Overall, we think that should apply in Optomed as well. The U.S. should be about 40% of the global market, and we are not anywhere near that. We expect a lot of growth possibilities in the U.S. in coming s and coming multiple s. The things what we have done there is that we have within the last six months hired a sales and marketing team. We have hired biness development staff there. We have started a lot of new collaboration projects with the hospitals and AI companies and telemedicine service providers. Also we have started establishing distribution channels in the U.S. and as a result of these activities.
Q1 was a strong growth compared to the, of course, earlier year, but also the previous quarter. Going to slide number 5. COVID it continues affecting in Optomed business, actually two ways. There are obvious negative effects on our traditional sales. It has been slowing down, especially our OEM sales, since all the face-to-face meetings have been canceled and are not possible. All the healthcare events, like conferences and exhibitions have been canceled. Also, distributors in many countries have been struggling to reach hospitals and doctors. The traditional sales work has not worked that well.
At the same time, the COVID has accelerated significantly the telemedicine projects and the telemedicine service providers have grown a lot and they need both cameras and software solutions from us. It has accelerated the takeoff of AI solutions as well. There are two-way effects. We think that now we have seen more acceleration effect in recent quarter compared to the negative effects. Now it's turning. Especially our own branded product sales has been growing now for a while quite fast and accelerating speed. OEM sales still continued being slower than last year.
Now we are seeing new orders increasing again for a long time. It may be that also those traditional channels and our traditional OEM customers are picking up speed again as the market continues recovering. Nothing new from the software segment. Recurring revenue continues growing as the installed base continues growing. Occasionally, we are able to do these larger solution deliveries. That, for example, created the jump compared to earlier quarters in a solution segment. Still, we are not traveling much, and we are not having much face-to-face meetings.
Markets every quarter have been looking more and more promising. Now we think that probably it will be good quarters coming. Going to slide number 6, Q1 2021 financial highlights. As mentioned, revenue increased 30%. Gross profit was in line, increasing 30% as well. Gross margins remained in the same level compared to the last year Q1 . EBITDA improved even though we have now newly established U.S. company and sales team and all the business development activities. The cost base in the U.S. has increased significantly.
Additionally, we had some one-time costs we are taking currently and some one-time costs in China related to this channel restructuring so that we need to make room for our new large distribution partner in some of the key provinces so that creates and has created some expenses. We still expect Q2 to have some of these one-time expenses coming from China. The third component, what we have started now during the Q1 , increasing significantly our investments, is we are accelerating the clinical trials.
We are running lot of large pilot projects for introducing our cameras and AI solutions to the multiple markets. They are quite significant costs for our company that are currently seen as expenses. Even besides all of those activities, EBITDA still continue to improve. That was a good achievement. On operating cash flow side, we continue operating roughly in a cash flow break even. We have had recently some quarters have been slightly cash flow positive and some slightly negative. This is roughly the level that we wanted to keep it.
We can keep the current good cash position that way. Going to slide number 7 and actually slide number 8, devices segment highlights. Revenue was growing 49%, and mainly driven by our growth in China and then started sales in the U.S.. OEMs remained in a relatively low level compared to historical years and quarters before COVID era. But own-brand product sales continued growing. Gross margins increased because we sell more own-branded cameras nowadays, and also additionally last year we had a one-time sourcing arrangements in the Q1 , so that decreased our last year Q1 gross margin a little bit.
This is the level that we aim to keep our gross margins in the Devices segment. Because of these activities, increased revenue, increased gross profit and also additional costs in the U.S., China, and this business development and clinical activities, EBITDA still increased. Software segment highlights going to slide number 10. There was now a little bit bigger jump in the growth rate in the Q1 than what we had in previous quarters to EUR 2.5 million. That was mainly because a couple of larger solution deliveries which we managed to complete.
At the same time, the existing user base continued expanding and the revenue increased from that side as well. The cost base increased slightly. In these larger solution deliveries, the gross margin was a little bit lower than our normal gross margin, but still EBITDA continued increasing well. Going to outlook 2021, slide number 12. As we have stated a few weeks earlier, we expect now our full year revenue to grow strongly compared to 2020. Long-term financial targets in slide number 13 remain the same as before.
Our aim is to deliver double-digit annual organic revenue growth and in the long term, the growth to remain over 20%. We think that we are in an excellent position because our products to grow significantly faster than the overall fundus camera market continues growing. Handheld cameras overall have been and we believe they will continue being the fastest-growing product category in the fundus camera market. The growth will further accelerate once the AI solutions enable us to open the new market in a primary care. That helps us in a two way.
First of all, we can get to some kind of a blue ocean market in primary care where there is no installed base and 20 times more possible clinics compared to the traditional eye clinic market. Then the second positive component is that we get increasing amount of recurring revenue from especially the AI sales once that accelerates in coming years. We don't give guidance for the EBITDA in a short term. That's not the priority. Our priority is to launch the new products and make sure that handheld cameras becomes number one screening tools for the blinding eye diseases and later in other diseases in primary care as well.
That's the market transformation, what we are aiming to do. Since gross margins are high and business model is highly scalable, eventually the EBITDA will reach 30%, driven by the growth in the revenue. Going to balance sheet, slide number 14. I give the floor to our CFO, Lars.
Thank you, Seppo. Hello, everyone. I will not go into details while you have access to the interim report for the Q1 . Just some highlights and equity ratio of 64% compared to 66% last year, which we believe reflects a strong balance sheet. Total borrowings of EUR 6.4 versus EUR 6.6 last year. Last year, EUR 3.2 million was repaid in the Q1 , and we think we have a good balance between equity and loan. Net working capital of EUR 3.7 versus EUR 3.5 last year. Finally, interest-bearing net debt of -EUR 3.4 versus -EUR 5.6 last year. Let's move to slide number 15, where, sorry.
Where I only highlight that cash flow was pretty close to zero, and it's -EUR 2.9 million last year. The reason for the high outflow of cash last year was because of the deferred payments related to the successful IPO in late 2019.
Back to Seppo.
All right. Thank you, Lars. Overall, we could conclude that we are back in a growth track as the market recovers and data proceeds. COVID is nowhere near being over, but now we see that these new telemedicine projects and demand on that side is fully compensating the lack of traditional sales opportunities. I think that favors a lot of our type of products and we are seeing that now during this year in growing sales. Probably also these traditional sales channels, OEM channels, and sales to eye clinics. The recovery will continue on.
We see that side recovering as well, later part of this year, and then continue the next year. At the moment, we are in a very good position at the moment, and there are a lot of exciting new opportunities in the market, and we are in a very early stage, just in a market entry stage. Vast majority of the clinics, eye clinics and other clinics have yet never even tried our products yet. Every quarter and every year, handheld cameras are getting more attention and, at the same time, AI is getting wider acceptance on the market. All the mega trends continue supporting us very well.
We remain now very optimistic.
All right. Thank you, Seppo. This concludes the presentation phase and takes us to the Q&A phase. Again, as a reminder, everyone can unmute themselves by pressing star six. I repeat, star six. We are happy to answer your questions now.
Hi, it's Pia Rosqvist-Heinsalmi calling from Carnegie. Can you hear me?
Yes, very well.
Good. I have a few questions. If we start by discussing sales. When you talk first of all about software solutions and particularly software sales and solutions deliveries, that was a positive surprise during the quarter. When you have these so-called one-time solution deliveries, will those solution deliveries lead to recurring revenues in the longer term, or are these really kind of one time lump sales?
They lead to the recurring revenue. Part of the software deliveries we make on a SaaS basis, then there is not a significant upfront payment. In this case, what happened in the Q1 was bigger installations and one-time payments, including the licenses and installation work. Then we have a recurring revenue based on the usage volume coming in a later quarter. In this case, this was one of those larger projects that we have had in a pipeline for a while. Finally we got them implemented. From now on, yes, they run on recurring revenue.
Okay. Have you now emptied the pipeline, or do you still have a lot of these kind of larger projects?
There are a lot of these larger projects in the pipeline. Currently, we can only do the installations effectively in the markets where we can travel. There are a lot of such projects that have been on hold for a year now after COVID started. We have such a project we have earlier announced that we have in some of the European countries, some of them are in Middle East and some in Asia, which have not materialized yet because of COVID.
All right. In the solution sales or the software projects, do they also include artificial intelligence?
Quite many of them, yes. Like in this case. Okay. Yes. They do include quite often AI and more and more. However, the recurring revenue in terms of absolute euros is not a significant contributing factor on our software revenue yet. However, that being said, it is still the fastest growing revenue type what we have in the software, but in absolute euros it is not significant yet.
Okay. Just for clarification, in the future, when you start to increase the share of AI revenues, those will be registered or booked under software-
Yes.
Not under device sales?
Yes. All the software and all the AI revenue is written in a software segment revenue, and then vice versa. In whatever way we sell or rent our devices, they come to the device segment. All the hardware goes to the device segment, and all the software goes to the software segment. AI goes to the software segment. Even though quite often we sell them as a combination or in a package, but in a revenue booking, they are separated in their own segments.
Okay. To the devices part of your business. During last year, you launched several new products. You have also launched the Aurora IQ, and in China received a CFDA approval for the Aurora camera and for the AEYE camera, I think. What can you tell us about the penetration in the market of these new products? How big a share of your sales now comes from these new products?
Yeah
What is the reception among clients?
In Western markets, maybe we divide markets in three categories: USA, China, and the rest of the world. If we start from the rest of the world, meaning Europe, Asia, Middle East, Africa, Latin America, a vast majority of our sales in cameras is new Aurora camera or Aurora IQ nowadays. That's the vast majority. In the U.S., it's about 50/50. Our own sales. Okay. In the U.S., our own through our own sales team, what we sell directly, that is mainly new Aurora IQ camera.
Some of our partners, resale partners and telemedicine partners, they still sell our previous generation Smartscope PRO quite much. USA is turning quite strongly to Aurora IQ now as well. In China, a vast majority is still our previous generation product, Smartscope PRO, and Aurora is still a small part of that. The reason being that in China, Aurora just got about half a year ago the CFDA registration and the launch takes some time.
All right. If I still may continue with a question on gross margins in devices. If I heard you right, you said you aim to keep the gross margin at the current level. I'm thinking here about, I mean, potential mix shifts or shifts in sales, if and when the OEM channel again activates. I mean, I assume the effect on gross margin then is negative, but still you now say you aim to keep the gross margin at the current level. Did I understand you correctly?
Yes. In our own branded product sales in China and USA has been in a very positive growth trend, and that is the higher margin revenue for us. As combined, these two markets, they are so much bigger than our OEM business is nowadays. That even as our OEM sales, as it seems now, starts to recover as well, we believe that it should not change the gross margins from the current level that much.
Okay. Yeah, that were my questions now at this point, so I go back into the queue. Thank you.
Thank you. All right. Any additional questions?
Hello? Can you hear me?
Yes. We can hear you.
This is Helena Åhman from Redeye. I just had a question about the you said you will invest more in R&D and what exactly will you develop more in terms of product?
We are currently running a major development program for new generation products. They are retinal imaging products, but we do not yet disclose what type of retinal imaging products and the timeline.
Okay.
What we are seeing, as our R&D investments, they are major developments. The second part of the development, what we are doing is continue building our AI service. There are coming significant amount of new algorithms for diagnosing different diseases, including different eye diseases, but also cardiovascular and neurological diseases. That's the second part of the development investment, what we are doing.
Yeah, that's very interesting. The second thing I would like to know more about is the collaborations in the U.S. You say that you have new distribution collaborations, and could you elaborate on that, please?
In the U.S., we have as a distribution partners. Actually, the channel is going away in the U.S. that we have a few large national distribution partners there now. Some of these distribution partners also provide software, their own software and telemedicine services as well. You could basically, I don't know if you consider in our point of view, they are like distributors for our products, combining their services and to our cameras, and then we occasionally provide them some software components from our software segment as well. You could also see them as almost like an end customer since they also provide a screening services. That's one part.
What we are building is a network of independent sales reps. They are usually smaller companies operating in one state or one city region, employing maybe between 5 and 20 people, in a typical case. That's complementary. Usually these channels complement each other in order to have a good coverage in the U.S., you need both. You need large national distribution partners or strategic partners and a sales rep network. That's what we are building there now.
Okay. When it comes to the hospitals and the primary care?
We in hospitals and this traditional fundus camera market, meaning optometrists and eye clinics, we can reach two ways. Traditionally, we have reached through our OEM channels, for example, when they buy bigger solutions and our cameras go as part of that. Our sales rep network also reaches those hospitals. We do some direct sales to hospitals and eye clinics as well, by our own sales team in the U.S. For primary care, we work with these strategic partners who also offer grading service and the software platform.
In your mind, how strongly will this pick up in the coming months in the U.S., pick up camera?
When we started this year, we didn't exactly know yet if the U.S. market is ready to open. The Q1 response from the market was more positive than we expected. We clearly see that the U.S. market is now opening faster than what we earlier expected. As a result, we had a good revenue in the Q1. We think that that trend will continue so that as the vaccinations proceed quite fast in the U.S. and the economy is opening up. Probably in the coming quarters, we believe that we continue growing strongly in the U.S. market.
Okay. Thank you.
Hi, this is Anne-Leena Räsänen from .
Hey.
I have a couple of questions. First, on the possible logistics or capacity constraints. Have you seen any, for instance, component shortages in the market?
Since the COVID started, that has been the constant concern. We are monitoring that actively. We are tackling that issue by occasionally purchasing some additional components to secure the situation that we have no shortage. Yes, key component lead times have extended, not only because the COVID, but we are using the same components. Like every camera manufacturer, we are using the same components that, for example, electric car industry is using, and they are sucking a lot of components now in accelerating phase. We are quite small player compared to the Tesla, and we are occasionally competing against the same component. We are using the large EMS companies as manufacturing partners.
Additionally, we are purchasing the safety stocks of the key components. So far we have had no shortages, but they are, of course, possible in the future, but hopefully not for too long periods. We are not foreseeing such a major problems at the moment.
Okay, that's good to know. Another question on your OEM channel and the role of it going forward as your own branded products will continue growing quite strongly, as it seems. How do you see that going forward?
Our goal is to support both channels equally, our own branded and the OEMs. We are very lucky to have world-class OEM customers and partners selling our products. It's very important in order to make handheld cameras in general widely accepted products. If it was only Optomed branded cameras available, it would be a hard battle to make the market see and learn about handheld cameras that fast. What now, when there is a Carl Zeiss and Topcon and other leading OEM customers of ours also promoting our technology and telling to the market that handheld cameras are now really serious alternative to desktop cameras, that helps a lot.
For that reason, we do everything what we can to continue supporting our OEM channels. On other side, of course, when we sell our own branded products, we make higher margins and also make it possible for us to get more recurring revenue when we sell our own software solutions and AI services on top of that. That software and AI service sales, we do not get currently from our OEM customers. That's the limitation of the OEMs. In a big picture, it's very important that they sell our products, and we really want to continue supporting them, as well as we can.
Okay. Thank you. That clarified the issue pretty well. That's all from me.
All right. Thank you. We still have time for additional questions, so please ask away. All right. I guess that's it for this quarter, and I thank everybody for participating, and I hope to see you again after summer when our Q2 results comes out. Thank you very much, everybody.
Thank you.
Thank you all.