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Sight Sciences, Inc. (SGHT) Q4 2024 Earnings Summary

Executive Summary

  • Q4 2024 revenue was $19.1M (+2% YoY), gross margin 87%, and net loss per share was $0.23; Surgical Glaucoma grew 9% YoY while Dry Eye declined as the company pivoted to reimbursement strategy .
  • Management initiated FY 2025 revenue guidance of $70–$75M (down 6%–12% YoY) and adjusted OpEx of $105–$107M, citing MIGS LCD-related utilization headwinds and an assumed ~$1M Dry Eye contribution without reimbursement wins .
  • The MIGS market shift (LCDs restricting multiple MIGS in combo cataract cases) and a new 20% China tariff are near-term margin and volume headwinds; SGHT intends to offset tariff costs and accelerate OMNI adoption via education, stand-alone strategy, and OMNIEdge launch in H1 2025 .
  • TearCare reimbursement is the key 2025 catalyst: payer dialogues and a published budget impact analysis (BIA) suggest potential cost savings versus Rx drops; management expects initial coverage/payment decisions in 2025, with 24-month SAHARA data to follow .
  • Wall Street consensus estimates from S&P Global were unavailable at time of request; comparisons vs estimates are not provided. Values that would have been retrieved from S&P Global are unavailable due to system limits.

What Went Well and What Went Wrong

What Went Well

  • Surgical Glaucoma revenue rose 9% YoY to $18.8M with ordering accounts +7% YoY and utilization +6% YoY, despite LCD impacts; total Q4 revenue reached $19.1M (+2% YoY) .
  • Gross margin improved to 87% in Q4 (vs 85% prior-year), driven by favorable mix toward Surgical Glaucoma; full-year gross margin held at 85% .
  • Cash discipline: FY 2024 cash used fell to $17.8M from $46.9M (−62% YoY); Q4 ended with $120.4M cash and $40.0M debt, positioning SGHT to reach cash flow breakeven without equity raise per management .
    Quote: “We expect to achieve cash flow breakeven without the need to raise additional equity capital.” – CFO Alison Bauerlein .

What Went Wrong

  • Q4 Surgical Glaucoma fell short of internal expectations due to the mid-quarter effectiveness of Medicare LCDs restricting multiple MIGS in combo cataract procedures; sequential utilization was lower than anticipated .
  • Dry Eye revenue dropped to $0.3M (from $1.6M YoY) as SGHT implemented price increases and prioritized reimbursement access, compressing near-term cash-pay procedure volumes .
  • New 20% China tariffs on SGHT manufacturing (OMNI, SION, TearCare components) are expected to pressure gross margin and 2025 results until mitigations take effect; management plans offsets but flags “modest impact” .

Financial Results

Consolidated Performance vs Prior Quarters (Q2 → Q3 → Q4 2024)

MetricQ2 2024Q3 2024Q4 2024
Revenue ($USD Millions)$21.37 $20.16 $19.07
Gross Margin (%)85.8% 83.9% 86.8%
Operating Expenses ($USD Millions)$31.00 $28.14 $28.49
Net Loss ($USD Millions)$(12.33) $(11.07) $(11.85)
EPS ($USD)$(0.25) $(0.22) $(0.23)

Note: No comparisons vs estimates—S&P Global consensus unavailable at time of request.

Segment Breakdown

MetricQ2 2024Q3 2024Q4 2024
Surgical Glaucoma Revenue ($USD Millions)$20.24 $18.63 $18.77
Surgical Glaucoma Gross Margin (%)88.0% 86.8% 87.4%
Dry Eye Revenue ($USD Millions)$1.13 $1.53 $0.30
Dry Eye Gross Margin (%)46.5% 47.7% 51.0%

KPIs

KPIQ2 2024Q3 2024Q4 2024
Surgical Glaucoma Active Customers (Count)1,131 1,107 1,138
Dry Eye Lid Treatment Units Sold (Units)4,088 5,379 1,125
Dry Eye Active Customers (Count)277 296 83

Guidance Changes

MetricPeriodPrevious GuidanceCurrent GuidanceChange
RevenueFY 2024$81.0–$83.0M (Aug 1) Actual: $79.9M Missed prior guide
Adjusted Operating Expenses (Non-GAAP)FY 2024$104.0–$106.0M (Nov 7) Actual: $101.3M Lower than guide (positive)
RevenueFY 2025N/A$70.0–$75.0M Initiated; implies −6% to −12% YoY
Adjusted Operating Expenses (Non-GAAP)FY 2025N/A$105.0–$107.0M Initiated
Dry Eye RevenueFY 2025N/A~ $1.0M (assumes no reimbursement wins) Initiated
Revenue DirectionalQ1 2025N/ADown low to mid-double digits YoY Initiated directional guidance

Non-GAAP note: Adjusted OpEx excludes stock-based comp, D&A, restructuring, and certain one-time costs .

Earnings Call Themes & Trends

TopicQ2 2024 (Aug 1)Q3 2024 (Nov 7)Q4 2024 (Mar 5)Trend
Medicare LCDs (MIGS)Proposed device-intensive status for CPT 66174 in ASC (pending final) .Final LCDs restrict multiple MIGS in combo cataract; recovery slower than expected .Mid-Nov LCDs effective; industry-wide reduction in stacked MIGS; SGHT adapting strategy .Headwind crystallized, strategy pivot underway
OMNI/Stand-alone MIGSBuilding interventional mindset; training and reengagement .Focus on stand-alone patient targeting and efficacy narrative .Emphasis on pseudophakic stand-alone adoption; OMNIEdge launch planned H1 2025 .Strategic priority intensifying
Dry Eye/TearCare ReimbursementPrice increase to $1,200 effective Oct 1; early payer dialogues; SAHARA RCT 6–12M published .More claims paid case-by-case; BIA adoption; expectation for 2025 coverage/payment decisions .Increasing claim traction; 24M SAHARA phase completed; expect 2025 publication and payer wins .Building toward reimbursement catalyst
Tariffs/Supply ChainNot highlighted.Device-intensive not finalized; facility rates modestly higher; no tariff mention .New 20% China tariff likely impacts COGS; mitigation actions planned .New headwind introduced
Competitive LandscapeN/A.Elevated trialing of lower-priced devices during LCD disruption .New canaloplasty/trabeculotomy entrant; trialing contemplated in guidance .Competitive noise persists
Cash/CapitalCash usage reduced; no equity needed for breakeven .Positive Q3 cash generation; continued discipline .Q4 cash generated $1.8M; FY cash used $17.8M; confidence in breakeven without equity .Improving liquidity profile
Legal/PatentN/A.Awaiting final ruling in Alcon case; potential royalties/damages subject to appeal .Mediation failed; judge ruling pending; appeal possible .Timing uncertain

Management Commentary

  • “We believe the comprehensive procedure performed with OMNI…will continue to be a market-leading choice for surgeons…We are also excited about the TearCare market access opportunity…including an upcoming next generation OMNI release expected in the first half of 2025.” – CEO Paul Badawi .
  • “Surgical glaucoma revenue…was $18.8 million, up 9% versus the same period in the prior year…ordering accounts…up 7%, and account utilization…up 6%.” – CFO Alison Bauerlein .
  • “We expect to achieve cash flow breakeven without the need to raise additional equity capital.” – CFO Alison Bauerlein .
  • “We expect…initial positive coverage and/or payment decisions for TearCare…first of its kind for interventional MGD treatments.” – CEO Paul Badawi .
  • “We intend to…offset [20% China tariff] with other business adjustments…there should be some modest impact to the P&L in 2025.” – CFO Alison Bauerlein .

Q&A Highlights

  • Stand-alone MIGS market development: Management sees momentum in building an interventional mindset across the continuum, with curriculum and KOL engagement; expects paradigm shift to build through 2025–2026 .
  • TearCare reimbursement: Increasing claims volume with certain payers paying more consistently; 24-month SAHARA data and BIA deployed to support coverage; expects initial 2025 wins with ramp dependent on size/region/pricing .
  • OMNIEdge launch: Iterative OMNI family advancement emphasizing safety-first viscodilation and usability; targeted to meet varied physician preferences; expected H1 2025 .
  • Tariff and margin impact: 20% China tariff expected to modestly impact gross margin; mitigation includes renegotiation, supply-chain shifts, inventory timing .
  • Competitive entrants: Trialing is contemplated; guidance prudently incorporates dynamic MIGS environment; OMNI’s efficacy and product family strategy aimed to sustain leadership .

Estimates Context

  • Wall Street consensus (S&P Global) for Q4 2024 EPS/revenue and FY 2024/2025 was unavailable at time of request due to system limits; therefore, no vs-estimates comparisons are provided. Values that would have been retrieved from S&P Global are unavailable.

Key Takeaways for Investors

  • Near-term surgical glaucoma headwinds from LCD restrictions are structural; SGHT’s response centers on surgeon education, stand-alone strategy, competitive counter-selling, and OMNIEdge launch in H1 2025 .
  • FY 2025 revenue guide down 6%–12% YoY reflects LCD impact and conservative Dry Eye assumptions; watch Q1 2025 trend (“down low to mid-double digits YoY”) as a barometer for utilization stabilization .
  • TearCare reimbursement is the principal 2025 upside catalyst; BIA suggests payer savings, and 24M SAHARA durability data should enhance coverage discussions; a few large wins could materially alter trajectory .
  • Tariffs add incremental margin pressure; management plans offsets—track gross margin progression and any supply-chain diversification as indicators of mitigation effectiveness .
  • Liquidity/investment capacity improved: FY cash burn cut to $17.8M; Q4 cash generation; management targets breakeven without equity—supports continued R&D and market access investment without dilution risk absent unforeseen events .
  • Competitive noise likely persists; OMNI’s comprehensive efficacy and iterative product family may defend share—monitor surgeon adoption and stand-alone utilization KPIs (active accounts, utilization) .
  • Legal (Alcon) resolution remains a potential non-operational catalyst; timing uncertain—any damages/royalties could bolster funding for commercialization and pipeline .

Additional Data References

  • Q4 2024 press release: revenue/mix, margins, OpEx, EPS, FY results, FY 2025 guidance .
  • Q4 2024 call: strategy, LCD impacts, tariff, Q1 2025 outlook, cash, TearCare reimbursement progress .
  • Q3 2024 press/call: LCD finalization, device-intensive not finalized, operational execution, interim reimbursement progress .
  • Q2 2024 press/call: price increase for TearCare, SAHARA publications, proposed device-intensive status, training growth .
  • TearCare BIA publication (Dec 19, 2024): PMPY savings with increased TearCare adoption .

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