Glaukos Q1 2023 Earnings Call Transcript

Quartr
Provided by Quartr
May 3, 2023

There are 12 speakers on the call.

Operator

Welcome to Glaukos Corporation's First Quarter 2023 Financial Results Conference Call. Copies of the company's press release and quarterly summary document, both issued after the market close today, are available at www.glaukos.com. All lines have been placed on mute to prevent any background noise. After the speakers' remarks, there will be a question and answer session. This call is being recorded and an archived replay will be available online in the Investor Relations section at www.glaukos.com.

Operator

I'll now turn the call over to Chris Lewis, Vice President of Investor Relations and Corporate Affairs.

Speaker 1

Thank you, and good afternoon. Joining me today are Glaukos' Chairman and CEO, Tom Burns President and COO, Joe Gilliam and CFO, Alex Thurman. Similar to prior quarters, the company has posted a document on its Investor Relations website under the Financials and Filings Quarterly results section titled Quarterly Summary. This document is designed to provide the investment community with a summarized and easily accessible reference document that details the key effects associated with the quarter, the state of the company's business objectives and strategies and any forward statements or guidance we may make. This document is designed to be read by investors before their regularly scheduled quarterly conference call.

Speaker 1

As such, for this call, we will make brief prepared remarks and transition into a question and answer session. To ensure ample time and opportunity to address everyone's questions, We request that you limit yourself to one question and one follow-up. If you still have additional questions, you may get back into the queue. Please note that all statements other than statements of historical facts made on this call that address activities, events or developments we expect, believe or anticipate will or may occur in the future are forward looking statements. These include statements about our plans, objectives, strategies and prospects regarding among other things our sales, products, pipeline technologies and clinical trials, U.

Speaker 1

S. And international commercialization, market development efforts, efficacy of our current and future products, competitive market position, our regulatory strategies and reimbursement for our products, financial condition and results of operations, as well as the expected impact of general macroeconomic conditions, including foreign currency fluctuations on our business and operations. These statements are based on current expectations about future events affecting us and are subject to risks, uncertainties and factors relating to our operations and business environment,

Speaker 2

all of which are difficult

Speaker 3

to predict and many of

Speaker 1

which are beyond our control. Therefore, they may cause our actual results to differ materially from those expressed or implied by forward looking statements. Review today's press release and our recent SEC filings for more information about these risk factors. You'll find these documents in the Investors section of our website atwww.glaukos.com. Finally, please note that during today's call, we will also discuss certain non GAAP financial measures, including results on an adjusted basis.

Speaker 1

We believe these financial measures can facilitate a more complete analysis and greater transparency into Glaukos' ongoing results of operations, particularly when comparing underlying results from period to period. Please refer to the tables in our earnings press release available on the Investor Relations section of our website for a reconciliation of these measures to their most directly comparable GAAP financial measure. With that, I will turn the call over to Glaukos' Chairman and CEO, Tom Burns.

Speaker 4

Okay. Thanks, Chris. Good afternoon and thank you all for joining us. Today, Glaukos reported 1st quarter net sales of approximately 74,000,000 up 9% versus the year ago quarter on a reported basis and up 11% on a constant currency basis. Our first quarter results and return to top line growth reflects continued strong performance across our international glaucoma and corneal health franchises alongside the reemerging growth in our U.

Speaker 4

S. Glaucoma franchise driven by the initial commercial launch of iSpendInfinite. I'd like to recognize the continued dedication and performance of our teams around the globe who remain committed to their work in advancing our key initiatives. Given our solid Q1 and latest forward outlook, we are raising our 2023 net sales guidance range to 295,000,000 to $300,000,000 versus $290,000,000 to $295,000,000 previously. From a commercial perspective, Strong execution of key strategies within our core franchises drove an encouraging start to the year.

Speaker 4

Within our U. S. Glaucoma franchise, where we delivered 4% year over year growth in the quarter, we are progressing our combo cataract efforts and continue to advance iStent Infinite ahead of establishing formal MAC coverage and payment. In parallel, we are accelerating our founding mission at Glaukos, which is to advance glaucoma care by driving intervention of therapies earlier in the treatment paradigm for glaucoma disease and in turn pioneering a new standalone market over time. These efforts will be on full display at the ASCRS CRS meeting this weekend in San Diego, where an extensive array of symposia highlighting the performance of our novel technologies will be presented.

Speaker 4

This includes a new subgroup analysis of the combined iDose Phase 3 trials, which demonstrated statistically significant superiority of iDose's IOP lowering effect versus current standard of care topical prostaglandin therapy. We believe this first of a kind real world effectiveness data further validates the game changing potential of iDose. Moving on, our international glaucoma franchise delivered strong broad based growth this quarter of 20% on a reported basis and 28% on a constant currency basis. And our Corneal Health franchise saw 10% growth as key strategic initiatives continue to take hold in support of this important business. In addition to our commercial efforts, We also continue to prudently invest in and advance our robust pipeline of novel promising platform technologies that we believe have the ability to significantly expand our addressable markets and fundamentally transform our company over time.

Speaker 4

During the Q1, we achieved a significant company milestone with the successful NDA submission of iDose TR, are novel microinvasive interocular implant designed to continuously deliver therapeutic levels of proprietary formulation of travoprost from within the eye for extended periods of time. We're also pleased to announce today we recently received communication from the FDA that our submission has been received and accepted for substantive review. We look forward to learning of our PDUFA date imminently, which we expect will be in line with our approval target by year end. Alongside this, our teams continue to make encouraging progress with preparation and planning of the iDose commercial launch targeted for early next year. Turning to the Corneal Health Pipeline, we've built strong subject enrollment momentum in the 2nd Phase 3 confirmatory trial for Epioxa, our next generation corneal cross linking therapy for the treatment of keratoconus, and we are now on track for targeted enrollment completion by mid year ahead of our prior expectations of year end.

Speaker 4

So as you can see, we have a lot to be excited about when it comes to the significant and potential value that we believe our pipeline programs may create. At the same time, given the macroeconomic environment and social uncertainties as well as anticipated investment to support the potential commercial launch of iDose, we continue to prudently review the prioritization and cadence of our investments as we strive to strike the right balance of risk based investments and our capital position now and in the future. As such, We will continue to keep you updated as we evaluate and potentially adjust development timelines associated with our earlier stage pipeline. In conclusion, I'm very pleased with the strong start to the year and excited about what is to come as we continue to advance our mission to truly transform vision with disruptive, droplets and game changing technologies. And so with that, I'll open the call to questions.

Speaker 4

Operator?

Operator

Thank you. The first question is from Tom Steffen with Stifel. Your line is open.

Speaker 5

Great. Hey, guys. Thanks for the questions and Congrats on the strong quarter and also the Eidos NDA acceptance. And I think I'll start there actually, kind of big picture with Eidos. I want to ask about just the technology and candidly not totally familiar with the patents, the IP, etcetera.

Speaker 5

But With what you're willing to share, what type of optionality does the technology itself have? Maybe this can be in the form of Drug optionality or even possibly licensing the technology. And I guess where I'm going with this is maybe even beyond iDose TR, T Rex, Rock, how should we be thinking about the value of the broader iDos platform beyond just the products themselves in the pipeline?

Speaker 4

Yes, Tom, I'll be happy to take that question. So this is something I've addressed previously, but happy to be able to talk about it again. I think iDose is an incredible platform. And so you've seen what we've been able to do with the prostaglandin analog Trevor Prost, being able to obtain 70% control of patients on the same or fewer meds at 3 years in glaucoma. I think you're also aware that we're pursuing a Rho kinase inhibitor, which can be encapsulated in the vessel of the iDose platform, which we think could be an extraordinary combinatorial treatment for glaucoma in the future.

Speaker 4

The technology itself is pretty robust. It allows us to be able to consider a number of active pharmaceutical agents that we can be able to treat anterior segment disease. I think we need to focus and we will focus on small That's where the limitations of the platform rest, but there are host of small molecules that you could consider as we look to develop forward. These small molecules have to be invariably potent. We have to have high nanomolar concentrations And they have to be relatively insoluble.

Speaker 4

Having said that, you know that we must be looking at a number of different agents that can Be able to exploit the opportunity of the platform that we've created and then carry us forward into the next decade. The patents on the technology itself are profound and take us into the next decade, both from a method and apparatus standpoint. And then I think you know as well, we look for taking the current product of iDose And being able just with a simple modification to the platform itself, being able to create an extended release version that we're calling iDose T Rex that will hold nearly twice the amount of Travoprost medication as the 1st generation iDose version. And we believe that will give us another kind of a material event to be able to launch a second generation product in the 2020s. So this is where we're focused as a business.

Speaker 4

As I've talked about in general, we have a number of platforms. IDose is an exceedingly powerful platform that can serve this company both now and in the future with multiple variations.

Speaker 5

Super helpful. Thank you, Tom. And then my second question is just on the guidance. Great to see you guys raise it. I guess just the components of it, how should we be thinking about what's changing?

Speaker 5

I think U. S. Glaucoma was thought to be flat, But that was really strong in the quarter. I think OUS glaucoma low double digits and Corneal Health high single digits previously. Joe or Alex, maybe what's changing?

Speaker 5

And then as a follow-up to U. S. Glaucoma, just on iStent, any updated view Your potential, I guess, level of confidence that we've hit a true point of stability with that in the U. S. And Maybe we are past the worst of reimbursement headwinds.

Speaker 5

So 2 parter there, but thanks for the questions.

Speaker 6

Sure. Hey, Tom, it's Joe. I'll start with that and if Alex wants to jump in, he can. Obviously, it was As you dig in more tonight, it was definitely a high quality Q1, solid execution and we were pleased to be able to raise The guidance by $5,000,000 as you noted. If you think about that in the context of the individual franchise, the way you asked the question, I'm not so sure Despite the strength in the Q1 across the board, that there's a significant material change to how we thought about the original guidance on a franchise by franchise Perspective, although obviously we're slightly incrementally positive across the board and probably in U.

Speaker 6

S. Glaucoma in particular. But we still want to be somewhat cautious as we make our way through 2023 and particularly until we get more certainty around The math timelines associated with iStent infinite and what that can mean in terms of accelerating the growth of the U. S. Franchise in our business overall in 2023.

Speaker 6

As you talked about one subcomponent of that obviously is the combo cataract mix business here in the U. S. And you characterize it obviously as iStent. I think we were encouraged to see continued stability in the quarter in that franchise as well as actually A restoration of growth in our combo cataract business for the Q1. And as you know, coming out of the last year where The CMS related headwinds were having an impact.

Speaker 6

It was a very encouraging sign to see that return to A growth cadence as we started the year.

Speaker 5

Very helpful. Thank you.

Operator

The next question is from Margaret Kaczor with William Blair. Your line is open.

Speaker 3

Hey, guys. This is actually Mike on for Margaret. Congrats on the nice quarter and thanks for taking the questions. So I just wanted to maybe start out on the quarter, follow-up a little bit on your comments on U. S.

Speaker 3

Glaucoma. Was there any new products that you'd call out having tracked better than you expected this year, like maybe Eye Prime Or even iXS or was it mostly the core iStent returning to growth like you guys mentioned?

Speaker 6

Yes. Thanks for the question, Mike. I think it was broad based in the context of the stabilization and the growth we were able to demonstrate. I'd probably characterize it as sort of a little bit of a recap what I just said. The starting point was stabilization and some modest growth coming out of the combo cataract franchise, Of which now we ultimately have multiple potential tools working within that.

Speaker 6

And then on top of that, we started to see That impact of Iceton Infinite in particular and I think we were if I was going to call one thing out, I would call out Iceton Infinite in particular It's really being a nice driver of the performance in the Q1 and the outperformance versus our expectations for sure.

Speaker 3

Got it. That's helpful. And then maybe one longer term just on the standalone opportunity with iStent infinite picking up and then iDose becoming part of the picture next year. You guys have mentioned making an effort to maybe raise awareness for standalone intervention in the market. Can you maybe speak to any market building initiatives you started to look at or may pursue in the future?

Speaker 6

Yes, I'd be happy to Mike. And then I'll let Tom jump on as well. Because quite frankly, this has been something that's been a part of The founding mission here, which Tom has been apart from the beginning, so I think it's good for him to comment. But as we sit here today, we're putting a lot of effort and investment into really changing that mentality and that treatment paradigm. And you've heard us talk for years About the fact that topical medications work.

Speaker 6

The challenge with topical medications is the compliance rates and some of the side effects and various things that come Alongside it. And for us, now that we have available a suite of tools that are truly minimally invasive And able to intervene and I think in an attractive way from a risk benefit standpoint. Now is really the time for us to be putting that behind it. It's an organic initiative more than a traditional marketing program, right? This is about the leaders of the industry out there, the key opinion leaders, All the various folks who've been saying this for some time and us trying to really help drive that The energy and enthusiasm behind that to the next level, particularly as you think about in the context of for us iStent infinite and then iDose going forward It's 2 important tools to help support that from a product standpoint.

Speaker 6

Tom?

Speaker 4

Yes. I think what I would say, Mike, is that The whole concept of interventional glaucoma really was the birthright for how this company got founded. And we saw Just a tremendous opportunity to take a single injection of either iStent or as we've evolved an iDose that could be able to liberate patients from a consignment to drug therapy over the course of their lives. And so iDose and MIGS, I think entirely changed the benefit to risk calculus of what topical drops have been able for patients. And we know that patients that are on topical drop therapy progress despite the fact that they're diagnosed and followed.

Speaker 4

And I think the advent of iDose and iStent infinite now changes a whole new paradigm and forces surgeons to be able to confront The current algorithm of how they treat patients and we'll be driving that. Much like we created the entire market of MIGS, We will be creating this market of interventional glaucoma led by the catalyst of iDose and iStent infinite. I think the question always comes up, where will they be seen and where will they take place? When we do launch iDose and certainly it's happening with iStent infinite as we speak, We know that surgeons will look to pseudophakic patients first while they get their C legs on a standalone basis. And then there's a whole array of patients that are non compliant that surgeons and clinicians can serve.

Speaker 4

You've seen some of the recent data showing that there's the rate of noncompliance can be as high as 90%, which really encapsulates most of open angle glaucoma patients. We think there's tremendous promise to serve patients that are intolerant to medications. Those patients who have high degrees of hyperemia, allergy, periorbital fat atrophy, etcetera. I think there also be a tremendous reason to reduce drug burden. Over half of patients who are diagnosed Inglotcom are on 2 or more medications, which further exacerbates non compliance and we can reduce drug burden by placing them on a foundational therapy like iDose, it can make a considerable difference.

Speaker 4

Let's not forget as well that there's a huge patient convenience and quality of life factor. Topical drops are difficult and they are a nuisance and a burden on quality of life for patients. And so we do believe that none of these surgeons will look to be standalone opportunities to be able to liberate the patients from topical drops. And finally, make no mistake that we think that Surgeons and clinicians will look at currently where they're focused now. Anytime you have a combined procedure like a cataract procedure And you have the ability to treat comorbid glaucoma.

Speaker 4

We see and believe that there'll be a strong appetite for the interventional technologies such as Infinite And iDose.

Speaker 3

Very helpful. Thanks a lot guys.

Speaker 7

Thanks.

Operator

The next question is from Ryan Zimmerman with BTIG. Your line is open.

Speaker 8

Hey guys, thanks for taking the questions. And Again, tip of the hat to Chris Lewis on the most efficient earnings call that we have here. So Just want to highlight a couple of things, Tom. So you guys highlighted the study today on the use of PGAs versus iDose. And You submitted with the data package, I recall, the repeat usage study.

Speaker 8

And so I'd love to just get your thoughts on kind of How you're viewing the data in the context of some of the other studies and each have their merits and their own rights. But ultimately, I think what investors care about is And what they want to know is, what do you think the label ultimately looks like given the studies you've run? And what are those studies do to kind of set the stage for utilization Of Eidos when it does come.

Speaker 4

Okay, Raul. Well, let me hit that head on. I mean, the label that we're seeking is a wide open label. And that label is based on a 505(2) designation that basically is based on the predicate of topical Prostaglatin therapy, like a travoprost. So the labels that we're seeking is one that will basically say for the reduction of intraocular pressure In patients with ocular hypertension and open angle glaucoma.

Speaker 4

So that data that label will allow us to approach the full array Of glaucoma patients and pre glaucoma patients who have ocular hypertension. So there's no restrictions. The label has never been based upon the survey trying to find out what the duration of effect is. The duration of effect will be served by our Phase 2b studies, which show again at 3 years that we're controlling the vast majority of patients on the same or fewer topical medications and that's how we'll go to payers. And so that's Kind of the seminal interest there.

Speaker 4

When I look at the data that you just talked about, I get extremely Excited about what the possibilities can be. This is a subgroup analysis of patients that were on pretreatment topical prostaglandins. They were washed out of the medication. The pressures went up to roughly 24 millimeters. And after the implantation of iDose, the pressures actually We're driven lower than they were pretreatment.

Speaker 4

And a matter of fact here on the order of greater than a millimeter, which By any indication that any surgeon will tell you will lead to a 10% to 13% decrease in the propensity for What comment is progression. So this is a highly statistically significant finding and I think one that will help us Not only talk about the long term view of iDose, but actually the more shorter term real world Efficacy versus the topical prostaglandin therapy.

Speaker 8

Okay. That's very helpful, Tom, and Certainly looking forward to it. On the application itself, congrats on getting it accepted. Just want to be clear, no PDUFA date yet. You're not are you waiting on a day 74 letter?

Speaker 8

What just want to be clear when you expect that PDUFA and make sure there's nothing to read into there Given that you don't have that in hand yet?

Speaker 4

No, it's a good question. We have high confidence that we will be receiving the Dave 74 letter literally in the matter of a few days. And so our expectation is to be issued a PDUFA date at that time, Which will then put us in place to achieve our target of FDA approval of iDose by the end of the year.

Speaker 8

Okay. Good stuff guys. Thank you.

Speaker 1

Welcome. Thanks, Frank.

Operator

The next question is from George sellers with Stephens. Your line is open.

Speaker 9

Hey, thanks for taking the question. I just have one on the international side of the house. Could you just give us some color on how some of the international VELCOMA markets trended throughout the quarter? And then also have you seen any increased pressure from a competitive standpoint internationally? Thank you.

Speaker 6

Hi, George, it's Joe. I'll cover that. From an international headline standpoint, It was a standout quarter, right? We had record sales of a little north of $21,000,000 and just strong Performance across the board, across the various regions. I can't point to any particular Event that generated the outsized performance in the quarter, it was broad based across the Americas, Across Europe, Asia and really on a global basis.

Speaker 6

I think that We continue to do very well in virtually all of the markets versus competitive forces. In particular, we see that a bit more pronounced in Europe as you might expect. And I think our team continues to do a great job of holding The line and continue to grow that business quite impressively in the face of a lot of effort from competition. I think it speaks a lot to the amount of data that we've generated over the course of the last decade plus Around the optimization of the risk benefit calculus associated with the iStent franchise. So we couldn't be more pleased with the continued performance Outside the U.

Speaker 6

S.

Speaker 9

Okay, great. I'll just leave it at 1. Congrats on a great quarter.

Speaker 4

Thanks, George. Thanks, George.

Operator

The next question is from Matthew O'Brien with Piper Sandler. Your line is open.

Speaker 2

Hey, this is Phil on for Matt. Thanks for taking our question. Just some clarification on the iDose NDA process here and apologies if this is a bit rudimentary, but by my math, you received approval at the end of last week and Because you still expect the PDUFA date by year end, do you expect to receive accelerated as opposed to standard review here? And when exactly does that It's our 10 month clock again.

Speaker 4

Well, Phil, as you probably recall, we filed, I believe it was on February 27. And so we'd be looking at a PDUFA date that would be ranging from there, actually forgive me, February 10. And so we'll be looking from that as the starting course from the date of when we filed to when we expect to receive the PDUFA date. And so to your question, the day 74 review should identify that PDUFA date and then give us a mid cycle review that will be entertaining with the FDA. Any questions to move the NDA submission along?

Speaker 4

And again, we remain confident that we'll be in a position To be able to achieve a potential review approval by the end of the year.

Speaker 2

Okay, that's helpful. Thank you. And then just one on guidance. I mean, you beat by about $6,000,000 in

Speaker 6

the quarter, raised by about $5,000,000 Is there

Speaker 2

any reason why your current expectations are about the same now than at the start of the year? And specifically as it pertains to staffing, We're hearing about this backlog and as it pertains to staffing, any line of sight until when that might be getting better?

Speaker 6

Sure, Phil. I think, well, first, just a macro point around passing through The $6,000,000 of outperformance, I think $5,000,000 versus $6,000,000 is kind of a rounding error in the grand scheme of things. And You'll recall, we didn't really give Q1 guidance. We gave annual guidance. So I think that that's generally a narrative that probably needs to have an error bar established around it Or you draw any conclusions on it.

Speaker 6

More broadly speaking, I'd say, obviously, it's still early. It's only been 2 months since we established Their initial 2023 guidance like all companies reporting in the Q1. And we are pretty clear that we want to walk before we run as it relates to setting expectations for this year. And I believe our guidance raised today is a strong step in the right direction. If you think about it, 2023 for us is all about establishing the strongest foundation possible ahead of what we hope is a transformational period for us with Infant and iDose and then Ultimately, EpiOXa.

Speaker 6

So Q1 was a good start in that direction, but it's still early.

Speaker 2

Thanks for taking our questions.

Operator

The next question is from Alan Gong with JPMorgan. Your line is open.

Speaker 10

Hi, team. Congrats on the good quarter. I'll also leave it at once, because I think a lot of the most pertinent questions have already been asked. But just thinking about the Cornell Health business and specifically Epi auth and EpiOND, my understanding was that the Orphan Drug Designation 4 at the off would be expiring this year. So I'm just curious if you had any visibility into any potential competitors maybe looking to At their own trials or if that's something that you we still have to wait a little bit longer before we see anything on that front?

Speaker 10

Thank you.

Speaker 4

Yes, I'll be happy to take this on. So the orphan drug designation has terminated, as we've talked about in previous calls. And what that does is allow a competitor to begin to file for approval. But to answer your question directly, we're aware of no competitor that has entered into a Folsom Phase 3 clinical trial that would be competitive to us. And so therefore, we wouldn't expect to see any alternative version of any corneal cross linking procedure For several

Speaker 1

years.

Operator

The next question is from David Saxon with Needham. Your line is open.

Speaker 11

Hi, guys. This is Joseph on for David. Thanks for taking our questions. Maybe continuing with Perennial Health, Do you think maybe we're at a point now where reimbursement is no longer an issue for docs? Or would you say maybe there's more wood to chop there for the market access team?

Speaker 11

And then if possible, could you maybe give us your thoughts around penetration there. Maybe what kind of traction are you seeing outside of The group of doctors, the high volume group of doctors? Thanks.

Speaker 6

Yes. I'm happy to talk about That in the context of the overall cordial health franchise. I think in general, reimbursement will always be in focus For surgeons and their practices, it's highly relevant. They're always going to be watching and monitoring What's going on there? I will say that one of the more significant investments that we made over the course of the certainly the second half of twenty twenty two was within the payer side of our commercial our market access organization.

Speaker 6

And I think That certainly made a difference for us in terms of our speed to address issues as they emerge with commercial payers And our ability to stay out in front of those as best you can in a world that inevitably always has some volatility. So I really we're pleased With the investments we've made there and how that has, I'll say, thus far quieted Some of the volatility that we have seen historically and then how that translates of course into, I'll call it reimbursement confidence for some of the surgeons that deliver the potrexed therapy as you asked. I think more broadly, You asked about penetration. And I would say that as we continue to drive investment in this business, A big portion of that from a macro standpoint is towards raising awareness and the diagnosis of the disease. I think There are a lot of practices out there who perform, Botrexa and cross linking today.

Speaker 6

We've done a great job, I think, of getting the technology and the Dilutions deployed out into the market. One of our bigger challenges over time is to continue to drive that awareness of the disease to make sure that these patients aren't getting lost to alternative therapies that put at risk their cornea, quite frankly. So We've been doing quite a bit around initial, I'll call it, creative DTC campaigns and the various things you can imagine, As well as helping the ecosystem to drive initial diagnosis and then referrals to those centers who offer the Votrexa therapy.

Speaker 11

Okay. Yes, great. That makes a lot of sense. And maybe building off that a little bit more, Just given all the investments you guys have been talking about, I was wondering if you could maybe give us some Cadence around OpEx spend for the year, I guess, like quarterly cadence?

Speaker 1

Hey, Joseph, this is Alex. I'll happy to answer that one. So I think the way to think about it is there's a couple of things. First of all, I'll mention that we printed $88,000,000 in the quarter for OpEx. But there were some, I'll call them non recurring one time items Within that number of about $5,000,000 some of it related to the iDose PDUFA fee, some of it related to some stock compensation.

Speaker 1

So if you think about Backing out that, you get to about an $83,000,000 on a more normalized basis. So starting with that base, the way to think about kind of the cadence for the The years, if you take that and assume some modest increases over the course of the year, then you're going to kind of arrive at the end of the day Near what we talked about in the last call, which is around a 10% growth rate over our last year's normalized OpEx levels.

Speaker 11

Okay, great. That's super helpful. Well, appreciate it, guys. Thanks for taking our questions and congrats on a great quarter.

Speaker 4

Thank you. Thanks.

Operator

The next question is from Anthony Petrone with Mizuho Group. Your line is open.

Speaker 7

Thanks and congrats on a strong 1Q result here. 1 on just the base business, 1 on iDose. Just on the base, obviously, this quarter, we're hearing a lot about procedure rebounds and we're seeing that in ophthalmology as well. Although a little bit nuanced with J and J earlier in the quarter. And so when we look at the core iStem business, Just trying to get an idea of where procedures are at this point, and if there's any backlog recapture that you're seeing.

Speaker 7

And then the quick follow-up on iDose would be just a clarification on the PDUFA date. Is there a panel, advisory panel meeting that you're expecting just updated thoughts on that process? Thanks again and congrats.

Speaker 6

Yes. I'll start and then I'll hand it over to Tom for the second part of your question. I think the overall markets both In the U. S. And the majority of the markets internationally are pretty healthy at this point in the context of the combo cataract, The volumes and I think to your point, you've heard that somewhat consistently from others and I think you'll continue to hear that.

Speaker 6

Yes, there still are the dynamics around staffing and I'm sure that leads to some backlogs depending upon the practice you're talking to And that will continue to work itself out. It's hard to point to that as an individual line item contributor to any one period of time, any month or quarter. I think the reality is that these guys have been operating on the margin with a little less than optimal staffing for Some period of time now. I hope that continues to lead to a bit of tailwind. But at this point, all I can say is we definitely do continue to see expansion of the market in both the core combo cataract market.

Speaker 6

But then if you think about it, probably even more importantly, The beginning of the opening of that broader standalone opportunity with iStent Infinite as we lead our way towards Eidos. So I think that as we talked about over the years that broader opportunity from a growth perspective should dwarf The combo cataract market that we're talking about today. Tom?

Speaker 4

Okay. And then, Anthony, I need to make one correction. The NDA we submitted was on February 22. I think I mentioned, I thought it was on 10th. And so February 22nd, when we filed for substantive review on April 23rd.

Speaker 4

And so our expectation for the PDUFA data will be on May 5 with the day 74 letter. And so we given that rationale, we expect to receive the PDUFA date again by the end of the year. And we do not expect to have to engage with an advisory panel.

Speaker 7

Thank you so much.

Operator

We have no further questions at this time. I'll turn it over to Tom Burns for any closing remarks.

Speaker 4

Okay. I want to thank you all for your time and attention today. And thank you again for your continued interest and support in Glaukos. Goodbye.

Operator

Ladies and gentlemen, this concludes today's conference call. Thank you for participating. You may now

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