CMD 2021

Mar 16, 2021

Slides

Welcome to Revenue Capital Markets Day. My name is Jonny Torjela. I'm the CEO of Revenue Group, and I'm also going to be your host for today. Before going to the actual day agenda, so just a kind reminder concerning the disclaimer. So for today, we are going to have an interesting set of topics to cover. So in the next 3 hours, We are going to go through the revised strategy of Revenue Group. So I'm going to start going through our revised focus, which is going to be focusing fully on the eye care market. Then we have Giuliano calling in from Italy. So he's going to cover through the product strategy. Then we have been working quite extensively related to the software, so I'm going to go through the software strategy. Then Tommy is going to go through the channel sales and marketing part and then we are going to conclude today with Robin, and Robin is going to go through then the finance part. But let's start to go through the revised mission. So our revised mission is we aspire to keep the wonderful world visible for all. In order to do that one, we have divided key 5 key strategic cornerstones for us. So the first one is that we have to fully be focused on the eye care market. Then secondly, we are going to improve the quality of clinical diagnostics with target product innovation. So there we strongly believe that if we are going to be able to provide a high quality picture, if we are going to be able to deliver high quality results, So we are able to improve the clinical diagnostics. Then we are going to transfer the clinical care pathways, And there the logic is that we are not only concentrating on the clinic side, but we are also concentrating the care pathways for the patients when going forward. Then we have managed to build a strong brand awareness and the client experience based on the strong hold for the tonometer. So Tommy is going to go then through how we are able to utilize that one in the future and then we are committed to continue strong and profitable growth. So have we actually changed anything? So answer is yes and quite a lot. So if you go to our old mission statement, which was that we contribute to better quality of life with the healthcare solutions enabling improved diagnostics. And if you compare that one to the new one, which is we aspire to keep the wonderful world visible for all. So these are not These are totally different. So if we go for the old one, so in addition to the tonometers, in addition to the perimeters and the fundus imaging devices, Under that scope actually goes as well, the Kuttika and the Ventica products, what we are currently having. But if you compare now the new mission, so then that's fully focusing on the eye care part. Then of course, the question is that is the market big enough, so if we only focus on the eye care market? And the is yes. So there's an increasing demand for the global eye care due to an aging and growing population. Then we are facing a lot of lifestyle related diseases when going forward like diabetes, which is then reflecting and resulting to increased amounts of diabetic retinopathy. Then when the Amount of the patients are increasing, so that's going to create a huge load at the actual eye care delivery system, so meaning the clinics. And in order to cope that to increasing load in the future, so we are going to need a lot of digital services in order to be able to reduce the cost and also cope with the resource shortages. Then already before the COVID-nineteen, so we were kind of having a growing demand for the telehealth and remote monitoring, and that was accelerated during the COVID-nineteen as well. So these are providing us a long term growth platform years to come. If you go to the actual market size, we are currently playing in a ophthalmic diagnostic device market. The market is USD 3,300,000,000 growing roughly 4% to 5% per year. And there, our area is 1st tonometers. So that's roughly NOK 200,000,000, so including the tonometers plus the probes, excluding the home. Then the perimeter part, that's a SEK 300,000,000 and then the Finless Imaging. And if you compare our growth in the past year, so we have been able to grow the business roughly 4x compared to the overall growth rate of 5%. Then I'm going to actually finish here because that's this is the quite important item. So if we are going to In the future, fully focused on the eye care. So then there's a question that is the capital allocation following that decision. And the answer is yes. So we are currently actively seeking commercial partners to take the Ventica and Cutica forward and then putting in the long run all the R and D investments then fully to our eye care products and services. But with these words, I would actually like to hand over to Giuliano to Italy. So Giuliano is going to go through our product strategy. So thank you very much and over to you Giuliano. Hello. My name is Giuliano Barberum. I'm heading Revenu's R and D division for Imaging Devices, which is located in Padova, Italy. And today, I will focus on our products and the innovations incorporated in the products and how these contribute to improve the clinical process in the detection and monitoring of several eye diseases and ultimately how they contribute to our aspiration to keep this wonderful world, as we can see on screen now, visible for all. And I will start by briefly describing some of the most prevalent eye diseases and how they relate to our products. The first one is glaucoma. Glaucoma is an optic neuropathy that creates irreversible damage to the Nerves that convey visual signals from the eye to the brain. Glaucoma is the 2nd leading cause of blindness in people aged over 50, was responsible in 2020 for some 3,600,000 cases of blindness. And if you look at the numbers there, there are 80,000,000 patients with glaucoma with a diagnosed status of glaucoma. Another 80,000,000 are undetected. It means they don't know they have the disease. And this is why glaucoma is a dangerous disease. It goes undetected for a long time. It's a very slow progressive disease. And the patient does not realize the disease until it's late and until most of the nerve fibers are already lost. If you look at the images at the bottom and at the left corner, you see the simulation of the damage due to glaucoma. The visual loss starts at the periphery and grows to the center into what is at the later stage called tunnel vision and ultimately, unfortunately, blindness. Good news is that glaucoma is preventable and prevention is based on a combination of early detection, Continuous monitoring and of course compliance to treatment plans. And the way glaucoma is Actually detected and monitored is by means of tonometry, the measurement of intraocular pressure, which is crucial. Fundus imaging, which is used to inspect the status of the optic nerve with the imaging. And perimetry, which is used to measure visual function. I need also to mention OCT, which is used to measure retinal thickness. These are the main diagnostic components for the diagnosis and management of glaucoma. When we move to the second one, which is diabetic retinopathy, as mentioned by Joni, this is An ocular complication of diabetes. And diabetes has become epidemic in the last decades, with prevalence almost doubling in the last 30 plus years and with some countries with up to 30% of the population suffering from diabetes. It's again a leading cause of visual impairment And if not treated, even blindness. And again, it's preventable. And there are very effective guidelines and protocols for prevention of the serious effects of diabetic retinopathy, which are basically based on Detecting the pathology with full dose imaging and monitoring in time so that treatment is delivered timely at the right time. The third one is called age related macular degeneration. It's of course a progressive and age related disease that affects the macula. The macula is the central portion of the retina and also the most important from the visual standpoint. If you look at the numbers, they are of course impressive and growing because of the aging population. There are several treatment options for AMD. And the clinical management involves again detecting the disease as early as possible with fundus imaging and OCT and then monitoring the progression and also the effect of the treatment. Now the 3 diseases collectively, and this is based on a very recent study published on The Lancet Global Health in February this year. They together account for 19,000,000 cases of vision impairment in 2020 in people aged 50 or more. So They are all to some extent preventable. They are clearly important targets for prevention and treatment. And for all of them, the diagnostic component plays a major role. So we will now move from diseases to the diagnostic process and particularly to revenue's portfolio of diagnostic devices. We are basically covering 3 diagnostic areas. First one is tonometry, the measurement of intraocular pressure. And we did introduce 2 major innovations there, which we will describe in details in the next slides. First one is called rebound tonometry, which is the basic technology for all of our models. And then we also have introduced what is called home tonometry, which is a device dedicated to self measurement, to self use by the patient. Then we have a number of models in the area of fundus imaging. There are more than 2 that more than the 2 that you see there. They differ also because they deliver different types of images. The 2 innovations that I will describe today are called 2 color confocal imaging and fully automatic capture. Going to perimetry, which is again a measurement. So it provides numbers and measures visual function. We did introduce one innovation, which is basically consisting of a combination of fundus imaging and classic telemetry into one device and we have 2 models there. And then of course, I will mentioned in a later slide the pipeline of ongoing projects for the future. So let's now start with thermometry. And let's briefly look at the history of this test, which started 200 years ago, actually, with what you may call digital tonometry, but there's no bites here. It's really a finger which was used to indent the eye, the closed eye touching the eyelid to feel the intraocular pressure. This went on for many years. Then In 18/60, Fung Graef tried to turn this into a measurement with the first device for measuring tonometry, which was not so successful. 20 years later, Maklakov started to propose what was a major innovation, measure pressure by means of a direct contact with the cornea. And to do that, at that time, They were using cocaine as a local anesthetic. But it was only with shields in 1920 that The first form of modern tonometry was invented. This device was indenting the cornea. It was a sort of manual balance with exchangeable weights. The weights were applying the force to the eye and the force in grams was converted into millimeters of mercury to measure in trochlear pressure. This was basically the predecessor of Goldman Appellination Tonometry, which appeared in the 50 and which is still the gold standard in thermometry. It's a fairly invasive technique, which requires the operator to create contact with the eye. So it requires anesthetic, but it's definitely the most widely used today. Later innovation, we need to jump to the late 90s with non contact anometry, which is based on air path. AIRPAF is certainly less invasive, but it's actually still annoying to the patient and not very well seen in recent months. And because it blows air around. Since then, The next innovation and the last one has been rebound tonometry by revenue. The first rebound tonometer was introduced in 2006 and then the technology was incorporated in all subsequent models until now. So let's look at Rebound now. Why is this innovation clinically meaningful? So rebound is called like this because a very light metal coil Suspended in electromagnetic field is moved toward the eye to hit the cornea rapidly. The coil bounces back and the rebound speed is measured and used to calculate pressure. Very fast measurement, absolutely safe for patients due to the disposable probe, which is the actually the element that touches the eye. It's a plastic disposable probe. But most Importantly, this allows for highest accuracy and repeatability. And this brings me to 2 very crucial concepts that I will stress several times in the next subsequent slides. First one is Quality data. Quality data, quality measurements, quality images means basically accuracy, accuracy and diagnostic accuracy. And this in turn becomes improved care. The second one is usability. And again, Rebound made the device so usable. And usability converts to better adoption to reduce barriers for use and improves basically accessibility to the diagnostic procedure. And this is also very important, especially in screening, to maximize the effectiveness of any preventive program. So With these benefits, we have seen why we believe that rebound technology is becoming and will be more and more the clinical standard for thermometry. Now let's move to imaging. So Again, we look at the history of Fondus Imaging, which starts in the 19th century were the first photographs of a living human retina. It evolves slowly to what is still now called fundus camera, which is the classic device for imaging, the retina. By the way, fundus is Latin for the back of the eye, which is the retina. One important innovation was introduced in the 90s, 1990 derived from in vitro microscopy and is called confocality. And confocality was invented to improve resolution in imaging. And this is also what it does in Fundus image. Then Fundus cameras evolved to digital from film in the early years of this century. And then it's our turn. So we did introduce 2 major innovations. First one in 2010, second one in 2014. First one is the Complete automation of the capturing process. And the second one, as we will see next, is 2 color confocal imaging. So first, let's see what full automation means. Full automation in 2010 was really like an anticipation of artificial intelligence today. The device can autonomously capture images of the back of the eye through a 2 millimeters pupil by finally aligning the device head to the subject's pupil, by focusing the image, by triggering capture and by controlling exposure. And this is all done by the device. All the operator does is one single click with one finger on the touchscreen. So this technology It allows the device to deliver constant quality images. So it's much less operator dependent. 2nd, it greatly improves again easy of use, which turns into accessibility, as we said before. And this is critical, especially in screening, where the device could in principle be placed outside of eye care facilities and then put in the hands of a nurse or a family doctor. Moving to the second one, which is about the quality of the images. Historically, confocal devices, which were introduced several years before, were using laser light. What we did and where the innovation lies is that we were able to combine confocal techniques with LED illumination. And the advantage of that is that it preserves color fidelity, which is instead lost in laser based systems. So the advantages of this technology are that It greatly improves image quality in terms of resolution and visibility of details. I am using A lower solution, low color depth example, while on the right one, you see the nice picture. This technology improves dramatically the information content up to 3 times compared to a classic fundus scanner. And if we look at the real image of a retina, you see here the impact of confocality. The leftmost image is from a non confocal classic from this camera. The right one is from our confocal device. And this is a difficult case of a patient with opacities in the media, probably a cataract. And you see that the front desk camera is affected by cataract. The image is blurry. The details are not so visible, while cataract is not affecting the confocal image. And the combination of full automation and co Focal imaging, I would conclude provides 2 major advantages, Increased accessibility of the procedure because of automation, but also because of the reduced minimum pupil that confocality allows and because of the quality of the images enhanced clinical accuracy. And There's an interesting study that has been published recently that shows this with numbers. It's about Performance of an artificial intelligence based software for autonomous detection of diabetic retinopathy. And This study was published by using a third party solution, AI solution and comparing results on Our images, ADON is one of our models, with those from competitors from this camera. And If you look at especially at specificity, which is the ability of the test to avoid false positives, That improvement from 76% to 90 plus is really significant clinically. So this shows that improving image quality is not just nice. It's critical for the clinical process. Let's now move to the 3rd part, which is perimeter. Perimetry comes from the perimeter. So it's about measuring the perimeter of vision, the edge or the extension of the vision. This was at the beginning. Then it became a measurement of of visual function inside the visual field. And if you look at the image in the middle of the screen, you simulated areas of visual loss, those black areas. Now all Points of our visual field map onto corresponding points of the retina on the right. So even the black areas map onto damaged area of the retina. So What perimetry does basically is measure visual performance of different areas of the retina. And Of course, also, Pedimetry had a long development starting in 18/57 with the tangent screen, then developing to what is still now called bowl perimeter. And the concept since then is still valid today. Basically, the patient is asked To look centrally at the center of the ball in a dark environment, and an object is lit and moved across the ball and the subject needs to confirm or not whether he or she can see the stimulus. Now this was done with candles at the beginning and then evolved into manual perimeters with a mechanical arm that was moved by the operator. Then it evolved into automated perimeters in the 80s of the last century where the mechanical arm was programmable and was following a certain program. Going to later times, the first time imaging was added to perimetry was in 1995. And before that, and even today, perimetry has nothing to do with imaging. But then after one more development introduced by Nidec in the early years of this century, we came with 2 innovations in 2009 2016 by basically introducing automated confocal full display imagery and later deriving this from our imaging of course products, We introduced true color confocal imaging into Perimeter. And why Is that clinically meaningful? Well, in the last few years, we have seen Growing adoption of fundus perimetry in clinical trials to prove effectiveness of drugs. This was also thanks to recommendations by the FDA to use fundus perimetry as one of the functional endpoints in trials. And the reasons for this well match what We think are the clinical benefits of using this technology and why we think that fundus perimetry is a candidate to become a standard in the management of glaucoma. First reason is that with live Imaging occurring during perimetry, the device improves accuracy of the measurement by detecting and compensating eye movements. Without these eye movements become a source of inaccuracy in the measurement. The second reason, as you can see in the image on the left, is that the doctor can do a combined assessment of the anatomy of the retina with the image and the function of the retina with the perimetry part, the numbers that you can read there. In addition, In our latest model, the compass, we introduced using true color confocal capabilities, we added stereoscopic capabilities. With these pairs of images of the optic nerve, the doctor can use special goggles to get a three-dimensional view of the excavation of the optic nerve. And with these weapons, COMPASS is actually a very comprehensive tool for the clinical management of Glaucom. I'm getting closer to my conclusion, but a couple of slides more. Of course, we also have A pipeline of projects that will lead to new products in the future, both in Padua and in Helsinki. We are of course both counting on in house developments, but also on potential partnerships and third parties product for inorganic expansion of our portfolio. And we are working both in the retina diagnostics where we are already present, but also on the so called anterior segment diagnostics, which has to do with the cornea, the anterior chamber and the crystalline lens. And now I'm lucky because there's a very nice coincidence and I'm very proud to show you an example of new products. The new Icare Home tool is being launched today actually. So this is an example of innovation that made it to market now. The major efforts were spent here to improve usability Because this device is our 2nd generation device for self measurement. And the Improvement in usability were such that most patients can self train without a trainer and just use the tips that and the hints that the device provides to learn how to use it and perform the measurement by themselves. Then icare2 come the Home2 comes with an expanded software suite, which is consisting of a patient app and a doctor's app. The doctor with this app can daily and remotely monitor IOP dynamics in real life and assess whether the treatment is effective or not and whether there is a need or what was the effect of a surgery that may be needed or was performed on the patient. So on the patient side, having a chance to look at his own IOP readings every day improves compliance to medication because it gives a continuous feeling on how things are doing and how daily peaks of intraocular pressure are controlled by the medication. Last but not least, not always innovations are clinically useful. So this is one major role of research. We do support research in house and also with partners to assess whether innovations that we secured are meaningful clinically. I have two examples here of ongoing research projects. The first one, which is the image on the left is about mapping in a novel approach, retinal fluorophores that emit light that can be used to detect metabolic alterations occurring in the retina. So looking for biomarkers for ocular diseases is related again to early detection, of course, but also to the way changes in metabolism can be measured in time. The second project is about using sophisticated imaging tools and image processing software to detect signs in the retina of Alzheimer disease. And these signs are similar to lesions that are found in the brain and that can only be detected with PET, with PET. So these are two examples of research projects that are progressing and will tell us in the future whether this has clinical applications. And here are our conclusions now. We have seen how we leverage on innovations in our products, in tonometry, in fundus imaging and in perimetry to improve the diagnostic process, how we use research to challenge ideas and innovations and see whether they have clinically meaningful applications. And finally, how we look at expansions of our product portfolio, both organically and inorganically. And this whole Plan has to do with our continued effort to improve the diagnostic process and possibly even transform in some cases the ways eye care is delivered. And with this, I thank you. And Janne, over to you now. Thank you very much, Giuliano. And I'm sure that at least now, there's going to be a lot of questions After the Juliano's presentations, so you are able to send the questions for the team here all the time. And then we have reserved time at the end of the Robin's presentation so that we are going to answer also the questions that you may have. So please keep sending the questions, and we are going to answer them at the very end of the Capital Markets Day. Before heading to the 10 minutes break, so I'm going to go through the software part. And There, the logic really is that we want to transfer the clinical care pathways with the eye care focused software solutions. So what does it mean in practice? So if we start from my earlier slides, We have seen during the last 10 years that the amount of the patients have actually increased 25%. So that's a lot and it continues to increase. So what it causes for the actual eye care health system. So it means that actually the whole system when going forward years years, so that's not going to be able to cope with the amount of the patients that are going to need the help of the ophthalmologist or optometrists. So that's just going to be the fact. We have seen this one in the normal health and social care area. And there, we are going to have a constant resource limitations plus the increased system costs. So we have to do something. And there, the key is that we are going to need in a long run the digital solutions as well in AI Care. So currently, if you look at the device side, so the devices are able to deliver extremely good quality data. But then when it actually goes to the back end, so typically it goes to the EMR, so electric medical record system, But it's in a way in a one silo and the whole back end, it's not fully digitized and it basically prevents to move the patient and the data across the different domains. So currently, in quite many cases, you actually even have to print, As an example here, you can see, so you actually have to print the kind of a fundus image and fax it if you want to refer it over. And as we are talking about the quite kind of, how would I say, not so fast moving segment here. So there has been a bit of a positive side related to the COVID-nineteen. So the COVID-nineteen has now pushed also to Eye Care to move forward with the much more rapid change. So there's increasingly greater demand for the telemedicine. And then if we talk about the telemedicine as such, it's not just a simple video consultation, but it's a much more wider perspective. So it's actually starting even from the asynchronous side. So how do you actually manage the patient care pathway from domain to another domain. Then of course, you have a video consultation features. And then if the patient, as an example, in the Klaukoma case, If you have to remote the patient's intraocular pressure remotely, so then actually the telemedicine should include also the remote monitoring function. So What does this mean practice and what we are going to do? So the core of our strategy is to expand our portfolio from the ophthalmic devices, I. E, from the tonometers, from the perimeters, from the Finluss Imaging side to the eye care software platform. So goal is really in a long run to be able to connect the high quality data coming out from our devices, utilize the AI, also take care that the We are able to bridge the gap between the patients, between the ophthalmologists and the optometrists and then even after the hospitals. And here really the current challenge is that we are not currently fully able to move the patient from the domain to another with the required date. So that is going to improve then the clinical communication. It's going to improve the quality of the care and it's going to make the whole system much more efficient. So starting to summing up. So we are going to start entering to the eye care specific ophthalmology specific software business. And we are going to connect the data silos. And if you are able to connect these, you are actually able to enhance the continuum of the care and you are much more interoperable. Then because we are going to, as Julianna explained, so we are getting extremely high level, high quality data coming out from our devices. So if we are having a software platform, so we are actually able to use and combine the data as an example, IOP data, Findus Imaging, Perimetry data and draw conclusions and that's going to be then leading a much more better clinical decision making. And really the key is that we look this one, of course, from the health care professional point of view, but the most important thing is that we actually look this one from the patient care point of view. So we are going to take care that in the long run and in the future, the clinical care pathways for the different patients are going to be taken care much more better. That's going to improve the quality, that's going to improve the access, so the patient access to the quality care. And then, of course, we are able to meet the needs of the growing demand coming from the increased amount of the patients. So with these words, I think we are ready to keep 10 minutes break, and I would like to emphasize that please keep the questions Coming, so you're able to send the questions. And then when coming back to the 10 minutes break, Tommy is going to go through the sales and marketing part. And then after Tommy, we are going to continue with the Robin, then we are going to have the Q and A. Thank you very much for your time and let's be back in 10 minutes time. I'm back. Hopefully, you had a good short 10 minutes break. So we are going to continue the event by Tommy. So Tommy is going to go through how we are going to build on the eye care brand awareness and the customer experience also in a long run. So over to you, Tommy. Welcome. Thank you very much, Jonny. Good afternoon, ladies and gentlemen. My name is Tomi Karvo. I'm responsible for sales and marketing at Revenu and Eye Care. And I'm really happy to be here today to walk you through some of our major sales and marketing strategies. So if I start a bit with the history, we have had a quite a strong history of bringing a profitable growth. And it is mainly because of the people, of the culture, how we have been bringing the products to the market from both tonometer and imaging side. And now we are changing from a smaller player to a medium sized player. And really the question is that Where do we focus on? What things do we keep? And what do we start doing in a new way in the future? So I will focus on brand awareness and customer experience and I explain to you why they are the important things for us in the future. But first, I will take a look at the who we are, where we are covered, how do we serve the channels, who are our customers and also what is our focus in building on the channels because that is one of the key things from the past that has brought us the good track record of profitable growth. Then the 2nd major portion is related to building a holistic customer experience. And there, How do we do that by understanding customers? What is the meaning of the global brand? How do we have to add value in everything that we do? And then by serving the customers uniformly, we'll be able to go where we want to go. So let's start at looking at what we do today. So we are still a medium sized company. We have about 150 employees globally. But we have been able to sell our products in about 100 countries globally. And we work today through distributors in most of the countries. The U. S. A. Is the only country where we go direct. So in the U. S. A, we have our offices in the East Coast and West Coast. We have a direct sales force, but we also use distributors in the U. S. We are headquartered in Finland, and we have our 2 R and D centers of excellence. So why is distribution channel important for us? So the markets in the world are very, very, very different. You have different types of segments. You have different types of customers. And The one reason why we don't have still today even only 1 distributor in each country is that there are different segments that require different types of services. So some of the countries have a ophthalmology segment, some of the countries have optical chain segments, some of the countries even have a hospital segments, And these will need to go through different channels. When we started with the Centerview integration, we had Close to 200 distributors globally. So clearly, now the trend is going towards having 1 bigger, more covering distributor per country, but I don't think that we will ever have only 1 distributor per country in the world. So how does the market look like? So Jocheni already mentioned the size of the market. So we are talking about a USD 3,300,000,000 U. S. Dollar market. And it is split in the way how you see in the picture. So United States is the biggest market in ophthalmic diagnostic devices with about onethree of the market. The next after that coming the Western European countries, Japan, other high income markets and then China, India, developing markets. And What is interesting here is that traditionally for me, being long time in the medical device business, USA has been close to 50% of the global market. And now it seems that in our field, it is changing. And one of the reasons could be that the markets, the developing markets are coming fast, and they are taking a bigger portion of the total global business. And that means for us that we still need to keep a really, really close eye on the developing markets and what the channels are there, how do we approach the customers, how do we serve them in the best possible way. Doesn't mean that USA wouldn't be important for us. It will remain our number one market. They have the highest spend per capita on medical devices. They offer the latest services, the latest diagnostics, the latest devices. So it's going to be the number one market for us in the future clearly. Then talking about a little bit about our customers. So on the left hand side here, you see 3 different customer groups of telemologists, optometrists and optical stores, which are a little bit overlapping. In the world, there are about 400,000 ophthalmologists and optometrics altogether who work in different places in the market. And like a little bit already said, there are very different ways of providing diagnostic services in different countries. So if we take Finland, for example, you can get diagnostic services for your eyes in hospitals, In general practitioners, so in local health centers, you can get it in the optical chain stores. And so basically, it's well covered. Then if you go to some other countries, there are regulations related to giving diagnostic services. So In some countries, the optometrists are not allowed to touch the eye. In some countries, the ophthalmologist really control how treatment is given. And that really is something that we need to understand very properly so that we will find the correct the optimal access to these markets. One other thing is that Giuliano and Joni have talked about screening, increasing number of diseases, population increasing. So if there are 400,000 doctors in the world today, In the U. S. A, the ratio, doctors per patient is 15 to 100,000 citizens. In Germany, it's 30 per 100,000 and in China, it's 3 per 100,000. So you can clearly see that some markets will not be able to provide the same services if there are no new ways of providing the services. If they would stick to the old ways, they will never be able to treat all the patients that they have. And I kind of move on to the right hand side, which are the new developing target segments. And the first one for us is really important, which is the screening market. And there, it is all about improving throughput, improving efficiency and then being able to catch many of these newly developing diseases. So it is a big potential market for us. The other market that is developing is the home market and patient end user market. So we clearly see patients taking more control of their own disease. They want to see, they want to understand how what is their disease doing, how they are doing. So they want to take more responsibility, invest into their own treatment. And so that is another new potential market for us. Also the pharmaceutical companies, where I mentioned the clinical studies. So all the Major new drugs need a clinical study. And when it's related to the eyes, we have a lot of different products that can help making these clinical studies. OEM partnerships for us is a new way to access places where we can't go. So looking at global, Maybe optical change, maybe something else. So another place to go in the future. Next one is non profit organizations. So typically, There can be global organizations that provide help, that provide services in areas that don't have the financing or don't have the possibilities of getting the devices that are needed to provide the treatment. And then last but not least, and this is really related to how the markets are in different development phases. So in some markets, like I mentioned, Finland, treatment is given in every place. So it's given in emergency rooms, primary care, endocrinology. And in some markets, this is not yet there. But it will be a future development so that it will spread. And we really need to keep a close eye on how we can really serve our customers, make available our products for everybody in the world. So that was a little bit on existing and also on new segments. So what is the future focus on how do we optimize our channel even more to the markets? So one of the things that I touched is really related to the current distribution channel. We want to improve it. We want to train it. We want them carry our message in a uniform way. Secondly, we are keeping a close eye on some of the larger markets. And it may be that due to regulatory reasons, manufacturing opportunities, whatever the reason is, we We'll look at going directly into certain markets when and if it adds value. Digital sales channels is something new. This is a very And we have already started selling some of our probes. We have started selling the home device in the net. And this is something that will clearly grow in the future. Then you only talked about the teleophthalmology channel. And that is one way of actually for us approaching customers that we cannot approach at this moment. So these guys will offer consultancy services, they will offer drugs, They will offer different kinds of things through teleophthalmology channel. And if we are able to bundle together with them, that will create us a big new opportunity. Last but not least is the key opinion leaders. We are actually already pretty good there. So we have had the luxury of having doctors to come to us and ask if they could speak about our product. And so it talks really good about how easy to use and how wonderful products we've been able to make. But this is very important in the future because mouth to mouth, from doctor to doctor is the best way of spreading the word and so clearly an area for us to focus in the future. Good. So moving on to the second part, so the holistic customer experience and why it is important. And here, I really want to first talk about the brand a little bit and what is the importance of a brand and what is a brand. So a brand is not the logo. The brand is not the font. The brand is not the website. But it's actually everything related to what the customer keeps in his or her mind when they meet us somewhere in the world. So it is very, very important that we are able to provide that kind of message that really is true to our brand. And the brand is not something that you create, that you make up. It is something inherent in the culture of the company. Of course, you can twist it and you can guide it, but still everybody in the company needs to be in needs to be with the brand, and we need to speak in the same language. So some of the we have gone through a major brand development project last year. We have introduced our new IKEA brand last year in the fall. And the key attributes that we found that were true to us. There are words like being positive, being open, being forward looking, respectful. And these come kind of naturally for us. And this is probably one of the main things why we have been successful in the past and will continue to be in the future. I will move on to the next one and at the same time tell about the brand study that we did In the end of last year, we went out and we wanted to find out that where are we with our brand and so how good we are, how well our customers know us. And it was expected that our brand awareness is not at the same level as the large competition. So you have people there who have been out doing this business for almost 100 years, and we are still the newcomer. Our brand awareness was not high. What was really, really positive is that we found out that if Those customers who have been in touch with us, who have been using our devices, who have received a demonstration of our product, so who have been already seeing us, There were actually customer loyalty. The conversion rate from these customers is pretty close to the competition. And the conclusion there is that we really, really need to increase, improve the customer awareness of us. There are plenty of customers who don't know anything about us. And if we're able to improve the awareness, we'll actually get very quickly to the same level as our competition. So you've been looking at the picture now for a little while. And this is a typical picture about our brand and how we want people to feel about the brand. So we are showing pictures where we show the wonderful world. And this is our mission. So there is a wonderful world out there, and we want to keep it visible for all. So we have people looking at the wonderful world. And we have almost always more than one person in the pictures because it is stronger together. So we do it better together. And this is kind of the feeling that we want to transmit through our images and the brand. Good. Our customer promise is that we want to help the professionals, our customers to reach the next level of eye care. And what does it mean? We want to give them the possibilities to do things a bit better. So with our products, with our solutions, with our service, we want to give them the possibility of providing next level eye care. So be a bit better than they are today. Why is this important or why is it meaningful? No one deserves to lose eyesight due to the insufficient know how, technology or lack of time. Every patient is entitled to receive the best diagnostics and to enjoy all the benefits of the newest technology. And our goal is to work in the frontline of eye health and to help professionals care for and save their patients with vision. How are we going to do this, reach the next level of eye care? So the customers and patient needs are the core of all our work. We are committed to continuously innovate and improve. And now come a list of very, very, very important words because they basically drive everything that we do, everything that you should see in our products. We strive for the best usability, accuracy, reliability, Safety, comfort and quality, effective and competent customer service and support, resulting in value for money. We believe that this is a list that will take also us to the next level. So in short, what do we deliver? So this is our elevator pitch, if you ask us what do we deliver. We deliver highly advanced medical devices, which are tonometry, perimetry, fundus imaging and software solutions for eye care professionals around the world. So wrapping up with the customer experience and what it is and what it is not. So a customer experience is not a customer going to our website. It's part of it. But it's actually really the whole process. And there are many, many, many different components in how do you build a good and positive holistic global customer experience. Challenges there are for us because we are working with a lot of distributors. We need to make sure that it's an integrated approach so that everybody is doing the same thing. It's not that if I am able to do it, it's not enough, but all the colleagues need to be able to provide a similar kind of service. And so it's related to the culture and leadership, so that we understand what it is and we take leadership on building a customer experience globally. We need to have proper CRM systems so that we understand what's happening there. We understand who to connect, how to message, so all the systems needed. So kind of the modern world needs to be there as well. It's based on continuous innovation, so we can never stay put. We have to move forward. We need to come up with new ways to impress our customers. But it's mainly it's related to understanding the markets and customers. So Examples on what we already have been doing a long time. Of course, all of our product development is based on customer requirements. So we have a process where we go and understand the customer needs. We start building market requirements. We take them to our R and D. Product management is there. In the end comes a product that is hopefully fitting to the customer needs. We also do that nowadays when we are talking about marketing communications and how we communicate to the market. So we have been looking at who are the major customer target groups. And so we have divided into 3 or 4 different groups. We have faced the process of buying so that If we know that the customer doesn't know us, when they know us, when they have an interest by the product, so there are different things that you need to do in different phases and different communication channels, how you take your correct message to the customer. So it really is key that we understand the customer as well. Then for us, as a small company, now becoming bigger, wanted to become even bigger, We need to be efficient in how we use our resources. So we need to add value through all of our sales and marketing efforts. So everything that we do, we need to be sure that we add value for our customers, because we don't really have the chance to waste time in doing something that is not valuable. And we really want to serve the customers uniformly in everything. So it's not only sales, marketing, it's the operations, it's the customer service, it's the distributors. So if we're able to achieve this, then I think that we will continue with the profitable growth track also in the future. So coming to an end and the key conclusions. I would say that the major key conclusion is that we see plenty of growth opportunities. You have seen that there are growth opportunities in our existing target area, and there are plenty of new ones. The software business is completely untouched so far and not completely, but big parts got untouched. So there are huge opportunities for us if we Utilize modern value adding tools, be efficient there. When we improve the eye care brand awareness and when we build a unique and holistic customer experience, so that we stay in the minds of the customer and it's always easier to get the repetition business than to attract new customers. And definitely, we will not forget on serving the customers through existing channels and new channels in all of the selected segments. So in short, We want to give a better perception for all of our customers. Thank you. Thank you, Tomi. As a next step, so we are going to go through the finance part, Victor Robin. And we have thank you very much for the questions. So we actually have quite many questions coming in. So please keep sending them, and we are going to go them all through then at the end. So very welcome, Robin. Thank you for coming. Thank you, Yoni. Thank you, Tommy, for the great presentations. My name is Robin Pulkkinen. I'm the CFO for Revenue Group. I'll go I'll take you through how do we continue to grow strong growth, profitable growth also in the future. So like we've already heard today, we've taken the strategy in a direction where we focus on ophthalmology market, the eye care market going forward. So this will mean that the non core businesses related to Cutika and Ventica are going to be something that we're going to be Looking for commercial partners to take them forward. Potentially, we're going to be part of the journey or even exiting those totally. The cards are all on the table and no final decisions have been made how we're going to proceed with those. Our operating model as a company, it's served our company extremely well over the years. Something very identical for us is that we tend to outsource many of the non core functionalities. So like for manufacturing for years we've already outsourced the manufacturing function from our company. For the tonometers, we manufacture all our devices and probes in Finland. For the probes for example, we actually used to do them also outside of Finland and in Asia and other European countries some years back, but we have now brought all that manufacturing back to Finland. It's all done in fully automated production lines And with the same process that we bring the manufacturing to Finland, we've actually been able to also cut the manufacturing cost by nearly 50% on doing it. On the imaging devices, we manufacture our device in Northern Italy in a very similar fashion. So all the manufacturing is outsourced there as well. On R and D, we keep all the key R and D resources in house. We do use also for outside service providers to support with the changing demands in the different projects as the development progresses. And then finally, like we covered already by Tommy earlier, we sell our products to over 100 countries. We have 130 distribution channels partners. And basically, the U. S. Is the only country globally where we sell straight to the end customers. So in the U. S, basically we use sales representatives To cover the different states, we also have some direct sales staff. But basically, everywhere else outside of the U. S, we go through channel partners. And also means that the P and L is a bit different. So in the U. S, our ASPs for the products is roughly double for what we get outside of the USA. And then also on the kind of the gross margin side in the U. S, we pay a commission for our sales representatives. So the P and L in general looks quite different from anything outside of the U. S. So over the years, we've been able to grow extremely well. For the last 5 years, our compound annual growth rate has been around 27% compared to the market growth rate of 4% to 6% ages. Of course, in 2019, as many of you remember, we did the acquisition of Centuri which has of course brought kind of an inorganic growth element into the last 5 years. If you take that out of the equation, the growth organic growth over the years have been roughly 13% to 14% for the existing businesses. Like we heard from Tomi and Giuliano, we are committed to accelerate the organic growth for all our product lines going forward. So that's something that we are putting a lot of effort on. And also we continue to work actively on the M and A side of the business. So something that could be that comes across in the kind of expanding our existing product portfolio or something maybe in the software side. So time will show, but that's something we've already been working on for some time and we plan to continue to do so also in the future. So our balance sheet is strong. It gives us options to shape a more profitable future for our company. Our equity has been very strong, very over 80s even some years back. So as part of the transaction with Centerview, we of course needed some funding, so we did use some equity funding and senior debt financing to finance the transaction, so the equity levels and the return on investments came down at that phase, so kind of the capital employed grew quite a bit. Last year, We're still able to improve our profitability. Those are adjusted numbers. So we've taken out from the 2019 number, there were the Centivi acquisition costs and last the equity amortization, cleaned those out. So the kind of the clean operating business was able to improved the profitability last year. We did that without cutting any running legs. So we kept all the employees, nobody was temporarily even laid off and we continue to hire. We continued all of our R and D investments and continue to do so as we speak. Also over the years, the cash flow has been following very much the revenue. So the operating cash flow has been strong, growing on average 26% over the last 5 years. On the investment cash flow side, of course, any M and A activities might have a quite significant impact on the total cash flow, but the operating cash flow has been very stable. On the dividend side, some of the people have been asking this question earlier also. Earlier on like 5 years ago, we actually paid out more dividends than our earnings were. That kind of payout ratio has now been coming down for the last 5 years. Basically, we do plan to pay a dividend also in the future. The idea here is that if there are better investment opportunities that we think that we could use the cash in the company. There is a chance that we might progress with those ones. And if we do if there is room for dividend payment, I think there's no reason why we would not continue to increase it also in the future, but it's not something that we are fully committed on. So if we do M and A transactions, for example, Those will be probably temporarily could be lowering the dividend. But then with the expense, of course, the plan in the future looking would be that the idea behind the transaction would be to increase the organic growth going forward, which would then bring the return in maybe a different form. So we remain committed to our financial targets. So our Group's exchange rate adjusted net sales we estimated to grow strongly from the previous year and the profitability is to remain at a good level without non recurring items. So as we've been able to prove earlier, we have a really robust financial and operating model just to go through some of the key takeaways. The revenue operating model and the value creation has been second to none over the last decade. It has really played well for the company. We're committing to new improved organic sales on all our product lines. This is going to be backed up with any inorganic opportunities that may arise as we move on. And like we've seen earlier, But that's it for my part. I'll invite Joni back. Thank you, Robin. So I think it starts to be the time to conclude the day with the following words. So a couple of key takeaways. So we have really changed our mission, and the new mission is we aspire to keep the wonderful world visible for all. And we are going to do it by focusing fully on the eye care market. On the product side, we are going to improve the quality of the diagnostics by innovative products. Then we are going to transfer the clinical care pathways with the eye care focused software solutions. Then we are building and we are going to build on the IKEA brand awareness and the customer experience gained by the tonometer success. And then we are going to be committed to continue strong and profitable growth. And