Sight Sciences is no longer only a single-franchise glaucoma vendor waiting for Medicare coverage to stop hurting. The second quarter showed that implant-free MIGS volume can grow again after the late-2024 local-coverage shock, while TearCare finally converted published fee schedules into paid procedure volume. That combination, not a one-time tariff refund, is why management raised the year and trimmed the adjusted expense range. The equity debate is whether dry-eye access is a durable second engine or a reimbursement spike on a still-small base.
The tension sits in mix and cash rather than in a single headline rate. Interventional Glaucoma still supplies almost nine tenths of sales, so an 8% glaucoma print matters more than a 704% dry-eye print until TearCare's run-rate is large enough to change the model. Cash at mid-year was $80 million against $40 million of Hercules term debt, and underlying quarterly cash use compressed after a one-time litigation success fee. The Alcon Hydrus judgment remains uncollected and under appeal, so it is optionality, not runway.
The print itself is the first clean test of the reimbursed TearCare strategy. SmartLid volume more than doubled sequentially, ordering accounts nearly doubled, and reimbursed lives rose after additional fee schedules aligned with Medicare pricing. Aetna's July coverage decision for OMNI and SION closed the last large national-payer gap in implant-free glaucoma. The next several quarters decide whether that access turns into utilization, whether OMNI Ultra's late-year launch lifts glaucoma growth above mid-single digits, and whether the cost base stays tight enough for cash-flow breakeven without a new equity raise.