The Glaukos Investor Day deck from September 2017 is a masterclass in technical storytelling for a life sciences audience. Spanning over 130 slides (with 10 key slides analyzed here), the presentation moves from the anatomical basis of their trabecular bypass technology to granular Phase II clinical results for their iDose Travoprost system. By showcasing a product roadmap that spans from ocular hypertension to refractory glaucoma, Glaukos positions itself not just as a device company, but as a comprehensive platform for glaucoma management. The inclusion of guest surgeons and comparative siz…
Key takeaways
- Glaukos targets the inferonasal quadrant for trabecular bypass placement to access the majority of aqueous veins (Slide 15).
- The iDose Travoprost system achieved proof-of-concept in both cynomolgus monkeys and pilot human studies (Slide 29).
- Phase II preliminary results for iDose showed average IOP reductions ranging from 7.9 to 8.4 mm Hg at months 6 and 9 (Slide 43).
- The iStent inject is positioned for mild to moderate OAG with an estimated FDA approval in the second half of 2018 (Slide 57).
- Clinical data suggests that increasing the number of stents (up to 3) correlates with lower mean IOP, reaching 12.2 mm Hg at 18 months (Slide 71).
- The management team is supported by external clinical validation from guest surgeons Eric Donnenfeld MD and John Berdahl MD (Slide 85).
- The product portfolio is segmented by disease stage, ranging from iStent inject for mild cases to iStent infinite for refractory cases (Slide 99).
- Glaukos emphasizes its miniaturization advantage, noting the iStent is approximately 1/48th the size of the competitor CyPass (Slide 113).
Introduction and Anatomy of the Solution
Slide 1: Title Slide
The deck opens with the Glaukos branding and the tagline "Transforming Glaucoma Therapy." Dated September 2017, this was a pivotal period for the company as it sought to expand its lead in the Micro-Invasive Glaucoma Surgery (MIGS) market. The visual theme uses a stylized iris, emphasizing the company's focus on ophthalmic intervention.
Slide 15: Targeted Trabecular Bypass Placement
This slide establishes the anatomical rationale for the Glaukos technology. It notes that a majority of aqueous veins are located in the inferonasal quadrant. By placing a single trabecular bypass in this specific location, the device can access the majority of the eye's natural drainage system. The slide highlights that "intelligent trabecular stent placement" is key to enhancing outflow facility, grounding the product's efficacy in physiological evidence rather than just mechanical bypass.
Clinical Milestones and Efficacy Data
Slide 29: Critical iDose Travoprost Milestones
Glaukos outlines the development path for iDose, a sustained-release delivery system. The slide lists three critical milestones: 1) Selecting a unique, long-lasting prostaglandin analog; 2) Developing a micro-scale elution system with near zero-order delivery; and 3) Attaining proof-of-concept in animal (cynomolgus monkey) and pilot human studies. The inclusion of chemical structures and animal testing photos signals a high level of technical maturity and readiness for advanced clinical stages.
Slide 43: iDose Travoprost US Phase II Results
This slide presents preliminary efficacy data from the US Phase II trial. It shows average Intraocular Pressure (IOP) reductions at 6 and 9 months. The data is split between "Fast Elution" and "Slow Elution" groups. At Month 6 (n=73), reductions were 8.4 and 8.0 mm Hg respectively. By Month 9 (n=43), the reductions remained stable at 8.3 and 7.9 mm Hg. This stability is crucial for proving the "long-lasting" claim made in earlier slides.
Slide 57: iStent inject Regulatory Status
Focusing on the iStent inject, this slide provides a clear timeline for US and International (OUS) markets. In the US, a 500-patient pivotal trial was complete, with a PMA filing expected by year-end 2017 and FDA approval targeted for 2H 2018. Internationally, the product was already available in multiple markets. The slide uses a high-quality render to show the dual-stent delivery mechanism, which is a key differentiator for the 'inject' version of their platform.
Slide 71: Titratable Therapy Data
One of the most compelling data slides, this shows the results of an international study where patients were randomized to receive 1, 2, or 3 stents. The graph clearly demonstrates a dose-response relationship: while 1 stent reduced mean IOP to 15.9 mm Hg, 3 stents brought it down to 12.2 mm Hg at 18 months without medication. This supports the company's "titratable therapy" narrative, allowing surgeons to customize the treatment based on disease severity.
Management and Market Strategy
Slide 85: Panel Discussion Participants
This slide lists the internal management team, including CEO Tom Burns and SVPs across New Technologies, R&D, and Regulatory Affairs. Crucially, it also lists "Guest Surgeons" Eric Donnenfeld MD and John Berdahl MD. In the medical device world, having top-tier Key Opinion Leaders (KOLs) participate in an Investor Day is a significant signal of professional acceptance and market pull.
Slide 99: Annual Market Opportunity
Glaukos maps its product portfolio against the stages of glaucoma. The iDose Travoprost is positioned as a potential monotherapy for ocular hypertension through moderate stages. The iStent family is segmented: iStent inject and SA for mild-to-moderate, iStent Supra for advanced, and iStent infinite for refractory cases. This slide effectively argues that Glaukos is not a one-trick pony but a comprehensive solution provider for the entire $3B+ glaucoma market.
Slide 113: Competitive Surgical Landscape
This slide provides a direct comparison to the CyPass device (a competitor at the time). It uses a visual aid—a penny—to show the scale of the devices. The text states that the iStent is approximately 1/48th the size of CyPass, and two iStent injects are 1/73rd the size. This "smaller is better" argument is central to the MIGS category, implying less invasive procedures and fewer complications.
Slide 131: Summary
The final slide is a simple summary transition, likely leading into a Q&A session. While the slide itself contains no text, it serves as the bookend to a massive 131-slide technical and strategic briefing.
What Glaukos Does Well
The Glaukos deck is exceptionally strong in its use of clinical evidence. By showing specific n-counts, mm Hg reductions, and longitudinal data (up to 18 months), they move beyond marketing claims into scientific proof. The visual comparison on Slide 113 is a masterstroke of competitive positioning, making a complex engineering difference immediately understandable to a non-technical investor. Furthermore, the clear segmentation of their product pipeline (Slide 99) shows a sophisticated understanding of the patient journey and market capture.
What is Missing from the Deck
Despite its length, the 10 slides provided (and the broader context of the 131-slide deck) are light on specific financial projections and unit economics. While market opportunity is mentioned, the deck does not explicitly detail the manufacturing costs, average selling price (ASP), or specific revenue targets for the upcoming years. Additionally, while regulatory milestones are clear, there is little discussion of the reimbursement landscape, which is often the biggest hurdle for new medical devices in the US market.
Founder Lessons: What to Copy
Founders in highly regulated or technical fields should emulate Glaukos's approach to KOL Validation . Including guest surgeons in an investor presentation provides immediate credibility that a management team cannot achieve alone. Secondly, the visual scale comparison (Slide 113) is a tactic every hardware or device founder should use; comparing your product to a well-known object (like a penny) and a competitor simultaneously is highly effective. Finally, the milestone-based roadmap (Slide 29) is a great way to show progress in R&D-heavy industries, breaking down a long development cycle into digestible, achievable wins.
Frequently asked questions
- What is the primary clinical goal of the Glaukos technology?
- The primary goal is the reduction of Intraocular Pressure (IOP) in patients with Open-Angle Glaucoma (OAG). As shown on Slide 71, the technology aims to achieve significant IOP reductions—down to 12.2 mm Hg in some cases—without the need for daily topical glaucoma medications, which often suffer from low patient compliance.
- How does Glaukos differentiate its products from competitors?
- Glaukos focuses heavily on the 'micro' aspect of Micro-Invasive Glaucoma Surgery (MIGS). Slide 113 provides a direct visual comparison against the CyPass device, stating that the iStent is 1/48th the size and two iStent injects are 1/73rd the size of the competitor, suggesting less tissue trauma and better fluid dynamics.
- What is the significance of the iDose Travoprost system?
- The iDose system represents a shift toward sustained-release drug delivery. Slide 29 outlines the formulation of a long-lasting prostaglandin analog that converts to an active metabolite. This addresses the 'monotherapy' market by providing predictable micro-elution rates at near zero-order, potentially replacing daily eye drops.
- What is the regulatory status of the iStent inject as of this deck?
- According to Slide 57, the iStent inject had completed its 500-patient pivotal trial enrollment and 2-year follow-up. The company expected to file a full PMA by the end of 2017, with an estimated FDA approval window in the second half of 2018.
- How does Glaukos categorize the glaucoma market opportunity?
- Glaukos views the market as a spectrum of disease severity. Slide 99 illustrates their strategy to offer specific products for Ocular Hypertension, Mild, Moderate, Advanced, and Refractory glaucoma. This 'product of choice' approach allows them to capture value across the entire patient journey rather than just a single niche.
