Glaukos Shorts Rise Faster Than Peers Into Q3 Print

GKOS is more crowded on the short side than most of its ophthalmology peers heading into Tuesday's Q3 results, with short interest at 7.9% of free float. That compares to a lighter picture for close peers: BVS gained 12.5% on the week and AXGN 9.9%, broadly in line with Glaukos's 8.5% weekly gain, but neither carries a comparable short position. COO and STAA are also moving with the sector, up 5.6% and 6.3% respectively, suggesting the recent strength is partly a rising tide rather than Glaukos-specific conviction.

The company's own short position has been building steadily for weeks. From roughly 3.9 million shares in mid-September, the short count climbed to 4.5 million by October 22, a 13% rise over the past week and nearly 15% higher than a month ago. The options market corroborates the caution: the put/call ratio reached 6.43 on Thursday, well above its 20-day average of 4.26, though that figure also reflects the structurally elevated PCR that GKOS tends to carry. Neither the borrow market nor the lending pool suggest a squeeze is imminent. Availability is ample at 951%, meaning there are nearly ten shares available to lend for every one already borrowed, and the cost to borrow has eased 25% over the past week to 0.56%.

The central dispute between optimists and pessimists on GKOS runs through a single word: reimbursement. The bull case rests on iDose TR's strong early adoption, with survey data showing doctors expect procedure volumes to rise from 220 in 2024 to 290 this year, and a broadening pipeline including Epioxa, which one estimate places at roughly $106 million in 2026 revenue. Analysts have been largely constructive: targets have moved up from multiple firms since the last print, with Jefferies raising to $210 and BTIG lifting to $205 in October. The bear case is more specific. Proposed Medicare local coverage determinations would require failed medical therapy and prior SLT before iDose TR can be used, and would restrict concomitant MIGS procedures. Physicians in survey work estimated a roughly 25% volume hit if the LCDs are finalised as proposed, a figure that would leave 2027 iDose volumes roughly flat year over year. Photrexa's complete discontinuation in Q2 removes another revenue layer.

The stock's history around earnings sharpens the stakes. After the last print in July, GKOS jumped more than 11% in a single session and extended that to nearly 13% over five days. Going into this week's release, the stock is already up 12% over the past month, trading at $178.88 against a mean analyst target of $199. The valuation is demanding: EV/EBITDA above 232x. One index-related angle adds texture without changing the short-term picture. ORTEX puts the probability of GKOS graduating from the Russell 2000 to the Russell 1000 at 60%, with a rank date of October 30, just two days after the earnings release. The stock is 5.5% above the entry line for that transition. The Q3 print will test whether the commercial execution on iDose TR has held up well enough to quiet the reimbursement debate, or whether the overhang grows ahead of a policy decision that management has limited ability to influence.