Thomas Burns wasn’t initially impressed when noted ophthalmology investor Bill Link asked him to work at a small startup.
Then Burns looked at the prototype.
“I saw the size of the device and thought, ‘My gosh, this could change the whole paradigm of how glaucoma was treated,’” Burns told the Business Journal.
That’s why in 2002 he joined Glaukos Corp., a company at that time with four employees and no revenue. It would take about a decade before the product began generating revenue.
“Like most small companies, we have had plenty of near-death experiences,” Burns recalled. “There were plenty of times that we got knocked down and had to continue to move forward. What sustained me were people who had the same conviction and resilience to carry this thing forward. Failure wasn’t an option. We were going to succeed.”
Burns’ hunch has proven correct. Glaukos has invented by all accounts the world’s smallest medical device – smaller than the dot above this “j” that you are reading. The product has been implanted inside 1.5 million eyes, helping relieve the pressure brought on by glaucoma.
Analysts are expecting sales to boom an estimated 20% in 2014 to $379 million and then accelerate another 27% to $479 million this year. It has a compounded annual growth rate topping 30% in the past decade.
The company’s shares have almost quadrupled in the past two years to an all-time high of $154.75 and an $8.5 billion market cap. It is the most valuable ophthalmology company based in Orange County and sixth overall (NYSE: GKOS).
For all these reasons, the Business Journal is awarding Burns a Businessperson of the Year Award in the health sector. He’s being honored along with three others who are playing a pivotal role in the OC ophthalmology industry: Bobak “Bobby” Azamian at Tarsus Pharmaceuticals and Ron Kurtz at RxSight as well as Gavin Herbert, who is being honored with the first ever Orange County Business Journal’s Lifetime Business Achievement Award (see special report, page 1 and elsewhere).
The Bill Link Magic
Link, who is well known for savvy investments in ophthalmology, in 2001 joined Glaukos, which at that time was a three-year-old startup. Link went on to serve 20 years as its chairman until 2021, when he was replaced by Burns.
The two knew each other previously because Burns worked at Chiron Vision, which Link had founded.
When Burns joined in 2002, the company had problems even starting clinical trials because ophthalmologists and their patients didn’t want to experiment. Burns got around that initial hesitation by having the device implanted during cataract surgeries.
Trials on the iStent began in 2005, and it won Food and Drug Administration approval in 2012 and sales began immediately.
The company also had trouble finding a contract manufacturer.
“They all told us to go jump in the lake – there was no interest in this nanotechnology,” Burns recalled. “We went through in inordinate amount of skepticism.
“Most people thought that this was far-fetched and a crazy idea. Yet, we had the courage of our conviction that this was going to work. We believed in it from the very beginning, and it’s paid off.”
Engineers and scientists at Glaukos themselves thus developed and built the needed machinery. The company now has almost 400,000 square feet of manufacturing space in Aliso Viejo and San Clemente. It’s also planning to spend $82 million to build a research facility on a 25-acre site in Alabama.
The Problem with Eye Drops
Around 2007, Burns asked his scientists if they could turn the iStent into a mechanism to distribute medication.
About 80 million patients worldwide suffer from glaucoma, with 5 million having lost their vision. Research shows 90% of patients are non-compliant with topical medication use and 50% purposely discontinue their medication within six months. Worse, only about 7% of eyedrops can reach the affected area.
“Drops are archaic,” Burns said. “In many ways, mother nature has created corneas to keep stuff out of the inside of the eye and yet we continue to try to put stuff on top of the eye to be able to plow through the cornea, to get inside the eye to have it work.”
In 2012, Glaukos began a decade of clinical trials on what it now calls iDose TR.
Even before FDA approval, Burns was confident enough to spend $100 million constructing a 134,000-square-foot facility in San Clemente to build iDose.
“That was a bet the company moment,” he said. That decision is emblematic of our ‘we go first’ risk taking culture.”
With iDose, Glaukos submitted more than 100,000 pages of documents to the FDA because it needed approval for both the medical device and the drug. The FDA finally approved iDose in late 2023 and the company began ramping sales last year.
“No question it was worth the wait, because it’s going to revolutionize the way that surgeons treat glaucoma,” Burns said.
Three Years of Medication
Doctors implant the iDose, which is made from medical-grade titanium and is about half-a-millimeter wide and 1.8 millimeters long. Once implanted, 75 micrograms of a proprietary formulation called travoprost continuously elutes into the anterior chamber via membrane-controlled diffusion. Travoprost is 25,000 times more concentrated than a typical glaucoma medication.
Hence, instead of a typical thousands of eyedrops administered per eye over a several-year period, a patient only needs to receive “one administration” of iDose with its formula that is secreted into the affected area 24/7 for up to three years.
“Nobody has been able to replicate it. We’ve established a formidable technical moat. Our institutional knowledge and the technical breakthroughs we’ve developed would require a herculean task to reproduce.”
Glaukos is positioning itself to use the iDose technology to treat other eye related problems. Since 2018, Glaukos has spent more than $600 million on research, with 14 products in the pipeline to treat problems like dry eyes, keratoconus and presbyopia.
“We tell our investors that in the bowels of our organization, the beakers are spinning. We’re looking at new compounds and things to put inside the device.
“What’s keeping me here is we’re just at the cusp of another huge transformation in growth. We are unafraid of risk. And it’s the reason we are where we are.”