Good afternoon, everybody. I'm David Adlington of the European Medtech research team for J.P. Morgan in London. It's my pleasure to introduce David Endicott, CEO of Alcon. There will be Q&A afterwards. Please wait for the microphone for questions. But David, over to you. Thank you very much.
Well, thank you, and good afternoon. We are excited to be here and start another year kicking off with JPM. It's fun to be back and talk about, you know, a lot of things that we've been working on. As most of you know, we have a broad portfolio of stuff and a broad kind of source of growth.
I think when you look at the surgical market or you look at the vision care market, you can see kind of steady mid-single-digit growth across the portfolio of markets in which we play, which is underpinned by a whole bunch of fundamental positives like, you know, aging demographics, comorbidity, the need for eye care being one of the highest interest topics for elderly folks, and obviously the myopia epidemic running around the world. I think directionally, we feel like we're in some very, very positive markets, and they run across a wide gamut of opportunities. Obviously a big market all in with about $33 billion. The thesis that we had when we spun out was really around product flow.
It was really about, you know, could we, with the right amount of investment, get products back in, grow in these markets, not just kind of at or below market, but rather above market rates? And I think we've demonstrated that really since the spin. You know, we got product flow moving very quickly, you know, afterwards and, you know, through really 2022, 2023. And if you balance the two years, excluding the 2020 COVID year, you can—you know, you can divide that in half if you like. But directionally, you know, very good performance here as we kind of look forward to accelerating growth. I would say that what's been doing that has been, you know, a strategy that underpins a decision-making process that we think is unique at Alcon.
We think that the basic idea has to be to focus on eye care and be really, really good at that. And, you know, we believe that folks that know these markets can anticipate which markets will develop, can anticipate where competitors will go, and can apply technology in a way that others cannot. That specialty orientation, that focus, will deliver, you know, superior results, better odds on the projects in which we engage. So, you know, you do that with a disciplined capital deployment, with an efficient enabling function, you get leverage off of the top line growing significantly faster than your cost base. That has been the strategy, that's been the idea from the beginning. I wanna cover a couple of ideas that kind of demonstrate that.
One is, you know, first and foremost, you know, we've put a lot of money into our contact lens manufacturing platform, into the development of a series of new products, of which, you know, many have occurred in the last couple of years, but there are several more to come. So I would point to, you know, in the contact lens business, our Precision portfolio, our portfolio of Torics, in particular. You know, for many years, we had enough capacity to support the spherical contact lenses, but not really the Toric business. So we entered the high-end market, if you will, for Torics, with a zero share, you know, in 2021. So nothing but upside from there, right?
I mean, the value of kind of getting fair share when you've got a DAILIES TOTAL1 product doing very well, but no Toric to complement it, was really substantial. We've been successful getting that TOTAL1 out. The same thing with PRECISION1, PRECISION1 Toric. We've got the multifocals now. We've got a new reusable, where we see the opportunity, not so much as a growth, you know, a market, reusable market, pretty flat, but we have a disproportionately low share, where we have a high 20 share in the contact lens market. Generally, we have a 16 share-ish, you know, kind of number in reusable. So very profitable business. Can we catch, you know, a little bit of profit and additional gain there by developing a better reusable, which one hasn't been done for a long time?
So water gradient technology, use the TOTAL brand, apply it to a reusable, find our way into a more comfortable setting for that brand. It's done very well. Pataday over the counter, SYSTANE COMPLETE, some additional RX products that we brought to market have really benefited the vision care business as we've tried to build it out. Going forward, you'll see some more products coming. We've obviously got a multifocal on TOTAL30 to finish the family. We made some announcements on our dry eye product last night. We'll talk a little bit more about that in a minute. And of course, we are working on a weekly lens as a new modality, which again, we'll see in the next 12 or 24 months. So we're looking to kind of move that forward as well as an alternative to the two-week market.
I think directionally, the OTC product is something underappreciated in this portfolio. I think if you think about where the profit of the vision care business is really moving nicely for us, the SYSTANE brand is a really exciting product. Around the world, this is the number one artificial tear. You know, believe it, you know, it is a terrific add to this portfolio that, along with Pataday, has become, you know, a nice driver of growth, certainly this year, but also of profit in the vision care business. If you look at what's going on in our development program, we've got an HA add to the COMPLETE brand, which has really strong acceptance and potential going forward. We have a number of other ideas, I think, moving that way. You can see that the share's done.
I mean, you know, our thesis was put, you know, new products out there, you'll see growth, and this is exactly what we've seen. So when you go back to where we were pre-spin and what's happened since, you know, we basically have put new products in the market, and of course, the market's responded nicely. So, you know, directionally, we feel good about this strategy in vision care. It is driving our growth, and we are right in the middle of that growth right now. It is... We're still kind of on the front end of what's gonna happen here in our contact lens business. So we're excited about the potential growth going forward, both in contacts and OTC. A couple of notes on pharma to complete the vision care business.
Rocklatan and the acquisition of Aerie has been a terrific program for us. We acquired not only capability in that process, but I think nicely growing glaucoma assets. Rocklatan has done very well. The market, you know, is generic right now, but we still are seeing an 8% TRX growth, which has been really good in a market that I think is adjusting right now. So we feel, you know, very positive about what's going on with Rocklatan and Rhopressa. And I think the surprise in the portfolio for us, or maybe just the upside in the thesis on when we acquired it, was, you know, would we get a dry eye asset, you know, out of the program that was running at the time?
So directionally, we're very excited about the results which we reported last night, which really have shown kind of significant change on the primary endpoint to drive, you know, a path to signs and symptoms of dry eye disease. And, you know, what we saw was not only, you know, significant, you know, difference and clinically relevant differences at day 14, which was the primary endpoint, but also at day one, really important, and day 90, you know, so end of the trial. So, and improving throughout that.
So I think what we're excited about is the potential of a product that works much faster, that could create a natural tear, and not just a supplement for a lipid layer, or a supplement for an aqueous layer, or a supplement for a Meibomian layer, but rather a tear that actually stimulates the trigeminal nerve, stimulates the natural production of your own tears in proper proportion. So that's a very unique mechanism, very interesting, TRPM8, and an exciting opportunity, I think, going forward. Directionally, you know, we think this is a really interesting market. You know, as we've said, there's a lot of people out there who have dry eye disease. Some of them are diagnosed, but not most of them, and obviously, those that have sought or are under treatment for prescription products is relatively small.
So the U.S. market, maybe $1.4 billion, globally, about $3 billion. But I think directionally, this is a really interesting opportunity, and so, rapid stimulation of production of natural tears, as you can see, and directionally, you know, we see this as kind of a peak potential in the U.S., of about $250 million-$400 million. We have not pursued yet external U.S., registration, so we're working on that now. But we will, we'll bring you more information as we get forward on, on that, on that approach. Let me switch to the surgical piece and, and just give you the kind of the same story, different products, right?
So you know, when we started this journey, again, you know, we had some stuff that was on the shelf that needed to be developed but was not being funded. We went ahead, funded a lot of that, got, you know, some of the first products out that were really interesting, you know, the PanOptix trifocal, you know, again, very exciting, a new biometer, a new, you know, economically priced phaco machine. We've, we've spent a lot of the time in the last couple of years converting from what was an older material in our AcrySof material to the newest material in the world, Clareon. You know, the glistening-free, very clear material with new edge design, a design that we think is superior to all other materials that are in this market.
We've obviously done a lot with Hydrus. We've got a new WaveLight Plus that's out now. And directionally, we see continued development in this area, and I'll talk to that. On the implantables area, I would just say that, you know, the big story for last year for us was, you know, penetration went sideways. You know, we started the year at 19. We had hoped to get about 100 basis points of improvement. We did not get that. I think a lot of that is down to our view, which is, you know, staff turnover in the critical elements of moving patients into advanced technology lenses where they are cash pay, you know, changed a lot. There was almost...
We were with somebody yesterday who was talking about, you know, staff turnover in the 60% range in these critical roles, where you've got to retrain people now and get them going. That's a very different world from where we saw the world several years ago. I'll also say that, you know, one of the things that was interesting was 20% of the high-volume practices in the U.S. now are in private equity, which means some of the most productive surgeons in our business have gone into an arrangement where they're now employees, not owners of that business. And, you know, the sum of the productivity questioning, I think, that's gone on in there, you know, is an important, you know, question as to whether or not they're really motivated to keep doing what they've been doing. So we see that as a temporary scenario.
We believe over time, this continues to grow. We know the headroom in penetration is somewhere around 35%, and we're sitting at about 12% globally. We're getting good penetration growth internationally, good share growth internationally. U.S. has gone sideways, and that has been the driver so far. So that's really the story, you know, from last year. Now, going forward, you know, lots of stuff coming. We, you know, we've got a new PanOptix that's really working on contrast sensitivity and trying to generate more energy at distance. I think these are really important ideas. When you start splitting light or moving and stretching light, you know, you will find that there are significant differences in the lenses, in contrast, sensitivity, and other kinds of, of moments where the clarity of what people see can be improved. We're on a path to improving that.
Directionally, we've also got a lot going on in China right now. We have almost no share in China. I think we have less than a 10% share. We did just win the VBP process there, so we are the number one position for all of the AT IOLs in each category. So we'll see an opportunity for the next couple of years, you know, to grow our international business on the back of China, which is the second-largest AT IOL market in the world now. It may not be known to people, but it is an important and exciting change. And obviously, we're working on new injectors, and we've got a number of things coming, you know, on the way that advance, you know, our autonomy project and change some of the interesting things going on in those spaces.
So exciting stuff there. Probably the most interesting thing in the near term is going to be our next-generation phaco- vit machine. This is a combination of a better, newer CENTURION and a better, newer CONSTELLATION, and it will be in one machine. So it's a joint machine that will be approved somewhere this year. We submitted to both the U.S. and the EU in late December, so we expect a relatively rapid approval. We're gonna spend about a year with this in market, so we'll probably sell 50 or 100 of them. Don't look for revenue this year, but look for it in 2025, because I think what we're gonna do is be in a very strong position to have tested this thing, you know, washed it out, made sure everything's working perfectly because it...
You know, obviously, we're working against, you know, two of the best machines in the world, you know, ever created. So we're gonna make sure we got it right. As we go through that process, we are very excited about the speed of this machine, the safety of this machine, and the time it takes to do additional surgery. So we believe that efficiency is the major topic to be solved. We have lots of cataracts out there. We don't have enough cataract surgeons. The throughput that we can generate with these machines is significant. We think we can do more cataracts in a day, and that's gonna obviously pay for a lot of value. We'd like to share in that value, obviously, with some kind of premium positioning of our consumables.
So we'll work through that process over the next couple of years, of very exciting technologies that have been advanced over the last really five or six years. Additionally, we obviously are involved in trying to change the speed at which we move cataract patients through the clinic. In the pre-op phase, there are a lot of diagnostics that get done. If you look down the right side here, there are about six tests that are often done. Most of them, four of them at least, are done almost all the time, and a few of them are a little bit optional. I would just say that directionally, the amount of time it takes to move people through this and the potential for error in this is really important.
The biometer that we have now is doing really well. We've had a lot of success. Our win rate, when we're head-to-head, is better than 50% on ARGOS. We know we are a faster machine. We know we can get through hard cataracts better, and I think we feel really good about our ability to compete with, you know, the market leader, which is, you know, the ZEISS 700 . The beauty of this machine will be that it puts all of a bunch of machines into one, and with one click, in a lot faster motion, you can collect all this data and export it then to a cataract planner and your electronic medical records.
This is all gonna be surrounded by, you know, the ability to move this data from the clinic to the cloud, into the OR, and then back post-operatively capture the outcome, and then improve the surgeon by recalculating surgeon constants, and also, at the same time, beginning to introduce algorithms that we think are unique to our lenses and unique to those surgeons, which will be done, you know, through a series of machine learning programming that will sit on the cloud and/or on the on-premise machine. So it's a really big opportunity, I think, to drive incremental value and incremental efficiency in the cataract system, which we think gets more throughput. Again, so we'd like to share in that value with the surgeons.
As we look forward, then, what we're really after is, you know, trying to make sure people understand the breadth of the vectors of growth that we have. And I think, you know, one of the things that we're excited about is certainly, you know, our surgical business, where we enjoy significant share. But we're also very excited about our contact lens business, which, you know, has been, you know, a sleepy business for us for a lot of years but is really just now taking off. I think directionally, the portfolio of, you know, OTC products is underappreciated in many ways. We get a lot of benefit from both the margin and the growth in that market right now.
You know, the pharmaceutical business is small for us, but I think the AR-15512 gives us an interesting opportunity to go along with a glaucoma market that's quite large. And when you look through the equipment part of our portfolio and the consumables part of our portfolio, premiumization of those consumables will drive additional value. Throughput on increasing the number of procedures that surgeons can do will create economic value for the individual pieces of equipment that we create. So we feel very well positioned right now to continue to drive above-market growth in markets that genuinely, you know, are very sound and will be for some time. So with that, let me just finish that up. Thank you for listening to that, and we'll take any questions you may have.
Okay, thanks, David. I'll just kick off here with maybe a question on the new news this week on AR-15512. You've presented some of the data up there, but I'm just wondering, first up, when we might expect to see the full data?
Full data, once we get the file in, and we've analyzed everything for that and we can bring it forward, we will do that. I expect that will be sometime in the fall. But we've got probably eight very important secondary endpoints. There's a SANDE score, which is the patient-reported outcomes. There's a series of other secondary, you know, endpoints, which I think will be valuable in thinking through how the potential of this product plays out.
Maybe sort of following on from that, in terms of the, when you approach payers with this product, what do you think is going to be the key, key selling point that you're going to?
Well, look, I mean, here's the idea, and I think it needs to play out in real terms. But I think what we believe is, if the product works on day one and has a somewhere in the 50% response rate for significant improvement, that's very different than what you see with Xiidra and with Restasis. And I think what we'd like to say, what we'd like to see happen, is that we, you know, we can articulate that this product works quickly, and why would you put something that you have to wait 90 days to find out whether it's going to work, and in most patients is not going to work? That's a lot of wasted resource to the payer when you've got a very high percentage chance in knowing that, you know, very quickly.
So if you need to come off of that product and do something else, you can do that, but you don't waste 90 days' worth of drug for 80% of the patients. That's a real immediate economic savings that we think plays, and I think it's really valuable. That's the beauty of the onset. You're going to see a different kind of onset with this product versus others.
Perfect. And then in terms of the sales force you'll require for that, can you do that with the current sales force?
We may. We would probably expand the current sales force if we do that, but we may also think about if, you know, what the portfolio looks like at that moment in time. We're probably still, you know, more than a year away, a year, year and a half away from really having to deal with that idea. I do think that, you know, we have enough products in the portfolio now where we could create a glaucoma sales force, we could create an external disease portfolio with Pataday and SYSTANE in it, and AR-15512. We'll look at the potential of this to see whether it's better to expand the existing one or separate into two, but we'll probably make that decision in a year or so.
Perfect. And then just moving on to IOLs, you mentioned the presentation, how staff turnover had been a maybe a factor in not seeing the uplift of 100 basis points in AT IOL shift. What's been causing that staff turnover?
You know, there's a very interesting phenomenon right now, I think, where a lot of these skilled positions are moving amongst the cash pay people. And I think they're, I don't know whether it's a, the moment in time coming off of COVID, or whether it is just the demand for people who have these skills. But aesthetics has them, dentistry has them, plastics, there's a series of other specialists who have a lot of cash pay products, and they are a valuable commodity, and they are moving around, I think, right now, to opportunities if they see particularly the relationship between them and their practices change in some meaningful way. So it's an interesting phenomenon that we've at least observed in, you know, in the last year or so.
Any thoughts in terms of the, whether we get to return to AT IOLs taking more share through 2024?
I'm sorry, say again?
Are we, are we going to see a return to AT IOLs increasing their share through to 2024?
Well, we hope so. I mean, I think we'll talk a lot more about 2024 in, you know, in February. But I would say that, you know, our general thesis on AT IOL share is that, you know, a lot of these markets have moved just very patiently over long stretches. So AT IOLs have been basically a 50 basis point shift per year on average for about 15 years. It's a little bit like. And we expect that to continue on for another 10 years. So the beauty of that is that you get nice, stable market growth, you know, and we should be able to participate in that. That's the same thing that's going on with contact lenses. It's been shifting from reusables to dailies for 15 years. It's got another 10 years to go, at least.
So I think what's nice about that is it creates a nice, steady, stable market to participate in. And, you know, obviously, we share very nicely in that.
Then you also mentioned Chinese VBP, which is a market historically you've had sort of underpenetrated or certainly when relatively to the rest of the world. How should we be thinking about scaling that opportunity for you this year in terms of a tailwind?
Well, it's going to be a tailwind for us in China, for sure. You know, we have a very low share in China relative to everywhere else in the world, and we, you know, we did not participate in the first go-round, believing that we could help participate in the private sector of China. I think what we learned was that the private sector is very overlapped with the public sector, and we've made a change to that. We participated this year. Obviously, we've made some positive strides there. I do think it also coincides nicely with the launch of Vivity, Vivity Toric, PanOptix and PanOptix Toric on the Clareon platform.
So I think we are in a very good position to have the products we need at a moment where we are going to win the largest tender in the world, and, you know, we'll see how that plays out.
Perfect. And then just on the equipment side, with a new launch coming, you're going to be quite conservative this year, do you see any potential for clients to postpone the purchase of the machine into 2025 when the ramp comes through, and how will you manage that?
Yeah, I mean, that's a natural phenomenon. We'll see a little bit of the market freeze that you see normally, you know, when this happens. I do think we'll, you know, we'll obviously... If someone needs a new machine, we will, you know, offer them an upgrade path. So, you know, buy the CONSTELLATION or buy the Centurion now, you know, we'll get you on the list. When we get the product, we'll get it to you. We'll trade in your existing machine. We'll work that out. So, you know, there'll be a little bit of that, but I do think we can manage it.
Perfect. And then quickly shifting on to the contact lens side. This time last year, you were pretty cautious on the outlook for the contact lens market, and you were, I think, pleasantly surprised.
Yeah.
Thoughts about-
Well, I've been wrong twice. I don't know if I should be wrong a third time, but, you know, we, like a lot of folks, thought there would be a recession this year, last year. There wasn't. We did model it like the 2009 asset recession, and that was wrong. It didn't happen. I think, you know, we'll be wrong again this year, probably. I hope not, but, you know, we've said we think this will be returned to kind of a normal growth rates. You know, read that as mid-single digits, and I do think that that's historically where it's been. You know, there's about 16 things that could go wrong with that assumption, but that's where we are right now.
Great. And then pricing for the market has probably been better than it has been for some time on the contact lens side, probably helped by some supply issues in the marketplace as well. Again, pricing expectations going forward from here, slightly more modest?
Well, historically, you know, the market value has always been driven by the trade-up, and so really it's a mix shift. So two-thirds of the, if you call it mid-single digits for contact lens, two-thirds of that value growth has been reusables to dailies. And then there's been about a third of that that's been price historically. Last year was a little bit better than that. There was a little bit more 50/50, you know, but I don't think you're going to see that quite as aggressive this next year. I do think there'll be some price, there always is, but I, I don't think that the environment will necessarily accommodate for a lot of price.
Perfect. Great. Any questions in the room, please? Just, just wait for the microphone.
Just interested, going forward in the IOL market, what are some new technologies coming out that could really kind of expand things, maybe not in the next year, but over the next five years, and help you to gain even more share and, you know, provide more benefits for the people?
Yeah, well, I mean, if you go back to our capital markets, say, last year, you know, we've obviously been working on making changes to our existing lenses for the benefit, as I said earlier, of contrast, sensitivity, and/or putting more energy at the focal points that are of interest. I do think that, you know, there's a lot to be said for, you know, tunability postoperatively. And I do think that, you know, while there are some tunable ideas out there, I think we've got a very good one with an argon laser that can lyse, you know, pockets inside of a lens in a fluid-filled lens. We've been working on that for a number of years.
You know, it's been slower than we would have liked, but it's been a very good idea, and I think directionally, something that you know for sure is going to be stable when you come out of it and stay that way, or if it doesn't, that you can adjust more easily with a laser that's handy in your office every day is a really big idea. And importantly, that is a right now, we know we've got three ideas around that. One is a combined accommodating and adjustable lens, but if either of the, you know, that combination doesn't work quite right for us, we know we can do the adjustability, you know, in other kinds of formats.
So I think, you know, we probably have six or eight ideas that we think create a postoperative adjustment process that is the most efficient one. You know, today it can be done in some certain cases with certain technologies, but it's difficult and, you know, takes two or three, four or five visits. Whether that's stable over the long haul, it's hard to know. And we'll, you know, we'll see. You know, we have to watch the explant data and see what happens there.
Thanks for your presentation. Here.
Ah.
Given your leading position in eye care, do you have a plans to develop and commercialize your pharmaceutical ophthalmology products? If so, what will be your plans?
Well, we'll, you know, we're obviously continuing on with Rhopressa and Rocklatan. You know, those are terrific glaucoma agents that I think have a real place, and I think... You know, going forward, you know, we'll continue to work on AR-15512, get the dry eye product out. That takes us, you know, forward. But I think we will also, you know, we're looking as a strategy, you know, to continue what has always been a legacy of Alcon, which has been, you know, what I would loosely call, you know, the development of these products, and I would mostly call that, you know, kind of technology enablement.
You know, we've never been the one that invented the biological activity, but we've bought a lot of them from a lot of really smart people who aren't that interested in eye care. So, you know, you think about the prostaglandins, you know, they came from, you know, Pfizer, the beta blockers came from Merck. You know, we always licensed those technologies and then applied science to them to formulate them for an eye, deliver them to the eye. And we've got a lot of different technologies we're thinking about to try and reapply, you know, biologically active, demonstrated, you know, activity in some other place.
So we aren't going to do the R work, but we are going to do the D work, and we'll try and build our way into what was always a legacy business for us, which was, you know, a whole lot of pharmaceutical products that were probably too small for Big Pharma, but perfect for an eye care company like us.
I have a question for Tim, actually. So as we think about the building blocks, not so the top line for 2024, but in terms of gross margin and operating margin, what are the bits we should be thinking about in terms of tailwinds and headwinds?
Yeah, I think, you know, not too dissimilar to what we talked about on the, on the Q3 earnings call. I mean, FX right now is, is a pressure point for us. So as you think about year-over-year expansion, that, that'll be a pressure point for us. But the, the overall P&L shape will, will be very similar. Whatever you think the market is gonna grow, we think it's gonna grow mid-single digits. We plan on growing faster than that. At the same time, as I work my way through the P&L, you know, we will see gross margin. We've got some mix input in there. We've got some FX in there.
We're still working through some of that higher cost and inventory that we purchased in 2023, but it doesn't work its way through the P&L until 2024, so that'll cause a little bit of pressure. But overall, we would expect operating margins to continue to expand. And again, the overarching thesis at the highest level is we're gonna grow faster than the market. We're gonna continue to be disciplined around our cost envelope, make the appropriate trade-offs, and manage that SG&A base at sort of inflationary-type levels, and when we do that, we'll continue to get operating margin expansion.
...Perfect. And then just coming back to the glaucoma side and on Hydrus, in terms of how your thinking has evolved since you acquired the product, and what are the key learnings and how you might address that going forward?
In pharmaceuticals or-.
No, on the stents line.
On the stents. Yeah, I mean, one of the really interesting insights I think on the stent business is I think one of the adjustments we've made, which has really begun to accelerate the Hydrus product, and really nicely so, has been the mistargeting of kind of really core cataract surgeons. I think, you know, if you know the cataract surgeons, they really just want to do cataract surgery. The busier these guys are, gonna do one cataract, they want to do the next one. They don't really want to get hung up in the eye doing something else, and they really don't want to follow up or have problems postoperatively.
One of the targeting misses early on was we were going to the largest customers with cataract surgery, because the labeling was, of course, glaucoma and cataract surgery. Gonna make sense, you'd go to the guys that have the most. But their intuition isn't to slow down on a particular case and, you know, really be patient to put something in like this. And then they really don't want to do the follow-up work, you know, if they don't have to.
And so I think directionally, what we've been much more successful with, and has really begun to accelerate, is getting, you know, comprehensive ophthalmologists involved in this, and really thinking about where do we refer these, you know, combined procedures to inside of a group practice, so that if you're the cataract, you know, specialist, you keep doing what you're doing, but send me the combined procedure because I can do it. You don't really care, 'cause I'll send you a cataract patient, and we'll work that out. That's been a very, you know, successful move for us. That plus the glaucoma specialists, who I think directionally have been a big supporter of this. The data on Hydrus is unsurpassed in its efficacy.
I mean, you're seeing now, I think, you know, really valuable reduction, five-year data that says, you know, we're off medications for, you know, significant, you know, portion of the population, putting off second surgeries. You know, these are, you know, demonstrable outcomes that are better than anything else out there. You know, we're excited about what this can do. What we need to do is make sure we get more surgeons bought into the process, 'cause it's not, you know, it's not an easy surgery, but it's not a hard one either.
I think this is an area where Europe is actually leading the way.
Indeed.
-versus the U.S.
Indeed. And also in the total algorithm of glaucoma, if you think about it, I mean, some time ago, Europe started down the SLT path, which I think is an important, you know, thing to think about, which is if you could do non-interventional, you know... Well, I'll call it loosely non-interventional stuff, that, you know, really, you know, you can do it earlier in the process. First of all, treat earlier, treat non-interventionally to the extent you can, and then work your way through a path of drops. You know, start with SLT, go to drops, you know, try laser, you know, try MIGS, you know, end up in shunts and tubes. Make... You know, that's a, that's a path that makes sense.
You know, and I think that's really been developed more effectively, you know, outside the U.S. than it is here. But it will. I think it's coming.
Perfect. And then there's been some discussion in the market around the potential for refractive surgery to impact the outlook for IOL surgery. It'd be great to get your thoughts on that.
Yeah, I don't think it has any meaningful impact. Fundamentally, refractive surgery's been going on a long time. The bolus of patients that was described in some folks' views, you know, there wasn't, you know, maybe it was two times what it was, but it went from 1.5 million procedures down to somewhere in the 700,000 range. But that, you know, most... You know, the average age of a refractive patient is 35. Average age of a cataract patient is 65. So you're gonna have to add 30 years, and that doesn't add up to anything anytime soon. So what you're really talking about is a couple of misses in calculus there.
If you want, you know, if you have an irregular cornea, which is really the thesis, there is a very logical idea, which is it's more complicated to get that right, with a surgeon, you know, in doing the case correctly and getting all the measurements correctly. But advanced diagnostics and better lenses, like Vivity, which gives you a very wide landing zone, gives you a lot of room for that error, and I think that's why that continues to be the number one lens used in, you know, difficult corneas.
Are there any further questions from the floor? In which case, we'll wrap it up there. Thanks very much.
Thank you very much.
Appreciate the opportunity.