is Anthony on for Joanne. I want to switch to the stand-alone market. That's an opportunity we've been talking about for quite a while. I don't know if I'd characterize it as slower growing, but maybe not getting as much attention as combo cataract in the market. From your perspective, what additional work needs to be done right now to maybe make that a bigger contribution of the market or get more surgeons interested in doing stand-alone MIGS?

Paul Badawi

Yes. I think a lot of the work that needs to be done is work we're doing and we're going to continue doing this year, next year and in the years ahead, notably activating stand-alone. So I think we have a nice interventional glaucoma tailwind. I think as I mentioned earlier, I think the ophthalmic community fully appreciates that, clinically speaking, intervening earlier is better for patients. So that's the concept behind interventional glaucoma. I think OMNI -- the clinical data for OMNI, it's proven. We have very compelling long-term clinical outcomes in both combo cataract as well as stand-alone. And we have a commercial team that's very tenured and is out working with customers to drive that messaging around the better clinical outcomes from interventional glaucoma and activating IG.

And what does activating look like? It's working within practices. It's a lot of -- there's a lot of overlap with the work that we're doing with IDE, which is working with practice, not just the eye care provider. But it's a team -- this is a team sport. It's a team effort. It's working with the eye care providers as well as the administrators, the technicians, the staff. The goal is to like identify the right patients that can benefit from an earlier intervention. That could be IG, it could be IDE; how to bring that patient back for a consultation that will lead to a surgical plan. So in the case of IG in stand-alone, imagine a patient walks in, they have high pressure, they're on 3 meds, 4 meds. Currently, that patient might get another prescription.

What it takes to lead to an intervention? We believe we need to bring that patient back. We need to work with our customers to understand, bring the patient back, just like you would bring that patient back for a cataract consultation, a specific visit oriented around cataract surgery, do the same for interventional glaucoma. And in our case, microinvasive glaucoma surgery. So when the doctor brings that patient back and the staff brings that patient back, you walk through all of the IG options. And we found that when we do that, there is a much higher conversion to an IG procedure. Often, that could be OMNI. It doesn't necessarily always need to be OMNI. It could be other interventions, but that's what needs to happen over the coming years to drive and accelerate stand-alone adoption.

It's moving beyond clinical education to stand-alone activation. We have a team right now, about half a dozen folks, really good people on that team, doing great work in the field with practices who are activating IG, activating stand-alone OMNI use. There is growth. We're seeing growth. We're proud of it, and we expect to continue to drive it in the years ahead. It's obviously earlier days. The majority of revenue in MIGS today is combo cataract, a smaller percentage is stand-alone, but both categories are growing. In particular, we're very excited about continuing to grow the stand-alone market over the coming years.

Operator

Our next question comes from David Saxon from Needham & Co.

David Saxon

So maybe I'll ask one with an IX angle. So I'd be curious to hear what you're seeing in terms of docs positioning TearCare alongside cataract procedures as kind of like a preop treatment or prep for the surgery. And if you're doing anything internally to develop data on how the ocular surface plays into the outcome of a cataract surgery.

Paul Badawi

I'll start off and then Ali chime in. Again, IX is strategically a proprietary differentiation for us. We've got 2 proven interventional technologies in 2 major categories in eye care. And obviously, we're in interventional dry eye. When I say we're in interventional glaucoma, as I mentioned earlier, the vast majority of interventional glaucoma cases and revenue is coupled to cataract surgery. So our IG team has spent years developing very strong partnerships with high-volume cataract surgeons who also happen to be high-volume MIGS surgeons. So those relationships are very useful. Our IG and IDE teams have been partnering very nicely to leverage those relationships, as Ali had mentioned.

And there are -- there are many patients who have comorbidities. They might have cataracts -- they might have glaucoma, they might have dry eye. They might have 2 of those. They might have all 3 of those conditions. Often, that's the case. You often see glaucoma patients who either just have dry eye independently or the glaucoma meds are exacerbating the dry eye or causing MGD themselves as is the case with prostaglandin use. And so there's a lot of synergy there and a lot of overlap between these conditions. And we are, in fact, seeing in our early commercialization of IDE, high-volume cataract surgeons have patients who need cataract surgery who also have dry eye disease. And so we're seeing those same customers adopt TearCare and perform those TearCare procedures in advance of cataract surgery to treat the dry eye disease that happens to have -- in patients that have those comorbidities. So we're seeing quite a bit. We love it. We can be more helpful to our customers who are sharing those patients in the same practice.

David Saxon

And then maybe another one for you, Paul. Just in the script, you talked about expectations for fee schedules or policies for TearCare, I'm talking about, in the coming quarters. I'd love to hear what gives you the confidence in that? And based on the conversations or signals you're seeing, anything you can say around whether that be additional policies in the regions you're in, so increasing density or expanding that and getting into new regions?

Alison Bauerlein

Yes, I can take that question. And we really do continue to be confident that we're going to be able to expand patient access over time. And that's really based on both the robust clinical evidence that we have, the health economic data, the label expansion, all of those good foundational pieces. But we also are seeing increasing claims submissions and utilization, and that helps payers evaluate these types of new technologies that don't yet have coverage or fee schedules established. And so we -- obviously, we don't control the timing of those decisions, and we are engaged with MACs and commercial payers to get those across the finish line and believe that we're still close to having that happen, but we can't predict the exact timing. So we will continue to focus on driving that. We are seeing more and more individual payments come across. And so we are really happy with the progress there. Of course, we all want to see that turn into covered lives and expanded access over time.

Operator

Our next question comes from the line of [ Yen Chi from Associate Analyst ].

Katherine Degen

This is Katie on for Yi Chen with H.C. Wainwright. In the interest of not beating the dead horse, looking at your 10-Q, it looks like you pushed out your principal amortization until August 2027. How does that affect your flexibility for investments and liquidity plans? Are you managing towards operating cash flow breakeven before those repayments begin? Or should we expect cash to fund both growth investment and debt repayment starting in 2027?

Jim Rodberg

Yes, Katie, this is Jim. Thanks for the question. Really, I think about that extension of the interest-only period as just providing additional optionality and making sure we're being thoughtful with our capital, particularly with the growth opportunities in front of us. We've got a strong balance sheet in place. And importantly, our cash burn has improved significantly year-to-date. So we're continuing to be focused on improving cash flow and on our path to cash flow breakeven, but just wanted to be -- we view this as a prudent capital management decision more than anything else.

Operator

I'm showing no further questions at this time. I would now like to turn the call back over to Paul Badawi for closing remarks.

Paul Badawi

Thank you for joining us today. We are very pleased with the record third quarter performance, the trajectory of both franchises and the continued improvement in our financial profile. We remain committed to disciplined execution through the balance of the year and look forward to updating you on our progress next quarter. Thank you.

Operator

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