MIGS is Growing UpIke K Ahmed MD University of Toronto

IK Ahmed MD

DisclosuresAdeTherapeutics: CAccelerated Vision: CACE Vision Group: CAlcon: C, RAMO: C, R, SAerie: CAllergan: C, RAquesys: C, RBausch & Lomb: CCarl Zeiss: C, R, SClarity Medical Systems: CCroma Pharma: CEnvisia Therapeutics: CEyelight: CForSight Labs: C

Glaukos: C, R, SInnFocus: CIridex: C, RIvantis: C, R, SLayerBio: CNew World Medical: ROmega Ophthalmics: CONO Pharma: CPolyActiva: CSanoculis: CScience Based Health: CSOLX: C, RStroma: CTranscend: C, RTrueVision: C

C = ConsultantR = Research Support

S = Speakers Honorarium

60,000,000$6,000,000,000

IK Ahmed MD

Interventional GlaucomaMedications

Lasers

Trabeculectomy / Tubes

MicroInvasive GlaucomaSurgery

Cardiovascular MedicineCoronary Stents CABGMeds

IK Ahmed MD

Defining MIGS• Ab-interno approach• Minimally traumatic• At least modest efficacy• Extremely high safety

profile• Rapid recovery

IK Ahmed MD

Outcome MeasuresLower IOP & eliminate/reduce meds

IK Ahmed MD

3 MIGS Outflow Targets

Schlemm’s CanalConventional Outflow

iStentiStent inject

HydrusTrabectomeGoniotomy

Suprachoroidal SpaceNon-conventional Outflow

Cypass + Cypass VxiStent Supra

Scleral/SubconjunctivalXen MMC MIGS

“Plus”Internal MIGS (iMIGS)

IK Ahmed MD

IK Ahmed MD

GKOS (NYSE):Financial Strength to Support Continued Global Growth

TOTAL NET SALES(in millions)

Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 2014 Q4 2014 Q1 2015 Q2 2015 Q3 2015 Q4 2015 $0

$6

$11

$17

$22

$91.1as of 12/31/15

CASH, CASH EQUIVALENTS & SHORT-TERM INVESTMENTS(in millions)

$21.0M

$45.6M

$71.7M

IK Ahmed MD

How Big is the Market?Current? Potential?

IK Ahmed MD

Understanding the Market

Combo cataract surgery700K / year

Standalone procedures?2+M / year

IK Ahmed MD

80%

21%

Comorbid Cataract & Glaucoma• 15-20% of patients

undergoing cataract surgery have glaucoma

• 3.7 million cataract surgeries in the US per year

• 500-700,000 comorbid with glaucoma

Centers for Medicare and Medicaid Services. 2002 – 2007. Medicare Standard Analytical File. Baltimore, MD. 2007Tseng, V. L., Yu, F., Lum, F., & Coleman, A. L. JAMA. 2012;308:493–501.

Trabs; 63,000

ExPRESS; 18,000

Other; 42,000iStent; 80,000

Tubes; 50,000

US Glaucoma Surgeries

250,000 / year

IK Ahmed MD

US Glaucoma Prevalence

2% over 40yo 3M —> 6M

3Million USGlaucoma Patients

140KTrabs/Tubes

500KLasers

PotentialMIGS

Large TreatmentGap and

Opportunity in Glaucoma

Intervention

>=2meds; 1,011,408

SLT/ALT Laser; 541,998

Trab/Tube;

110,000

MIGS/Others; 123,200

Glaucoma Treatment MethodsPotential MIGS Patients

Marketscope

>=2meds; 5,085,230

SLT/ALT Laser; 1,902,897

Trab/Tube; 371,300

MIGS/Others; 197,734

US Patients Global

<0.65

>-6dB

0.7-0.85

-6 to -12dB

0.9+

<-12dB/10° Fixn

Glaucoma Disease & Prevalence Mild Moderate Advanced

0.3

OHT

2million 1.5million 750,0003millionMarketscope

IK Ahmed MD

The Glaucoma Pyramid: Target IOP Guides Therapy

Ocular Hypertension

Mild

Moderate

Advanced

Safety Highest Priority

Safety and IOP lowering needed

Max IOP lowering needed

1.5M

2.0M

750K

3.0M

US

Pop

ulat

ion

12

15

18

21

Targ

et IO

P (m

mH

g)

IK Ahmed MD

What is the Incidence of Glaucoma?

IK Ahmed MD

The Cycle of Glaucoma Therapy• Glaucoma is a life-long chronic

disease• Re-treatment rates are high• Multiple drops and interventions

over a lifetime

~ 200K newly diagnosed glaucomaper year

IK Ahmed MD

IK Ahmed MD

Glaucoma Treatment Algorithm

1 Med MultipleMeds SLT Multiple

Meds Trab 2nd Trabor Tube

1 MedSLT

DrugDelivery MIGS MIGS Plus Trab

or Tube

Phaco + MIGS

Now & Potentially in 5 years

Level of Invasiveness

IK Ahmed MD

www.youtube.com/journey104

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