place. It's also south in Africa, in Arabic countries, in the U.S., so all over the world, this business area is growing, and we believe that it's going to be one of the fastest growing for us in the future. Patients we have been working with for a long time with remote monitoring and home solutions, and like now mentioned already many times here, depending on the reimbursement successes or cycles in different countries, it's going to keep on being one of the most fast-growing segments for us in the future. Research, universities, pharma.
Kate was talking about the new treatments and new drugs coming to the market, which require certain devices to be clinically proven, and we have been on this segment, and next year we are introducing the new M, and we believe that with that, we are actually going to also get to a very nice growth path. So focusing on growing faster than the market in the traditional segments, and then having some high growth areas in the new segments. Maybe I'll just mention the bottom part, which is becoming more and more important, so the connectivity and integrations to all the places. So building an ecosystem in the future, we need to be able to integrate and interface with everybody, so be open. A couple of words on where we are today, where we're coming from, where do we want to go.
So 20 years ago, we got to the market with the tonometer technology that has proven to be fantastic, and we are number one tonometer company in the world with our tonometers. About five years ago, integrating with CenterVue imaging technologies, the same thing. So I would claim that we have the best high quality, high resolution imaging devices in the world. So we have had really, really good, unique technology that we have brought to the market. But we have been working in kind of niche segments, selling devices, and then with the acquisition of Oculo, taking the assets, taking the knowledge from software, we have now included or integrated clinical communication solutions, and we have been able to create the ILLUME solution for screening.
So we are already now able to offer some of the solutions. And this will continue in the future, so this is our path. We want to continue adding new diagnostic devices, hopefully with similar success stories than in the past, and we want to invest in software. So adding data solutions so that we can really collect the data, view the data, provide the data for different caregivers. And then working together with AI, so working together with partners like we do today, and create AI-assisted solutions, no matter what it could be. Because already today, there are new approvals for AI as the solutions for, for example, systemic diseases being detected by AI, so for example, cardiovascular diseases. So this could be one of the new segments for us in the future that will be a growth area for us.
So, where do we start? When we start now going towards building care pathways, what do we have today? So if we want to go towards managing and creating a good glaucoma pathway. So like you heard, the glaucoma detection is including main three measurements or main three types. So IOP measurements, evaluation of the optic nerve head, and visual field testing. And I strongly believe that we have a unique solution already today. Nobody else has the same. So we basically have all the devices that do it.
They are high quality, they have the special benefits for the customers, how it's done, related to our rebound technologies, related to the new COMPASS that we brought to the market just now, the automated track perimetry, and the software that we are able to provide to the patients and to the clinicians to actually to do long-term monitoring. So already today, we have a solution that is unique, and the next things are going to be related to data and data management. But, hey, let's take a look at one of the technologies so that we don't forget where we're coming from, the IC200 in a short video. 200, and this year we introduced the new version of the product with a quick measure, making it even easier to use with complicated cases.
Next year, we are going to be adding products to our glaucoma portfolio, so it will be even a more versatile offering in glaucoma. So if we do the same thing with the retinal sides, what do we actually already have today, and how do we start building the care pathway system? So here we also have a unique offering. So with the best image quality and the ease of use and the automated ways of working. I mean, it is a wonderful place to start from. So the TrueColors, the high resolution, the ultra-wide field images, we actually give tools to the doctor that they can detect. They should be able to detect most of the pathologies from our images.
They are easy, really, really easy to use, and I think that you will hear from our KOLs during the break what kind of experience that they have had with the product. One of the big benefits related to resources is that they are so easy to use, that they don't always need high-level, highly skilled technicians, but they can be used by almost anybody, like myself even. This is especially true with the DRSp lus, that together with the ILLUME software, has made it possible to enter the retinopathy, diabetic retinopathy screening. I will let now a video explain to you how versatile the ILLUME is and where it can be used. How does the workflow work outside of also outside of the ophthalmic area?
So yeah, as you have seen there, the ILLUME and the DRSplus can be used outside of ophthalmology, so in any hospital setting. Then referrals are included, and specialists will be taking care of, if needed, the treatment of the patient. So, how does the full portfolio or strategy, how does it look like? So here you hopefully, everybody can see, the two care pathways consisting of different phases, starting with the screening, going into examination, and going into follow-up and monitoring. So divided into diagnostic and management parts. And the blue boxes in the picture are the products that we already have today. So we can quite well cover most of the needs that are related to diagnosing retinal pathologies and glaucoma.
However, there are certain areas that we have identified and the extensive work that Jouni was talking about; this is where we want to add. So we have identified a few very interesting product areas, and if we are able to do that, that would double our addressable market size from EUR 1 billion to EUR 2 billion. So adding new diagnostic products. And critical here are the software. So we already know today have the part of the clinical communications that it needed to connect the eye care professionals and the patients and the data. We have a screening solution, but what might be missing is the data management. So I actually have the great pleasure to show you the world premiere of the iCare Data Management System, that is not yet available, but it is a very important part of our solution.
You will be the first people to get a sneak peek of the product to be launched in 2024.
We're thrilled to present you a glimpse of our data management solution, i Care Data Management. i Care Data Management streamlines the connection between devices and clinicians, helping eye care professionals work more seamlessly and efficiently. It saves time by eliminating the need to move between devices and consultation rooms, as well as by reducing the hassle of navigating through multiple device software programs. All the exams clinicians need, just one click away. This results in reduced waiting time and more efficient workflows. iCare Data Management has an intuitive user experience and doesn't require any formal staff training, making it easy to adopt. How does it work? Patient information, images, and reports will automatically flow into iCare Data Management. On the homepage, clinicians see a list of patients who have just undergone examination.
Clicking on a patient leads our users to the clinical workspace, where the clinical analysis takes place. Here, clinicians can view and analyze imagery and reports to check for any pathology and compare information from current and previous visits to properly analyze the progression of disease. There are features and functionality to support more advanced analysis, too. The flexibility of the tool will cater for various needs and specializations, whether they need a standard comparison or comprehensive disease overviews. Patient imagery can also be exported in various formats and will be connected to other clinical systems, facilitating improved sharing of patient and clinical information among practices. What's coming up? Down the road, we will look to enhance collaborative care and strengthen relationships with referral networks, contributing to more effective healthcare coordination.
We will also introduce richer analysis and AI tools that utilize imagery and data from various devices, improving efficiency and confidence in clinical decision-making. Overall, iCare Data Management will deepen eye care's ongoing relationships with core customer segments and lay a foundation for improved device and software sales. Thank you for watching our presentation today.
Critical product coming to the market next year, and I just want to emphasize the importance here with this slide. So we are building a one platform, which is uniting patients' data professionals for enhanced diagnosis and treatment. This will enable us to start creating collaborative care models by utilizing the data and doing clinical communications on top of the data management. It will enable us also to create or at least participate in creating efficient and effective care pathways. And this also is the road to assisted clinical decision making. So by having the data available from different sources, we will assist the eye care professionals in making clinical decisions. AI can be added so that it can be another tool in making predictive clinical decision making.
All of this on a secure level, of course, because we are talking about patient information. And as mentioned in the video, it's going to be one of the drivers for our device sales first, which we have now already seen with the ILLUME. So we have had great successes by selling a lot of devices because of having an excellent screening solution. Recurring software revenues will follow. So that has already started, but of course, in the beginning, it's small, smaller than the hardware sales. So summarizing here, what do we aim to do? So we aim to be the leader in patient-centric ophthalmic screening, diagnostics, and monitoring. We believe that our competencies in building devices and solutions are going to create a diagnostic confidence that nobody else can do.
We do it in a patient-centric way by providing easy-to-use solutions, which are safe, high quality for the patient. We create seamless connectivity so that we can actually take first steps towards being part of the ecosystem, and we will be able to start managing and creating efficient workflows. So our focus is going to be in traditional eye care segments, but finding new opportunities in new ones. Then the two care pathways, we will fill them with a solution made out of devices, tonometers, perimeters, fundus imaging, and new diagnostic devices. And we focus on creating software solutions that connect the data patients and healthcare professionals.
So this all we package under the iCare brand, and we work through different customer touchpoints in the world, and this work has been going on for quite some time, and we have been quite successful. So we have been able to increase our aided brand awareness from 81 to 90, so by 9 percentage points in the last three years, and we have become number three within all the diagnostic device manufacturers, measured by the Net Promoter Score. This work will naturally continue, but so far, so good. So, hey, key takeaways from my part. So we'll focus on building solutions for glaucoma, retina pathologies, and screening. The base for our success is a continued innovation in eye diagnostic devices and a sizable investment in building connectivity and seamless data solutions.
We will expand our portfolio to include new diagnostic devices, and we will keep on focusing on creating superior customer experience and a strong brand. Thank you very much. I think it is time for a break. During the break, we will play some interesting KOL videos, so please don't go too far, and we'll be seeing you in about 15 minutes.
Originally, when I started using the iCare HOME2, I was using it in patients who, when they came to my office, would have what I called normal IOP, but yet they would be progressing. At this point, with all the data I've collected on hundreds of patients, I actually see that almost every patient would probably benefit from at least using it and collecting some data. I also am now using it in patients preoperatively as well as postoperatively, because we know that not all surgical interventions continue to have efficacy over time, as well as my patients who are on different therapies.
Of course, iCare HOME2 is important to consider in terms of how do we change management. We change management if we find a peak IOP that's reliable and consistent over the period of time that we're evaluating IOP. This is often, again, in patients who are progressing. This is patients, for example, that have multiple risk factors, we're not sure what the target pressure is. In our experience, we find very commonly this is required to tweak IOP medications, for example. Probably in over half the patients we do, it either is reassuring that the pressures are controlled, we can monitor the patients, or we have to change and escalate therapy. In patients who are progressing, which need further therapy, it guides us. How aggressive does the therapy have to be? Should our therapy be designed to lower pressures very low with more aggressive procedures?
Or can we use a therapy that's maintaining a pressure throughout the day, 24 hours a day, at a pressure that's measured in the office? So in those circumstances, it does help us guide our management, either reassuring patients who are otherwise stable or guiding therapy for patients who are progressing.
We're in an exciting era now where we have new therapeutics for geographic atrophy, so identifying patients reliably and then tracking and monitoring their progression over time is really critical and essential. And so one of the huge benefits of the iCare EIDON system, confocal system, is that it really provides a beautiful rendering of geographic atrophy. Traditionally, with color photography, it was difficult to identify the borders of atrophy, but we actually published that if you use this kind of confocal color imaging, you visualize the atrophy very well, and you can actually grade the borders of the atrophy, the area of the atrophy, as reliably as fundus autofluorescence imaging.
Fundus autofluorescence imaging sometimes can be a little uncomfortable for a patient, so being able to do this using this TrueColor platform has really been a tremendous advance, and I think will be of great benefit in being able to monitor our patients in this new era.
Originally, when I started using the iCare HOME2, I was using it in patients who, when they came to my office, would have what I called normal IOP, but yet they would be progressing. At this point, with all the data I've collected on hundreds of patients, I actually see that almost every patient would probably benefit from at least using it and collecting some data. I also am now using it in patients preoperatively as well as postoperatively, because we know that not all surgical interventions continue to have efficacy over time, as well as my patients who are on different therapies.
Of course, iCare HOME2 is important to consider in terms of how do we change management. We change management if we find a peak IOP that's reliable and consistent over the period of time that we're evaluating IOP. This is often, again, in patients who are progressing. This is patients, for example, that have multiple risk factors, we're not sure what the target pressure is. In our experience, we find very commonly this is required to tweak IOP medications, for example. Probably in over half the patients we do, it either is reassuring that the pressures are controlled, we can monitor the patients, or we have to change and escalate therapy. In patients who are progressing, which need further therapy, it guides us. How aggressive does the therapy have to be?
Should our therapy be designed to lower pressures very low with more aggressive procedures, or can we use a therapy that's maintaining a pressure throughout the day, 24 hours a day, at a pressure that's measured in the office? So in those circumstances, it does help us guide our management, either reassuring patients who are otherwise stable or guiding therapy for patients who are progressing.
We're in an exciting era now where we have new therapeutics for geographic atrophy, so identifying patients reliably and then tracking and monitoring their progression over time is really critical and essential. And so one of the huge benefits of the iCare EIDON system, confocal system, is that it really provides a beautiful rendering of geographic atrophy. Traditionally, with color photography, it was difficult to identify the borders of atrophy, but we actually published that if you use this kind of confocal color imaging, you visualize the atrophy very well, and you can actually grade the borders of the atrophy, the area of the atrophy, as reliably as fundus autofluorescence imaging. And fundus autofluorescence imaging sometimes can be a little uncomfortable for a patient.
So, being able to do this using this TrueColor platform has really been a tremendous advance, and I think will be of great benefit in being able to monitor our patients in this new era.
Originally, when I started using the iCare HOME2, I was using it in patients who, when they came to my office, would have what I called normal IOP, but yet they would be progressing. At this point, with all the data I've collected on hundreds of patients, I actually see that almost every patient would probably benefit from at least using it and collecting some data. I also am now using it in patients preoperatively as well as post-operatively, because we know that not all surgical interventions continue to have efficacy over time, as well as my patients who are on different therapies.
Of course, iCare HOME2 is important to consider in terms of how do we change management. We change management if we find a peak IOP that's reliable and consistent over the period of time that we're evaluating IOP. This is often, again, in patients who are progressing. This is patients, for example, that have multiple risk factors, we're not sure what the target pressure is. In our experience, we find very commonly this is required to tweak IOP medications, for example. Probably in over half the patients we do, it either is reassuring that the pressures are controlled, we can monitor the patients, or we have to change and escalate therapy. In patients who are progressing, which need further therapy, it guides us. How aggressive does the therapy have to be? Should our therapy be designed to lower pressures very low with more aggressive procedures?
Or can we use a therapy that's maintaining a pressure throughout the day, 24 hours a day, at a pressure that's measured in the office? So in those circumstances, it does help us guide our management, either reassuring patients who are otherwise stable or guiding therapy for patients who are progressing.
We're in an exciting era now where we have new therapeutics for geographic atrophy, so identifying patients reliably and then tracking and monitoring their progression of, over time is really critical and essential. And so one of the huge benefits of the iCare EIDON system, confocal system, is that it really provides a beautiful rendering of geographic atrophy. Traditionally, with color photography, it was difficult to identify the borders of atrophy, but we actually published that if you use this kind of confocal color imaging, you visualize the atrophy very well, and you can actually grade the borders of the atrophy, the area of the atrophy, as reliably as fundus autofluorescence imaging. And fundus autofluorescence imaging sometimes can be a little uncomfortable for a patient.
So, being able to do this using this TrueColor platform has really been a tremendous advance, and I think will be of great benefit, in being able to monitor our patients in this new era.
Originally, when I started using the iCare HOME2, I was using it in patients who, when they came to my office, would have what I called normal IOP, but yet they would be progressing. At this point, with all the data I've collected on hundreds of patients, I actually see that almost every patient would probably benefit from at least using it and collecting some data. I also am now using it in patients preoperatively as well as postoperatively, because we know that not all surgical interventions continue to have efficacy over time, as well as my patients who are on different therapies.
Welcome back from a short break. Hopefully, you have refreshed yourself and are full of energy for the next session. We'll continue with the presentations, and we'll next go to sales. Welcome, John Floyd, to the stage.
Good afternoon. Thank you all for joining us today. My name is John Floyd. I'm the Vice President of Sales. Give you a little bit of background on me. I've been in medical sales for a little over 25 years, actually almost 30 years. I've been in diagnostic ophthalmic sales for over 20 years, and the last 13 of those 20 years I've been with iCare. So let's first talk about where we are, where it is that we are playing on the where our footprint is and where our global sales, where we're delivering our products and selling directly to customers. We're in over 100 countries across the globe, with five sales offices in multiple regions. The regions we have sales offices are in Finland, Italy, Australia, China, and the United States, where I'm based.
The United States is a little bit of a unique area for us or market for us because we use. It's the only area that in the world that we use direct sales force that work primarily, or we have some that are independent and some that are direct employees of the company, but they all work together for iCare directly. We also use 130 distributors across the globe in those other 99 countries to cover the other regions of APAC, EMEA, Latin America, and Canada. As Jouni mentioned earlier, the total global market for diagnostic instruments is approximately $3.5 billion, just under $3.5 billion in total revenue opportunity. There are, o bviously, it's not a balanced market across the globe. There are some larger areas.
The top 10 areas include the United States, Japan, China, India, Germany, the U.K., Italy, France, Brazil, and Canada. That top 10 segment of the market is representing 73% of the total global market for ophthalmic diagnostic equipment. If we extend that a little farther and look at the top 20 market share, it represents about 88% of the total revenue opportunity in diagnostics. If we take it one step farther and look at just the top 30, it represents 93% of the total global market opportunity in ophthalmic diagnostics. You know, I find that important to illustrate because as you can see, it's a very compressed market. The top 30 markets represent, you know, north of 90% of the opportunity, so very compressed market.
So we talked about where we play, we talked about what the market opportunity is. Now let's talk about who our key customers are. We have broken this down into a couple of different segments, and one of our strengths in our portfolio of products is that we have a broad relevance across multiple different customer segments. In ophthalmology, for instance, that segment can vary significantly between not only different parts of the world, but also within country. What I mean by that is the settings for diagnostics can range from multiple specialties, such as retina or glaucoma specialists. It can also extend into private practices, into large clinics, and into hospitals. What this translates into is that these different segments within ophthalmology have different requirements for different types of diagnostics.
Example of that would be the EIDON AF or the EIDON FA. Those are primarily found on a global scale. They're primarily found in specialty clinics and large hospitals. Whereas if you look at our tonometers, our tonometers are available, or you can find tonometers in any one of these different segments in ophthalmology. Optometry, again, on a global scale, can really be described in two different subsegments. The two subsegments are the clinical optometrist or medical model optometrists, as we sometimes call them. These doctors or these optometrists are focused, not only on refractive care, but they also are managing some early stage, and sometimes diagnosing for the first time, early-stage pathologies in patients and managing those patients for a period of time until it is needed to pass them off to a specialist.
The other type of optometrist is the retail optical optometrist, primarily focused on refractive care or lens care or selling glasses and contact lenses. Though we're seeing that market change over the last 5 years-10 years, they are beginning to expand with their services to provide more care for patients using screening technology, such as our tonometers and our DRSplus, and being able to screen and diagnose patients earlier. Within some of these larger markets as well, there is the large retail chains, and they are becoming a very substantial segment of some of our bigger markets. In the United States, for instance, they're quickly taking over double digits percentage of ownership and optical or optometry market.
With these larger institute or larger groups, they are really needing and are demanding reliable, reproducible, accurate, fast, and easy-to-use products in order to keep up with the demand that we keep hearing as the patient population continues to age and grow. Our newest customer is the screening segment, the retinal screening segment, often happening outside of settings where your traditional eye care is taking place. As Kate discussed earlier, diabetic retinopathy is a common complication for diabetes, and it is imperative, imperative that these patients are seen, screened, or have a full routine eye exam on an annual basis. It is for their. It's, it's imperative to, to protect their vision.
The highly automated and easy-to-use DRSplus, along with ILLUME, is a great package for these types of offices to be able to provide this service in an effective way. Examples of these types of clinics is, they've been touched on: diabetes clinics, primary care clinics. But the beautiful part about this, as Tommy mentioned earlier, our products are extremely easy to use, so they don't take a lot of training or specialized technicians to be able to run these, 'cause you're not gonna find them in those types of markets. The ILLUME platform that we've talked about as well connects the best-in-class AI, for example, the AI technologies and some of our partners like Thirona, OphtAI, and Eyenuk, just as a couple of examples.
The AI takes the image data, it analyzes that data, and then hands it over to the ILLUME platform, that supports continuity of care for referrals when necessary. This combination gives the best-in-class image capability with fantastic AI technology, which we believe is going to set the standard of care and set the bar for what our customers are going to expect. We're already seeing very high interest in the market. Though it is gonna be a, you know, slow market to grow, we are seeing high interest in the market, and we look forward to the adoption and the growth in the coming years. So we've talked about the market size, we've talked about where we're playing, we've talked about the different segments. Now, what makes people buy from iCare? Obviously, we're not the only tonometer company in town.
We're not the only imaging device on the market. What makes them buy from us? We'll start this, and we'll break it down into three segments again. With tonometry, it's reliability. Again, these clinics are seeing dozens of patients, in some cases, 100 patients a day. They have to have reliable equipment that is durable and will hold up. The other great thing about our tonometers is the very low maintenance. There's very little maintenance. There's no calibration that's required. The minimal maintenance that's required can be done by non-engineer, non-specific technician type of. It can be done by the customer, quite frankly. The other thing is reproducibility, and then this is gonna go across the board for everything I talk about on diagnostic.
Reproducibility, I know we've talked about that a couple of times on some other slides, but the key to reproducibility in diagnostics is we're seeing these patients sometimes one year apart, sometimes two and three years apart. If you do not have reproducibility from one patient to the next or from one technician to the next, it is very difficult to pick up on subtle changes in pathology. If it's not reproducible, you can't you have no benchmark to work from, so reproducibility is key. Our tonometers are highly reproducible, which, as we have our reception after, if you all are able to join us, more than happy to demonstrate the iCare tonometer on myself, and we'll show you just how reproducible it is, on myself. Patient friendliness. You know, we talk about no anesthetics and no air puff.
That was, I believe, where we started from with this technology, but I think it really expanded as we got to grow, and obviously, we got to know our market even better 10 years, 12 years ago. Obviously, this tonometer started with the idea in pediatrics to eliminate or reduce the need for exams under anesthesia in small children, and it has done that beautifully. We are beloved by pediatric ophthalmologists all over the world and their staff. But in addition to that, we've learned that it is patient-friendly in many different areas that we probably didn't know about in the early stages. Another example would be a cataract specialist. Cataract specialists, when they diagnose a patient or when they come to surgical conclusion with a patient to remove a cataract, there is a test they have to do called biometry.
They're measuring the focal length or the distance or the measurement of the actual eye. In traditional ways of doing tonometry in the old days, they would use applanation tonometry, which is still around today. But what that does is it flattens the cornea. It's pressing the cornea. It disrupts the shape of the eye for a temporary period of time, but what that causes is, after they've done applanation tonometry, they cannot do the biometry test, so they have to bring these patients back, sometimes from hours away. These patients many times are elderly. They live two hours, three hours away, and they're having to come back, and they also disrupt the flow of the practice.
Because the rebound tonometer, as you saw on the IC200 demo, is so light to the touch and measures quickly, it does not disrupt the cornea, and the patients can have that test done on the same day as the primary visit. I see that as extremely patient-friendly, but it's also highly efficient. And then, of course, portability. With being a handheld device, it's very portable. The imaging technology. We've talked about the outstanding image quality. That is. We can't say that enough. It is world-class, second to none, and I know we're biased, and I'm a sales guy. I'm telling you it is true. There's many, many different examples that you can find online, but we're also more than happy to show you our photos against anyone's photos in the industry.
The ultra-wide-field lens that we have talked about briefly has really revolutionized the EIDON product. That came out about two years ago. We call it an option for the EIDON. I will tell you that it is, it's more of an option to not buy an EIDON with an ultra-wide-field lens. It has just become the standard of care for the larger markets in optometry and ophthalmology, and not everybody in the imaging business can do ultra-wide imaging. We're one of the few. And again, with phenomenal image quality on that, and there's a photo we'll show in a second that will better explain that. Patient-friendly, the device is comfortable to use with the patient, as you will see in some of the videos from our KOLs.
But it's also, we use a true white light, LED light, and because of the technology, the confocality that we use, we don't have to put as much energy into the eye. Any camera has to have a flash, but this—every camera puts energy into the eye, and with the EIDON, we're able to use a lower volume of or a lower intensity of image, of energy, to capture a high-quality image. That's very comforting to the patient, and it also requires, it can be done in a very small pupil, with no dilation, which makes it extremely patient-friendly. The automation. Automation sounds very generic.
Automation is incredibly important to reproducibility because you have, just as everyone in this audience has different skill sets, with automation, we all can take the same level or quality of image from the least experienced operator to the most experienced operator. And what that really means to me as well, and one of the things that we talk to our doctors about, is now you can take your least experienced staff member, and they become much more valuable resource to the practice, and your more experienced staff member then can go around the practice and do other more sophisticated testing or take care of other issues that the doctor needs, which really increases efficiency, which is desperately needed today. Then we talk about screening. This one's easy because it relates back to imaging.
All of the same reasons I talked about, the image quality, the ease of use, the automation, but also the speed on this DRSplus is amazing. It'll take a photo in the right eye, left eye, go back to its resting position in 30 seconds, and it doesn't matter who's running it, it'll do it that quickly. As well as with all of our imaging equipment, can easily go through, corneal opacities as well as cataracts. Also bundled together with accurate and, pretty reproducible AI technology, it really enhances the screening capabilities, and it's why people are looking at the DRSplus to be the next leader in screening. So, I'll quickly talk about this image. The center ring represents the 45-degree field of view, which is the standard, what has been the standard for decades in retinal screening or retinal photography.
That is also what our DRSplus captures. The next ring is the 120-degree shot. That is the single shot from the EIDON ultra-wide field. The entire image that you see there is multiple shots that the EIDON and ultra-wide field is using and then stitching together with a proprietary algorithm that we use to give a beautiful 200-degree field of view. But let's see also from Dr. Sadda, who's a world-renowned retina specialist. Let's see what he has to say why this advanced technology assists him in some of his diagnosis.
I think the iCare EIDON TrueColor system has been quite transformative for retinal imaging. You know, having a natural color, white light source to view the retina provides us information that resembles what we see on a clinical exam. It helps us better interpret pathology. But the important, I think, significant advance is actually putting the light through a slit confocal pinhole. The confocal focality dramatically improves our contrast to be able to identify fundus lesions, which might otherwise be difficult to visualize. And we've particularly noticed that benefit in visualizing fine macular structures, including drusen and pigment alterations, as well as atrophy.
So, one thing I will point to that he said earlier is the image that he sees coming from the EIDON the DRSplus is the same image that he sees when he's looking through his slit lamp or microscope. So it is real color, true fundus imaging. It's not anything else anybody else can do. I know people claim it, this is reality. So while we have a broad range of products suitable for many different customer segments, it's a great asset for the company, but it also means that distribution channels are not necessarily the perfect fit for all markets and all segments. It works in some regions, but not in all. During the new strategy period, we're gonna focus on developing our current distribution structure.
We're going to be reviewing the full market potential for all of our products, focusing on developing areas where new skills and new resource partners or resources or partners may be needed to expand our reach to all customer segments. In the U.S., we have. We've got the ability, we have the scalability to go direct to market on our own with our own sales force in most areas. However, we need to continuously monitor the trends in the market to make sure we learn from our customers, where we need to strengthen our skills, where we need to strengthen our, strengthen our knowledge, we always can learn, and where we need to improve our operations.
Expanding our reach to advanced ophthalmology, such as retina specialists, is one with our fantastic products, is one of the key development areas we need to focus on in the U.S. For the rest of the world, we are using selected distribution partners, as I mentioned, to take our products to market. This will still be a model of choice for us, proving the high degree of flexibility, scalability, and speed to market. We're committed to continuous development of our distribution partners. We are working with them and helping them, and they are helping us to scale both of our businesses. We are reviewing potential and all market segments systematically, monitoring the performance, and setting new targets and goals according to those systematic analysis.
Together with our distribution partners, we will focus even more on strengthening a holistic iCare brand, covering all product lines with meaningful marketing activities. Our screening business, built on the combination of the DRSplus and the ILLUME platform, has gotten off to a very promising start. The big thing for our new strategy period will be to look for channel development for this new business. Our focus in the first phase is going to be on the non-ophthalmic channels for diabetic screening. This will not happen overnight. It's not that we're gonna be moving slow necessarily, it's the market is going to be slow to adapt. Things like this don't happen overnight. It's going to take time for the acceptance and the adoption of AI being used in screening and medicine.
And in different markets, it will be accepted or adapted, or adopted, at different, completely different rates. With that as well, different markets are gonna require a little bit different technology or a little bit of tweaking in our technology. We'll be able to do that. It'll take a little bit of time as well, but we'll focus on the large markets first, of course. And then lastly, regulatory requirements. Regulatory requirements are always a hurdle, and when you're in 100 different countries, it takes time as well. So running a little over my time, but I wanna share a quick success story that will kind of shed a little bit of light on our technology.
We were invited several months ago by one of the—this was in the U.S. market—by one of the largest medical care providers in the country, in the United States. They have dozens and dozens of hospitals and hundreds of clinics across the country. They were looking to expand their diabetic retinopathy screening program. So they asked us to come in and do an evaluation side by side with some of our competitors. These competitors were much larger than us. They've been in the market much longer than us. They've been in retinal photography longer than us, but we were excited for the challenge. So what they did is they actually brought real patients in from ophthalmology and optometry using staff.
They brought them in, and they brought in different types of patients with different ages, different ethnicities, different pathologies, to make it a real-world test. They did a really nice job. To abbreviate the story, we were able to photograph everyone that came through, where not every patient was able to be photographed by the other technologies. In one particular case, it was a cataract patient, and the staff member didn't even believe in the beginning that that was the image that came from the patient that we just photographed, so we had to take it again, which we allowed her to do. But then we were contacted by this group two weeks later for a round, a follow-up, and they told us, "We don't usually give the information like this away, but you were voted p- by staff.
Optometry and ophthalmology unanimously selected your technology for this project." Pretty amazing, but it gets better. They said not only were they so excited about how, what great technology this is, they now want to replace our non-mydriatic cameras in those departments with this technology. Even better. They said, "We hadn't." I don't think they had considered, but they said, "We actually would like to expand this even into our emergency departments." And they've now bought dozens of devices, not only for their screening markets, not only for their optometry and ophthalmology clinics, but now for their emergency departments, and they are using this technology across the board, and it will be a great client for us for years to come. So key takeaways. We have a broad product offering to really attack different market segments.
We have clear unique selling benefits to all of our technologies. We can adapt our sales channel and building on our existing strengths, as Tomi was talking about. Our superior customer service builds the brand forward. We are very, very focused on the customer. That's how you build a strong brand, and that's how you build a strong company. Retinal screening in non-ophthalmic eye care settings is going to be imperative, and it's gonna be a great opportunity. It's a new frontier for everyone that's in the game. Lastly, our global footprint enables our growth and our ability to grasp and understand the market and develop the correct products that the market is asking for. Thank you. With that said.
Hello, everybody. Hope you've enjoyed the great presentations we've been hearing here and seeing here today. My name is Robin Pulkkinen. I'm the Group CFO. I've been with the company a little bit more than eight years. So if we start with the growth, I see that many people have been commenting that already today. Going back to 2021 in March, back then, we looked at the historical organic growth, which said that from 2016 to 2020, our organic growth has been slightly faster or slightly above 13%. And back then, we committed that we would try to accelerate that growth, in the coming years. It's.
I'm happy to be able to say that actually, we've been able to deliver on those promises, and today here, we're coming back and saying that we're targeting to reach a growth rate of three times faster than the ophthalmic diagnostic device market, 2025 onwards. There's been some misunderstanding whether it means 300% faster, 300% faster, or whether it's three times the speed. It's three times the speed of the market. The next six months still look challenging due to the macroeconomic outlook, but we do expect to see and start seeing the market to normalize towards the end of next year. So just going through a bit, the business model. We've touched a bit different parts of this today.
Our business model has really played out well for us over the last decade. So we're fully focused on eye care nowadays. It hasn't always been the case. I'll come back to that a bit more later on. All our manufacturing is fully outsourced. So we do our tonometers and the probes in Finland. Probes are done on fully automatic production lines, and the imaging devices are manufactured in Italy in a couple of different factories. All our critical suppliers are backed up with double supplier principle. We invest in R&D. We've increased the investments in euros on a continuous basis annually, but we do also use outsourcing for some of the varying demands on different projects what we have in hand.
Then finally, like John covered in his presentation, we do have a direct sales operation in the U.S., and then we cover the remaining other 100 countries through distribution channels. So growing faster than the market. So looking at the last seven years, revenue has been able to grow roughly 27% on average on annual growth basis. As you remember, in 2019, we acquired CenterVue, so that's not fully organic growth that we've been reporting. Looking at how the growth has been, when you kind of eliminate the impact of the CenterVue acquisition, the tonometer business over the seven-year period has been growing slightly above 16%, and the imaging slightly above 18% during that seven-year period.
We've indexed here on the right, you can see the imaging and tonometry business kind of split it, both starting at 100 at 2016, and then kind of showing how the share of the revenue has developed. They are not kind of represented a true split between the businesses. As you maybe remember from 2019, when we acquired CenterVue, their revenue was smaller than the tonometry revenue we had at iCare. Software revenue continues to increase, especially now around the screening business. We've seen that already happen this year. Going through the plans for next year, it's pretty evident that that is gonna be one of the growth drivers for us. It's also important to understand that the solutions are not necessarily gonna be software revenue only.
It's actually most likely gonna be driving more of the hardware sales. So looking at the total revenue related to that, it's gonna be more on the hardware side instead of software alone. This year, like we've heard before, we've had some headwinds in the growth. There are some unfortunate things maybe this year that we kinda ran out of stock for some of our products, but like Tommy said, we are coming out with the new MAIA microperimeter next year. And kinda looking at this year, how we've done, excluding the perimetry business, the growth has been almost 9% FX adjusted. So the balance sheet, it's in a really strong and good condition. We've actually, our equity ratio went above 72% now at the end of Q3.
Profitability has remained pretty stable over the last four years, and the return on investment has been getting slightly better. On the kind of what's behind the numbers on the balance sheet, there's been quite a bit more changes there. So looking at the average invested capital in 2019 to 2022, it's actually doubled during that time. Looking at the equity at the opening balance sheet in 2019, it's actually EUR 18 million. Now, at the end of 2022, it's over EUR 90 million, so it's actually 5x over the four-year period. There's a couple of things, the retained earnings and then the equity issue in 2019, which have been increasing that over the years.
Basically, the net, it's net debt-free company, the net gearing being -13 at the end of last year. Cash generation, very much in the line with the top line, so over 25%, compound annual growth rate over 7 years. It looks pretty steady. Within the year, there is quite a bit of variance. So when you look at the quarterly splits, the bars don't look so smooth. So the first half typically generates less cash for us than the second half. And looking at the last couple of years, the last quarter of the year has been actually representing more than 50% of the whole year operating cash flow. There's no change here, so we aim to continue on this path and continue to generate positive cash flows.
The M&A side is something that may have an impact on the investment side of the cash flow, but not on the operating side. Continuously investing into R&D. So this year, looking at the right bar here, the first three quarters, we've actually spent a little bit more than 10% of revenue on R&D. Looking at our guidance, in order to keep our guidance, we're looking at a really strong Q4. So that most likely is gonna be that percentage dropping when we come to the end of the year. Kinda looking at the euros, from 2019 to 2022, we've, in euros, doubled our R&D spend over that time.
We have a little bit more than 210 employees in the company. One quarter or 25% of those work in the R&D function, so we are heavily investing there. Roughly 2/3 of our R&D investments go into hardware development and embedded software, and then the remaining one-third goes into the software development. So the M&A pathway. Many of you know, over a decade ago, the Revenio was involved in a number of different businesses. 2012, our board decided to focus on health technology, and we started divesting all the non-core businesses. There was quite a bit of stuff there. By 2015, we sold the last non-core businesses out, the RIB Boats being the last.
Starting from 2016, it's been a health tech company. Back then, we had the tonometers, and we had the Cutica, Ventica, Oscare products. Kind of like we've heard today, the tonometer market is roughly EUR 200 million annually, so it was rather small. We had a great product, still have, but we're still considered kind of a one-trick pony. And kind of it was obvious to us that back then that we need to start expanding the portfolio. And in 2019, after two years of negotiation with the CenterVue owners, we were able to close the transaction where we got access to the fundus imaging and the perimetry.
2021, we added also Oculo to our group, like we've heard today, and where we got the access to the software assets, platform, and team. So currently, looking at the portfolio, so we have the tonometers, fundus imaging, and perimeters. It's roughly 1/3 of the ophthalmic diagnostic device market where we have an offering. Like we heard from Tomi today earlier, and Jouni as well, out of that 2/3 that we don't have, maybe 1/2 of that, so 1/3 of the total market is at interest for us. We have been doing quite heavy studying and investigating about the opportunities that there may be, but it's something that we are continuing to work on.
At this time, I think the last 1/3 of the market is something that is not in our focus, as of today. Might change in the future, but not at this stage. So kind of, quite actively looking for product portfolio expansion. We're quite well geared, to move on potential M&A opportunities, so we do have the 10% share issue right from the AGM. And then, of course, the balance sheet is very healthy, where there's plenty of room for using leverage as well. So a little bit summarizing. The organic growth, screening, a totally new opportunity in the non-ophthalmic setting, where the growth and the opportunities are pretty obvious to us. We've seen that happen this year. We see that planning for next year.
Our fundus imaging, the market share is still rather low, below single digits. Our level of automation and the quality of the picture is second to none, so we do believe that there are growth opportunities there. Tonometry, our market share is approaching 40%. It is gonna be challenging on the professional side to maintain double-digit growth forever. I think there, the home and the related reimbursements are gonna be a key driver to maintain that growth. On the M&A side, we've covered a few times, so we carefully are assessing those opportunities and looking if there are anything that we could consider.
I think the distribution channel change probably then comes once or if we have a wider portfolio of products to cover and sell, then the distribution channel structure comes on table, whether we have enough breadth or, or wide enough portfolio to consider going direct in some other markets than the U.S. only. So larger Western countries. The profitability outlook, it's stable, but I'll actually jump to the next slide, where we can see kind of the M&A potential impact on the kind of profitability kind of outlook for the company. So when we screen the markets, that's. It's very obvious that there is no other revenues around. Our profitability and growth is very unique for the industry.
So we've collected some of the, kind of the relevant competition, profitability levels, with internally, not disclosing what those companies are, but it's, it's pretty obvious that the profitability levels in general are, are lower. This was actually the same case when we acquired CenterVue, so their gross margins were in the low 60s, EBITs in the low 20s, but we've been able to significantly improve those over the years. And, of course, we would plan to try to do the similar with any other acquisitions. The strong financial development has enabled a steadily increasing dividend, combined with lowering payout ratio. The DPS has been growing nicely, like the, the kind of the P&L in general, for many years in a row.
Our dividend has been increasing on average EUR 0.02 per year for a number of years now. I think all the way from 2016, maybe the 2016 to 2017 was EUR 0.01 increase, but other than that, it's EUR 0.02 increases. The payout ratio has come down. This was also kind of, well, I mentioned earlier in the balance sheet structure, the equity ratio has increased, and then, of course, the payout ratio has a strong play there. We are a growth company, so we do see. I've been asking actually over the last seven years a number of different investors, how they see revenue from a dividend point of view and how they value the dividend payments.
Nine times out of ten, investors feel that if we can use that money to accelerate the growth, they would rather do that than let us pay the dividends out. And that is also something that we think internally, similar way inside the Revenio and inside the board. So if there are opportunities where we could use the money better than paying out dividends, then that's something that is on the table. So our guidance was updated in August, so still unchanged. The exchange rate adjusted net sales is estimated to be between 1% and 5% compared to the previous year. Like everybody's been able to calculate, it looks like we need a really good Q4 to keep that. We're still on track, so profitability, excluding non-recurring items, is estimated to remain at a good level. So takeaways.
So we are geared up for strong and profitable growth. We have had some headwinds this year, but we have some potentially challenging beginning of the year, but I think we have really good new products and solutions in the pipeline that are coming out also next year, but also further in the future. There are the home side, the reimbursement, which we're working on, which is gonna be a pivotal part of actually getting that market to grow to what we've been discussing today, so from $150 million to over $700 million in six years, it really means that the reimbursements need to start going through in different countries, starting with the U.S.
We still continued searching for the potential M&A opportunities, especially, and partnerships, especially to expand the ophthalmic diagnostic device market reach and portfolio. We're in a good financial position, and the operating model is really robust, has really served us well, and is geared for value creation also in the future. The R&D investments, we'll continue those, to build a future based on key differentiators and the needs of our customers.
Good. With those words, I'll invite Jouni back on stage.
Thank you, Robin. Excellent. So, hey, let's start to conclude the day. So key takeaways from the day. So I'll actually start where Robin finished up. So we are going to continue to invest in the R&D, roughly 10% from the sales also when going for the future. So that means new, exciting products and the solutions. So not only the hardware, but the combination of the hardware, software, and the solutions. Then I also mentioned this is a key thing, so we are going to expand our offering to non-traditional eye care settings by connecting the care pathways and having a holistic offering both from devices and then the cloud-based software. So that, that's a key thing.
Then, still as before, so we are going to develop the customer experience brand and do the continuous improvement on the way that how do we sell and also the sales and channel configuration. Then we are going to continue the search for the M&A and focused partnerships in a long run, balance it in extremely good condition, and we are really geared up to do that one. And then, of course, ESG going to be high on our agenda, as it has been for the years. So we are maturing that one and being then ready when we have to report that one across even across the financial reporting. So on track with that one. And with these words, I think we are done, but not all things are done, so we go for the Q&A. All right.
It has been a pretty packed afternoon. Thanks for all the great presentations. Now is the exciting Q&A part still left. As I said earlier, the live audience here can just raise their hand, and we'll bring mic or assistants will bring the mic to you. We have already got some questions from chatbot as well, so we'll pick them from there as we go. Let's start with the live audience here in Sanomatalo. Let's start from here.
Hello, Pia Rosqvist from Carnegie. If I start with a few financial questions, and I look at Robin, at the guidance for this year. So, what could go wrong?
What is it now? Well, we're now starting to sell in December already, so but we haven't sold for, like, second half of December much as yet. So our delivery times are really fast, so our backlog is one week to two weeks on average, maybe. With tonometers in the U.S., out the door in 24 hours. So of course, there's still a lot to be done, but we are on the right track. I think nothing has changed in regards to the keeping the guidance so far. Fingers crossed, of course, the last week of the year is the best week in the U.S. every year. So I think John is gonna be busy after Christmas.
Always.
Always. But yeah, yeah, everything is kind of in order.
All right. Thank you. Then looking at the next year, you say that the next six months they still look difficult. What specific sectors where are your concerns, and what do you expect to happen then after, say, the summer next year?
Would you, Jouni, take this one? Start with this one.
Yeah, yeah, yeah. I could pick up this one. So if we go back to the Q2 this year, so we actually said at the time that we have had the challenges on the PE-driven optometry. So I think that has been the reason earlier on the Q2. Now, if you look where we are currently, so we have been able to kind of back up and fill up that hole. And then really if looking for the first half, so we are having still pretty tough comparables for the Q1, so we grew roughly 15% on the top line.
But I mean, we are now, I mean, sticking with the guidance and seems to be like house is in order, but the next year, as we told on the Q3 report, so we still share the same view. And then for Q. Sorry, for the 2024, we are going to give the guidance in roughly a bit more than two and a half months, so not too much time to wait on that. So the exact guidance for the next year is going to be given beginning of February.
Thank you. Finally, regarding the growth from 2024, can you separate the elements behind this speeding up? How much do you expect from devices? How much of the growth do you expect from software?
Was it PR related to 2025?
2020-2025 and beyond.
2025 beyond?
Yeah.
So we see that if we first start from the tonometers, so we see that there's room to grow on tonometers. Then we are working on the reimbursement for the HOME in the USA. So hopefully we are wiser on that one towards the end of the next year. So that would then, of course, help 2025. Then if we go back to the fundus imaging, so bit what John said, so products are extremely competitive. We don't see that trend changing at all. And then the market share is less than 10% still, so that's a clear growth driver. Then if you go for perimeters, we could divide that one in two buckets. So the one is the COMPASS product, so we just launched a new software version for that one.
We are looking forward, that's going to also start to gain more traction. And then we are going to have a new version of the MAIA next year. So that's also the really good. So that's kind of a second half next year. Then if you go for the software part of the business, so extremely good traction on the ILLUME, that's going to help us to sell the devices. We have a quite heavy angle growth rate, of course, also for the actual recurring revenue from the AI and from the ILLUME, but we start from the small part, so the big opportunity for next year and then the coming is still to enable and boost up the device sales as well.
I think those are kind of the main drivers. And then, of course, new products coming. So we have been, during the last couple of years, putting effort to actually bring the new products into the market. So on that time horizon, I can kind of. I'm committed that there's something new coming as well in the kind of next one to two years.
Thank you, I'll have-
Did I miss anything? Sorry.
Good.
I have-
There's a related co-
Yeah.
You know, thanks for questions.
Yeah.
So there's a related question in the chat box. I think we could take this here. This is from Juha Kinnunen in Inderes regarding tonometers. Again, I understand this is a bit long, kind of longer term, so for the strategic period. So we have got a dominant market share in tonometers, and market growth is maturing, or what he kind of guesses is the case. What's the revenue share of the revenue you expect from probes in mature state in tonometer market?
The probe sales hasn't been. We haven't been seeing similar slowdown than on the device side, so I think the probe side will continue to grow. The install base is increasing all the time, quite fast, so we are selling a lot of devices, even though the growth may be slowing down slightly. But the probe sales are still growing well. And of course, the home is the wild card there that we don't have really much sale. We have sales, but the opportunity is huge if we work our play our cards the right regards to the reimbursements.
And once we have got to the tonometers, before getting back to the audience here in Sanomatalo, there's a question regarding a new market entrant in rebound technology. I guess in this case, do we see currently price erosion in tonometers given the new entrants? Jouni, would you like to-
Uh, no.
Give view? Yeah. Clear answer. So who had a question next?
Daniel Lepistö from Danske Bank. So, I have a few questions. Maybe first one, still on the midterm growth guidance, seeking three times the market growth in from 2025 and beyond. I think, can you sort of reiterate whether you expect the imaging device growth to still be the sort of, the maturity from the growth contribution in the future? Or has the sort of, I think the outlook with the home and the potential with the home maybe changed the tonometer growth, you know, estimates a bit?
Yeah, I think the imaging has been growing faster for seven years in a row. The organic growth has been over 18%. I think the market share being below 10% versus tonometers, 40%. So definitely I think there is more room in the imaging side, and the market is almost three times bigger than the tonometer market. So definitely the imaging is gonna be key in delivering those growth numbers. But of course, the home, it's maybe still a bit difficult to estimate. We need to see how the reimbursement work goes through, and what the conclusions are from there before we're able to really do any good estimations ourselves, how it's gonna play.
Okay, and the natural follow-up question here is regarding profitability. I don't think you discussed your sort of margin expectations too much on the forward-looking guidance. What about as the imaging devices, they tend to have a structurally lower gross margin than the tonometers. Are you seeing any sort of structural pressure on the margin side going forward?
There are many different things that have a role, whether if we sell an imaging device in the U.S., the gross margin is actually really good. We're going through distribution channels, it's a bit lower because we leave more than 40% of the money on the table. But in general, I think the imaging devices we have been coming out with, in the ultra-wide field, the DRSplus, they all have a better margin than historically we've seen in these interim times for their products. So there are many different elements to the profitability. I think the general outlook for the profitability is stable. I think there's not really any major shifts there, when it comes to the margin.
Thanks. The final question about timelines. Maybe first about the much-talked AI and DRSplus, maybe especially for the U.S. market, the FDA approval. Is this something that you would expect any announcements maybe next year, year after? The second question about, same about the HOME2 and the reimbursement, that you seek, any sort of a timeline to wait for here?
I might take that one. So, for the AI, for the FDA, we are driving with two lanes. So the first lane is that we want to ensure that we are selling devices, and we sell the devices also with the other, with other AI players and not only with the ILLUME. So that's a one track what we, which we have been driving already for a long time. So I would be really disappointed that if we won't have our DRSplus FDA-approved with the AI player next year. Then we have a second lane, which we are now driving, and that's a whole solution kind of a drive. So that includes DRSplus, it includes ILLUME, it includes the Thirona AI.
So having that one package and clear that one with the FDA, that enables us to have also the recurring revenue from the AI, and then with from the ILLUME. So those are two tracks that we are driving, and kind of I would be disappointed that if we don't have positive news next year on the track, for the track number one. And for the HOME2, yeah, I recall that one. So I think the timeline, and Kate, you correct me if I'm wrong, but there's a certain days that you are able to do the submissions, prepare the paperwork for the payers and so forth, and kind of we are pretty good shape on that one.
So that would be then, perhaps towards the end of the next year. But do you want to open with the process, Kate?
No. It essentially, there is a submission deadline early next year that we're working towards.
All right. That's very clear. Thanks.
All right, Nikko Ruokangas from SEB. Thank you for the presentations. First of all, I'll also go back to financial targets, and about your growth target after 2025 or 2024. So it's a bit different wording compared to your earlier target of accelerating from 13% rate. So what were the reasons to change this wording? And does this growth target also include acquisitions, or are possible acquisitions an extra addition to that? I mean, that the previous target referred to organic growth.
Mm. Will you take on this one?
Yeah. I think we've been kind of wanting to move a little slightly towards our guidance in relation to the market growth. I know that we've used adjectives in the past. Some people like numbers more with a range. We've kind of taken now the approach with comparing to the market growth. I think it's still slightly in the air how the next 2024 guidance officially is gonna be given, whether it's gonna be adjective, number relative to the market growth. That's gonna. We'll see that in February, how that plays out for that part. The growth, it's not betting on us closing successful M&A to reach that growth. Basically, that's fair to say so. So potentially, we would need to reiterate that, if there are M&A.
Yeah. So it is. You see that it's realistic to reach without M&A?
Yeah.
All right, great. Then about maybe continuing on this a bit, and next year, so as you already discussed, that the H1 looks still challenging given the environment and also the tough comps. But do you see that when we go to H2 next year, that you could be able to reach those financial targets or this growth target?
Well, we're on the right way, at least that point, I think. We have new products coming out. We have the new MAIA coming out hopefully there, so we are kind of filling the gaps in the portfolio. So we're a bit limited now without the microperimeter, and there is a good demand for it, but unfortunately, we are out of parts, and are not able to deliver the old version. So-
There are other things also, like the home reimbursement, the screening opportunities that are definitely on the second half timeframe rather than the first half. So there are many drivers and different, new, different releases that are coming out, hopefully, on the product, product side as well.
All right, understands. Then moving onward from the financial questions. So, you discussed about the market growth, depending on timing of these reimbursements, and you also already discussed about the home reimbursement and timeline and possibilities, so on. But do you see trends that reimbursing coming in Europe, also in the AI space?
Yes. Yeah, let's hope-
You want to take this?
Yeah, so let's hope that's the case, because we have certain areas where we have. So if you go check, we already have a reimbursement, and that's a kind of continuing trend. But as an example, in Czech, there's already reimbursement in place.
Great. Great. Then about the data management tool you introduced, so will this work only with your eye care devices, or do you aim to expand this to so that it could be used with other devices as well?
Tom-
Yes, we are going to be able to connect other main manufacturers' devices as well.
All right, great. Then one last from me. How well are your potential clients aware of these kind of screening options regarding, for example, ILLUME? So that, are you getting inbound questions? Are your clients aware that this kind of AI can be used, and they ask about you, or is it you that you have to be proactive to introduce these kind of options? So could you describe how these kind of discussions have started, and have there been any changes during this 1.5 years?
I'd say-
Well-
I'd say yes. We do have inbound requests for information on the technology. We were just at another large hospital organization just yesterday or day before. I apologize, jet lag is setting in a little bit. I think it was yesterday that we had another successful demonstration with another very large hospital organization or chain, not chain, but organization, that's also looking to expand their diabetic screening opportunities. We feel that it went extremely well. We feel that it will be a repeat story to the story I told earlier today.
But then we also have some channel partners in the U.S. that are actively going out and working, and they are being, they're receiving a tremendous amount of interest in the technology that our DRSplus is built into. So, but then, of course, we are, we don't sit and wait for the phone. That's not sales, so we are also actively going out and marketing, participating in trade shows, and calling on potential clients. So it's good.
Do you want to comment on that as well?
Yeah, yeah.
Pihlni.
Top of what John said, so I think it's good to recognize the two things here. So, when we launched, it was April last year, when we launched the ILLUME and our capabilities related to the screening, whether is it capabilities for DRSplus as a screening device, or then the fully blown end-to-end software platform. So we have seen two trends here happening after that one. So the clients are asking more, of course, end-to-end solution, but the clients have realized as well that, okay, so the DRSplus is a, an excellent screening device.
So we have had also the cases that they come and, "Okay, so we use, as an example, human grading, or we use X, Y chat," so, "But you seem to have the best device and the most automatic device and the best image quality." So we have had also the cases, as an example, in the USA, that for the screening purposes, they want to have a DRSplus, and that goes for the human screening and so forth. So just one thing to summarize, right, John, that we have a kind of a two trends, so, kind of asking for the whole package and asking the single device. And then, of course, in the long run, we are happy to plug in the whole software solution at the end.
Of course, the goal is to also push the digital marketing and do active promotion, then across the geographies, that way we have regulatory approvals for the whole system.
Right. Understand. Thanks.
Thank you. Let's take a couple of questions from the chat box, actually related to the previous question. There was a question that: Should we think screening as one of the key areas now, as it was presented in the presentations pretty heavily, I guess? And then kind of another question on that: Is primary care going to be the key market for screening?
Tomi, do you wanna comment on the product strategy point of view, the screening, the retina kind of, and glaucoma pathways? So I think that kind of tells the story a bit.
Yeah, I think the screening is a very fast-developing market, and the segments are—it's not yet present in all the markets, but there are screening programs already started in many of the markets. So but it's—I mean, the screening is done through the eye, so it can be done in different setups, it can be done in different places, and then in the end, it will be part of a, one of the care pathways. So I think it's. Now, it's really difficult to say.
I mean, I think the question was related that is it a really, really important segment? And I would say that the answer is yes, it is a very, very important segment for us, because it is going to bring us a lot of device sales, and eventually it will also start piling up our software sales. So, hopefully that answers the question there.
Hopefully that answers the question.
Yes.
Jouni?
And building on top of that one, that doesn't mean that the other segments where we are playing are not important for us. So I think that's a good, too.
Yeah.
That was nice.
One more question from chat box related to this topic, I think: What kind of income do you expect from AI or your own software in the coming years? Is it possible to reach significant revenue without U.S. and FDA approval? So two questions in there. So what do we expect, and is FDA and U.S. mandatory for success?
Let's start with the FDA and U.S. Mandatory for success in the long run and really scale the business, and also if we think our, our presence in the USA, so we have the direct operations in the USA, so we can, we can drive, drive that business. And if you, if you look the overall market, so usually on the med tech, roughly one third of the potentials come from the USA, like John said, and we roughly 50 comes from us. So we have to be top of that game, so we have to get into the USA, and the plan for that one is, is, is good. Then what comes to the, to the getting the revenue from the software, so of course, the growth rates are looking good, but we start from the small number.
So we are looking for the future to grow that one, and if we are able to grow that one, so there's going to be, in years to come, positive impact to our cross-matching development, so that's a plan. But if you look the near term, really the key is with the software is to push additional device sales, especially in the segments where we currently are not in. And now I'm referring not the other segments in optometry or standard or premium ophthalmology. So I hope that clarifies the logic.
Then very last question probably for this topic from here, from the chat box: Could you comment on ILLUME key figures so far? So when can the audience expect to see some numbers?
We don't split the different. And I know that it would be highly, highly valuable, but for the competition reasons, we don't give the detailed numbers. But actually, with the Pirjo who is here in the audience, so we actually looked, so the amount of the reports that we are generating, so it's a good growth on the generated report point of view, month by month.
Thanks for that. Any questions from the live audience here? Mikael?
Hi, it's Mikael Rautanen from Inderes. In the strategy you outlined, shifting from selling devices into selling solutions and eye care pathways supported by software. But I assume, and this is my assumption, is that your sales partners and sales channels are motivated and driven to sell devices. So does this new strategy imply changes in your partner and sales channel strategy?
I might start with that one, then, John, compliance. Excellent question. So, let's look first at the channels where we have been playing a lot, so that's optometry, standard ophthalmology, and the premium ophthalmology. So of course, our. If you look at the distribution, U.S. is the different, but if you look at our distribution partners, so those partners, so we have been now training them in order to sell the solutions. So there are capabilities that for the existing channels, even our current distributor network is able to sell the fully blown solution. Then where they are not currently focusing is the non-traditional eye care segments, and there we have to work more, and I think that hopefully clarifies. But we have a channel guru and direct sales guru here.
Anything, John, that you would like to add?
Yeah, I mean, it also depends on the market. Yeah, it depends on the distributor. But in general, we are evaluating if there are better channel partners specifically for screening going into those primary care. You know, the distributors we use, as Jouni was alluding to, they've focused most times for decades on the ophthalmic industry. And, stepping out of that arena and going into primary care would be a stretch. So, we'll be evaluating each one of those markets and the commitment that those distributors are able to provide.
And then I think for the traditional distributors, we have a carrot, and that one we have to figure out, but we have a chance for carrot. It's a bit like on the tonometer side of the business, so they sell the probes, so that's a recurring revenue element for them. And then depending how do we wanna play this thing with the distributors, so we might have a similar type of recurring carrot for them, which is then getting certain share of the regular software revenue. So that might be the carrot that might be interesting for them in the long run.
Remember, too, one of the byproducts, just in the story I told earlier, if we do choose a different channel partner in a specific region to sell into primary care, those primary care doctors are not going to be managing these pathologies. They are gonna be identifying the pathologies and referring them to ophthalmologists. That data will be coming through our platform with our image quality, and that will open up opportunities for those distribution partners that are working in those channels to sell additional equipment. So one hand works with the other, so it's not mutually exclusive.
Also, that the ophthalmologists are really important decision makers in any screening program, and so it is this complementarity that John's describing from both sides.
Thank you.
Any more questions? I think there were in the front line.
Yeah, thanks. Joni Sandvall from Nordea. Maybe I'm starting with the easy one. I think, Jouni, you mentioned that you will get some support from the new MAIA in H2, so should we read this as the product is quite ready already? And are you able to maybe sell on clinical purposes already during the H1?
Not the H1, I would say. It a bit depends on all the labeling and because it's also going to be research use. But we are shooting for the second half.
Okay. Then a question about the investment needs, and maybe it's, it goes on the R&D side. So, you have been. Roughly one-third has been going on, on the software side, and now when the focus is shifting a bit on that side, so should we expect larger part of the, of the R&D spending on, on software during this strategy period?
I would say that no. So we have 2/3 going for the hardware, one-third going for the kind of a back-end software solutions. And why I'm saying this one is that, in the future, also, the amount of the software which is going to be embedded into a device, so we already have plenty of deep learning algorithms in the imaging devices and so forth. So, I think that's one part of the answer. Then the second part is that if you look at the dynamics, where next year, the year after, where the money comes, we have to build the best possible devices that we can build in order to add the clinical value, and that comes the data. So if we. Now I'm referring to John's comment related to image quality.
So if you move towards the predictive AI assist that clinical decision-making, so if you put crap into the algorithm, crap comes out. So the data, features, and functions what we have to have in the devices, so those needs to be top-notch, top quality. So we have to keep investing on the devices. And then I have been in the software businesses for the last 20 years, and usually the tendency is that it's always overinvested, and the money comes next quarter, and it's kind of not coming. So the goal is that we run, and we still keep running the software investment in tight leash and trying to do the things differently in order to stay competitive and find a few small niches where we are able to connect the device plus the software, like the ILLUME.
I think that's a prime example, and it didn't take too long time to get it out, and with quite small amount of people. But that's. Anybody would like to add anything on this one?
No.
Okay. Last question from my side. If you think your competition currently, how you believe that they will, you know, use software going forward, and you are building in-house now, is there possibilities for competition to come on the same play field, maybe, maybe through, you know, outsourced deals or stuff like this?
Should I or, Tomi, do you wanna-
Maybe you take.
Yeah, yeah. So, I think we have a competition already playing, so there's several players. So, I mean, Zeiss extremely strong on software, but they go really on the high end with their FORUM solution. So that's a premium ophthalmology, handling the whole care pathways for the different parts. So that's kind of we have directed our offering to the different segment. So we recognize that that requires an investment that for us, it doesn't make sense to do. If you go for Topcon, then the Harmony product, so again, a bit more different segment.
So I think it comes back to the understanding the segment and the customer and what segment to pick and what customer to pick, and then doing superior end-to-end experiences so that it's a combination of device, it's a software, and then we nail it down to do kind of a be the fit-for-purpose tool for, for certain parts. But I mean, Kate, John, any, any—anything, Tomi, you, you, you would like to add on this one?
No, I agree with you. I think the largest open opportunity is in the lower end segment, not going after hospitals and those are extremely expensive and would take a long time. They're very long sales cycles. Because of all the diagnostic technology that's being released, not only by us, but by others in the market, it just continues to drive the need for data management even in smaller offices. It's not uncommon to see in optometry offices in the U.S., three, four, five different diagnostic devices, and a lot of it's pumping out a lot of important data, and having all that data streamlined in one platform would be extremely valuable.
I think there's a global trend where in countries where there is optometry, but in countries where there's not optometry, where there's optical retail, for example, of more and more clinical service provision. So therefore, the needs, the platform needs, the device needs, continue to grow in less typical markets.
Okay, thanks.
Thank you. Let's take couple of questions from chat before moving to the audience again. Related to M&A: "So how do you see the valuations currently in the M&A market, given the interest environment?" And then couple of following questions: "Has the importance of M&A changed in the new strategy period versus the previous one?
Maybe I'll start with the valuations.
Mm-hmm.
They definitely haven't come down as fast as the public companies. So we do see there that the prices are stickier, almost not even changing in some cases. So it is definitely putting a challenge on that side of the process. So we'll see how the world changes, but at least, like, the ones we've been talking to, the valuation is not the same than it was like two years ago. At least it hasn't gone up, but they haven't come down.
For the private?
Private.
Yeah.
Yeah, yeah.
For perhaps—
The importance in the new strategy period.
Yeah, yeah. So no, no change. I mean, if you look at the revenue history, starting from, I mean, many, many years before the CenterVue acquisition, I think the CenterVue acquisition took two years to negotiate and kind of finalize. So no, no change. So we go with exactly the same strategy that we have been going.
Mm
Kind of since 2017, 2016, probably.
Yeah.
Right?
Yeah, there's not that many good candidates, so it's not that you can just dump one and walk to the next door. There's maybe less than 10 doors to go to, so you really have to be successful.
Good. And then this next one goes probably to Tomi, I think, as it talks about the kind of potential M&A targets or the kind of product category segments we want to fill. Is OCT still the most natural target, or are there other potential kind of interesting areas?
Jouni, maybe you want to take this because you have answered this before.
Okay. Thank you, Tomi. No, no, I think that if, as Tomi said, so if you look at the retina care pathways, and I think we have discussed this one in quite many times, so that's one interesting area for us in the long run, on the M&A side. Then if you look at others, so there's also other interesting parts which are kind of under the EUR 1 billion bucket, if we talk about the ophthalmic diagnostic device market. But that's. I mean, it's interesting for us.
Thank you. Any further questions from the audience? Here, Pia, go ahead.
Hi, it's Pia from Carnegie. Still staying with the M&A topic, so, what kind of leverage would you be comfortable as your current, you're currently net debt-free, but how much could you increase the leverage?
We haven't really decided on any maximum level, but I think personally, I would sleep worse if it were 3x EBITDA or more. So, but we haven't really cast anything in stone, even in the board level.
Mm.
So we haven't really. But definitely, yeah, there is room for leverage. It would've been easier with the lower interest rate times, but-
Yeah
the world has changed a bit.
Yeah, I was about to say the same, that if you have asked Pia this question three years ago, so perhaps... Robin have given a higher, higher EBITDA, kind of a multiplier on the debt, but.
Thanks. Then, to the presentations, I'm not sure if I understood correctly, but are you already selling kind of the imaging devices to, you know, emergency rooms? You are?
Yes.
Well, it's interesting, and I'm glad I have my clinical expert beside me, but, many patients that come in presenting with things like headaches, nausea, dizziness, which emergency rooms probably see in 85% of their patients that walk through the door, those are actually many times red flags for ocular issues, such as angle closure glaucoma, acute angle closure glaucoma.
Interestingly, this large hospital group I told the story about earlier, when they implemented their very first DRSplus, one of our, actually it was our vice president of sales, went in to do the installation because he wanted to learn more about the opportunity as well. He's a super sharp guy and understands the marketing very, very well. They actually identified during that day two patients that had papilledema, I believe, or yes, that they were actually moved into the stroke program, which is either extremely costly or extremely lucrative, whichever way you want to look at it. But it is a very, very serious pathology and disease. It could it have been picked up with other technology? Yeah, an MRI, but you're talking about a $ multi-million.
I mean, the service contract on an MRI is probably more expensive than what they paid on the DRSplus. But then, of course, they were able to leverage that technology. Ophthalmologists are on call around the clock for ocular issues, and being able to feed that data to the doctors on call is vital to keeping good care for patients. So interestingly, it's still a new market. I'm not saying that we have many, but this is a big success story for us, and we're able to take that story and go out and build it. But I will tell you, about 8 years-10 years ago, we didn't have any tonometers in emergency departments in the U.S. either. Now we have hundreds, and it's become the wanted tonometer.
It's the one that everybody wants because of the ease of use, and now with the IC200 in the supine position, everybody wants it. It's actually quite a fun market, because it's fairly untapped.
If I can just add, you know-
Yeah
for example, in emergency departments, just some U.S. data, one out of four adults who present to an emergency department have diabetes. All of these hospital systems have their HEDIS score, their quality measures. If you aren't doing adequate diabetic retinopathy screening, you don't get your HEDIS multiplier. So just being able to do that, at, you know, essentially opportunistically, as people walk through the door, is really important. Then it's about 3% or so of patients who come to an emergency department have an ophthalmic complication, and about 4% come with a headache. And as John's saying, every person with a headache, you wanna know, is it, you know, a headache and a migraine, or is it a brain tumor? And so getting a photo of the back of the eye is really important.
You know, most emergency doctors are not good at it, and we've seen a similar pattern, for example, in neurology clinics, where again, neurologists, junior neurologists, senior neurologists, it's often hard to get a view in the back of the eye. But given the eye is an outgrowth of the brain, as a neurologist, it's really. You can get really useful information by looking at the back of the eye 'cause it's your window into the brain. And so it's cost-effective, and it's in the literature. It's cost-effective to stick a camera to be able to look at the back of the eye in a neurology clinic. It's another example of a sort of non-traditional eye care setting.
Now I have to say that all good comes to an end at some point, and we have got time for one more question from the live audience, if you have got any .
I have-
Just go to-
Actually, I have many questions, but I'll choose now carefully. Regarding your customer segments, you showed a picture with your customer segments and also the new, the screening part. So, can you help us analyst in any way know how much of... How should we look - How, how is the sales split by segment today and, say, in five year, how has it changed?
That's a difficult question, Pia. So I try to break it certain parts, so. And John, you correct me if I'm wrong with these numbers. So if we start from the USA, where we operate directly, and we have the best data because we go direct. So roughly 50%-55% out from sales comes from the optometry. Roughly 30%-35% comes from ophthalmology, and then we have the rest. So that one we know pretty well. I think the numbers are kind of correct, John.
It's close enough that.
Yeah, yeah
Give or take.
Then if we go then towards the other part, so we go APAC, we go EMEA, and so forth. So we work through the distributors, so we don't have exactly the same split, and then it depends country by country. So if we go for France, no optometry, right? So everything goes to the ophthalmology side of the business. For the rest of the world, it's difficult to say. Then I think the question is that how it's going to look in couple of years' time. I think it's hard to say, but the goal is to increase our presence on non-ophthalmic channels. But-
It will be higher.
Yeah. Yeah, yeah.
From the sales department, it will be higher.
Kate, I think you have the certain figures related to the kind of amount of the practices and the sites, if you wanna-
Yeah
kinda add.
I mean, so for example, if you look at primary care sites, it's sort of a 10x compared to ophthalmology sites. And so, and if you think about the dynamics of screening programs, they're public health programs, so they're done at, you know, often national or regional scale. It's a totally different order of magnitude than a single device at a time. And I think that's why we're so excited about the opportunity because it really is a breakout opportunity. Although, as you know, I think we were talking, Robin was talking, the uncertainty is some of it's gonna be lumpy because it's big, and it, it's sort of national tenders at times, as opposed to those direct sales. So that's where I think the opportunity is exciting and the uncertainty less.
Thank you. So the last question comes from the chat, and then it goes probably to Jouni Toijala to answer. That kind of wraps up all the kind of afternoon. So how we are measuring success, so to speak, with the new strategy period? So what are the key elements and deliverables we need to see that we can dictate the strategy period being successful?
I would say that let's start from the devices that we are able to slice and dice. So we have to be successful in order to be delivering our compelling roadmap. So we have a good roadmap, so we have to come up and in the next three years to bring all the products what we have in the pipeline to the market. Then if you go to the software solution part, so data management, get that one through FDA approval. So work is ongoing on that one because as you saw, the software is on good shape. Then, of course, build more features, functionality around the ILLUME, get the AI part flying also in the USA, so that's clear.
And then I think brand-customer experience, optimizing that one, and really what John has been saying many times today, so get the channel right for the existing areas where we are operating and getting the non-ophthalmic channel in good order. And then I still want to come back to the people and the team. So we have been living pretty exceptional times, so we really have to take care that the team is kind of up and running still after three years. So I have to take care of everybody's health and well-being and competencies and training. So I think those are the recipes for the long-term sustainable growth. But anything, dear-
Well-
dear team that I was missing?
Good closure. So now, Revenio Group's Capital Markets Day 2023 is coming to an end. And, thanks for presenters, panelists, thanks for the live audience here in Sanomatalo in Helsinki, and you who watched the live stream from this event, for your active participation throughout, throughout this afternoon. Thank you.
Thank you.