We'll go ahead and get started. Good afternoon, everybody. Very pleased to welcome the management team here from Bausch + Lomb. Pleased to have Brent Saunders, Chief Executive Officer, and Yehia Hashad, Chief Medical Officer. Great opportunity here to dive into strategy, but also just the emerging product portfolio, given what you had introduced to the investment community in November of last year at your analyst meeting. I think the sort of multitudes of product launches you have across the different businesses. Appreciate the opportunity to be able to dive into that. Maybe we just start, Brent, kind of contextualizing Vision 2027. You took over the company when it was still obviously under sponsor ownership. There's been a lot of investment to build the pipeline and strengthen the foundation of the company.
Maybe just talk to us about where we are in that journey and how we should think about just the evolution of the business, both through 2026, but also beyond.
Yeah, sure. Well, first, thanks for having us, and thanks for Goldman Sachs for hosting this. I joined, I guess, February of 2023, so a little over three years ago. When I came, it was my second time, or my return to Bausch + Lomb after being there prior to my run at Allergan. It was a company I knew well and a space, eye care, that I knew well. What I found was a company with a lot of potential. What I wanted to focus on first was really three things. In order, it was selling excellence and getting top-line growth, operational reliability. Coming out of COVID, we had a lot of supply chain-related issues, and then building R&D capabilities. I think we stayed very focused on those three things for the first two years that I was here.
I think the proof is there, right? We have been a very consistent grower, faster than the market, faster than our competitors since my arrival. Our operations, our back orders are at historical lows. We've really done a lot to stabilize and fix our operations. Then R&D, under Yehia's leadership, he went out and really focused, I helped a little bit, on recruiting the best talent in eye care R&D and building capabilities across all of our different R&D organizations. Now we have 60 programs in R&D, all of them innovative. We got rid of all the me-too, copycat biosimilar work that was being done prior to our arrival. I think R&D is in a very different place.
Last year, in beginning January 2026, I said we have to add one more component to our strategy, which is financial excellence. That was the culmination of Vision 2027, where we really wanted to focus on maintaining that growth. What we said at Investor Day, 5%-7% top-line growth, but drive our margins from basically 600 basis points from 17% EBITDA margins to 23% EBITDA margins by the end of 2028. We've been at it for well over a year. It's been a massive structural change of how we run the business. It's a permanent structural change of how we run the business, and you're starting to see the results. You've seen it really flowing through the P&L through the last three quarters.
If you look at the first quarter, it was a very strong proof point that 178 basis points of margin improvement, 370 basis points of SG&A leverage, and good top-line growth. It is working. We have a lot of work to do, but I want to be clear, this is not a hockey stick program. This is a very consistent roughly 200 basis points of margin improvement every year for three years. You're going to see it this year, you're going to see it next year, and you're going to see it the following year. The plans are all in place, the actions are underway, and it's happening. I'm very pleased. At the end of the day, it's proven to me that our team can execute of growing the business, growing the pipeline, and reduce operational friction to get margin improvement. It's working.
Maybe we just get an opportunity to go into a little bit more detail on some of those drivers, maybe starting with the top line. You made a reference to outgrowing the markets that you serve. I think we can see that as we observe other companies in the space. Maybe we could just break down a little bit how you think, what's driving that relative outperformance, and maybe just kind of tick through the businesses, starting with vision care and then go to pharmaceuticals and consumer?
Yeah. It's always multifactorial. It starts with being able to supply the market. I won't spend a lot of time on that because it's not very sexy. People don't like to talk about it, but really building out manufacturing capability and efficiency. The two biggest drivers are field force execution and innovation. There's a lot that goes in between that, between medical affairs and marketing messaging and medical meetings and bringing the KOLs along. If you boiled it down to two things, it's feet on the street, knowing who to target with the right message, with the right offers, and then having great products that look and say, "This is going to help my patient." We've done a really clinically differentiating our products and having our field force execute with excellence.
Not this Monday, but last week, you had a session on contact lenses that you broadcasted in this community. It really struck me as, I was talking about it with someone on my team, that it just looks like these guys are really on offense here from a product perspective. Maybe just, was my interpretation accurate? Maybe just give people a little bit of the Cliffs Notes from that session and what you thought some of the takeaways were.
Yes, I'll ask Yehia to help me, but let me just set it up real quick for a second. You're right. Our focus is to be on offense, to take market share. Obviously, we considered defense, but I would say the vast majority of my time and then the team's time is spent thinking about market share gains and how to take it.
When you think about the contact lens business, we were playing catch up in daily SiHy. His team delivered a superior product in our daily SiHy INFUSE or ULTRA ONE DAY outside the U.S. We're seeing really strong results. I think Q1 was about 23% growth in daily SiHy. We were the fastest growing Q1 at 5% for the total contact lens market, and that's been consistent. Ultimately, this to have step change and be on offense, we need to drive meaningful innovation into the contact lens category. It's a category that hasn't had meaningful material innovation since 1999 when silicone hydrogel came out.
Yehia's team, I think, has done an amazing job figuring out how to solve for one of the biggest issues, which is end-of-day discomfort or end-of-day dryness of contact lenses, which is the number one reason people drop out of the category. About 20, 25% of newly fit wearers drop out in the first year because of it. He came up with Project Halo. His team came up with Project Halo. You want to talk about it?
Yeah, sure. Just speaking overall on the big picture, the guiding principle that we got from Brent once he became the CEO is that we want to invest in the four business areas. We want to grow all the businesses, not focusing on one area over the other. The second is that we have a lot of great infrastructure within Bausch + Lomb, and we need to utilize all these infrastructure from manufacturing capabilities or other capabilities in terms of research or development. The third one was focusing on talents. Really, this is a big area for us and was focusing on the best talents in eye care research and development to bring them and attract them to work with us. This is what we have done in principle as overall picture.
In terms of vision care in particular, I think the Project Halo actually changed completely the way we look at the contact lenses. Normal situations, when we put a contact lens inside the eye and the person goes all the day long exposed to a lot of environmental factors like air conditioning, wind blowing in the eye all the time-
Springtime
The contact lens itself lose part of its moisture. It becomes more and more dry over time. The idea that we are actually, and we developed this in our labs, is to have a contact lens that is bioactive. That means it interacts with the biology of the eye to keep the moisture inside the contact lens all day long. This is the HA. The HA is hyaluronic acid. It's a natural substance. It exists in our eyes, it exists in our joints, it exists in a lot of areas in our body. It has one particular characteristic, that it can actually hold water 1,000 time more than any other molecule. It can really keep as if you are putting a sponge in a water soaked, and you keep this sponge completely wet all over the time.
This is where the innovation that happened, is that we were able to produce the backbone of the contact lens is from HA to hold the moisture and the wettability all day long and addresses an important part, which is the end-of-the-day dryness for the contact lens, which is a very common complaint that we hear from contact lens wearers. Basically in testing, and we tested this in one of the external study recently, and we found out that 99% of the moisture of the lens is maintained over 16 hours of the day. Actually, also, we saw this translating into the comfort by the patients, as well as also in terms of lubricity. Just to give an idea what's lubricity, every time you blink, it's literally the interaction between the inner side of the lids and the contact lenses.
We were able to show with this HA lens that it had the least lubricity among all contact lens. This will also translate that you're not feeling with the contact lens as you're wearing it over the long day.
I know it's still a couple of years away, can you just remind us the remaining milestones between here and approval?
I think we are on track on the exact milestone as we calculated from the very early beginning. We concluded one external study early this year. We are going to conduct a second external study, which is based on what we learned from the first one to optimize. Next year, we are going to go for the registration studies. I think one of the most important things that we want to translate all the findings and the great things that we are finding in the expected studies into claims that we can do also for the lens as we are moving forward. Once we have the registration studies done, we can submit, we can get approval as planned on 2027.
I think one thing I would just mention, as you think about this kind of innovation, in 1999, silicone hydrogel, the innovation behind silicone hydrogel was oxygen permeability, right? ECPs or ODs, they were worried about the health of the eye, and they wanted to see more oxygen on the eye with the contact lens in. That's why we innovated around silicone hydrogel. It's now more than half the market, right? It's the preferred material. We were solving for a health issue with that, and it became the standard. Here, what we're trying to solve for, end-of-day comfort, is both a professional issue and the consumer's issue. The issue we're solving for, in my humble opinion, is much more important than the issue that was solved for by silicone hydrogel.
Well, it seems this is also not just an innovation opportunity for you. Is the market expanding as technology does?
Well, that's my hope. This is a technology that will expand the market, bring people who perhaps were fitted and dropped out, that 25% that drops out in year one every year, and we could talk about pricing, but price it to make it accessible to really take market share.
Okay. What is your latest thinking on the health of the contact lens market now that CooperCompanies's reported, and they expressed similar sort of broad trends to you around markets outside the U.S., but where do you think we are in kind of that historical 4%-6% range that most participants have discussed?
I think structurally the market is fine. As you said, the market, if you look at it historically, grows 4%-6%, so the average is five. Last year, the market grew at 4%, so it's at the lower end. At the beginning of the year, I said, I think at the JP Morgan conference in San Francisco, I expected the market to grow at about 4.5%. I think it's going to be somewhere in that zone, so it's going to be slightly better than last year. We're going to grow faster than that. There's always going to be parts of the world that have macroeconomic pressure, consumer pressure, that are going to be puts and takes, right? You're seeing that in Asia. It's not unique to the contact lens market. It's happening to the entire consumer market in those countries. I think the long-term outlook is stable at 4%-6%.
Okay. Maybe touch on surgical. Obviously, the business has seen some variability over the past year with the enVista recall. Maybe just update us on where we are? I think when you made pretty sharp doubts back last year, just maybe help us frame kind of the surgical business growth rate here going forward.
Yeah. I think surgical is a big opportunity for Bausch + Lomb. We've also had to do the most work in surgical over the last three years, right? When three years ago, we didn't really have a lot of innovation. We really did not participate at all in the premium category. We had toric lenses, but we didn't really participate in the premium segment. Now we have a very robust portfolio of IOLs, including premium. Our premium growth is strong. First quarter was 27% premium IOL growth, so much faster than the market. What we're hearing is our trifocal, in particular enVista Envy , which was launched in the U.S. first, is now launching globally or in Europe, is really good outcomes, good predictable refractive outcomes, and great patient satisfaction. I think we have a very strong performing lens.
More importantly, we're building a full portfolio, including equipment, packs, consumables. We'll have our ELIOS, our MIGS procedure launch later this year. We're becoming a really full-service provider to the ophthalmic surgeon.
Maybe we could dive into ELIOS a little bit. This is another one that you've had some news flow on and hosted an investor session. You get a lot of questions on ELIOS. Is this intended to be ELIOS versus iStent, or is this about market expansion? Maybe just frame your view on the positioning of ELIOS and how we should think about both the evolution of that product for you, but also how it fits into the market?
Yeah, I'll let Yehia answer a lot of it. Look, I think for us, it's about expanding the market and providing cataract surgeons with a best-in-class tool to manage IOP in patients that have cataract surgery. It's a very elegant procedure, very effective. We have very good long-term data. Reimbursement will be strong. I think it's set up for a really nice growth product for us. It's not much in the P&L this year, but I think in next year, in 2028, it will be a meaningful growth driver for Bausch + Lomb.
You want to talk about it clinically?
When we look first to the unmet medical need, obviously MIGS is the one area that's expanding rapidly in the glaucoma space. When we look to this area in particular, there are two categories. Either you put an implant or you leave behind a stent to maintain the intraocular pressure flow outs, or there are some other laser technologies. Usually with leaving a stent or a MIGS inside, there's usually a lot of complications that could happen from a misplacement, or could be some hemorrhage, or a lot of surgeons would not prefer that. When you are without a MIGS with a laser technology, you always look how patent the holes that you are making from the laser technology will be over time.
I think this is where ELIOS fits perfectly, because with excimer laser, you can have a very precise, clean cut stent holes inside the trabecular meshwork. This actually we followed up patients up to eight years now, and we have seen that the intraocular pressure lowering have been maintained and without the use of additional co-medications. In addition, there's a lot of surgeons are very relieved that they are not leaving behind any stent inside the eye that could cause any complications on the long term or even misplacement during the insertion. More importantly, I think the data have shown us from the pivotal studies over the two years period that the efficacy of intraocular pressure lowering first is decreasing by 23%-24% from baseline.
Second, that the proportion of patients are not getting back any co-medications is about 62% or 63%, which is big amount of patients. Third is on the safety side, we did not see a lot of the complications that could be happening with an implant. In terms of the surgeon population, I think we are targeting the cataract surgeons. We looked at the data, we found out that 50% of the cataract surgeons, although they can perform combined surgery, they don't perform it. This comes back to the learning curve for some of the procedures. It takes a lot of time. With the ELIOS, we solved a lot of this problem. In fact, we trained over 170, 180 surgeons currently. The learning curve is very fast. Many of them can perfect the procedure after two times.
The second is literally that many of them actually have found out that it doesn't add a lot to the surgery time, which is a very important factor for the cataract surgeon. It's approximately 13-14 seconds more to do create. This has added to us that this population that we would like really to target and start with, and this is our focus for the primary indication, which is with cataract surgery.
If you think about, you've talked about selling and commercial excellence is on the one hand, you might look at it as, say, from the outside, well, they have the surgical business, they can cross-sell here, but they also in other ways, you want to have deep product specialists. How are you thinking about the go-to-market strategy with ELIOS and how it fits with the overall franchise?
In the first quarter, we kind of reorganized how we work in surgical with more of a practice or account management focus, and then you bring in the specialists when needed. There'll be ELIOS specialists that will work with their account owners or practice rep, and they'll work together. For ELIOS, to be fair, I'm oversimplifying, but it's almost see one, do one. The way this procedure lines up is very natural for a cataract surgeon to do. It's not going to be a high hurdle, but we will have specialists for sure.
Do you go through a limited market release, a full market release process, or are you going to use AAO as the sort of coming out party for ELIOS? How should we think about when we start to see commercial traction?
It depends on the FDA. The file is in. We'll see when we get it approved. We'd love to use AAO if that's possible. We've also, as Yehia said, we've already trained some of the top surgeons. We can't take orders yet till we have an approval, but we have a lot of inbound interest in ELIOS, so our team is gearing up, and we'll be ready to go as soon as we get that approval.
Excellent. Maybe just closing out on pharmaceuticals. I mean, the dry eye market looks like it's getting kind of crowded. I think you've talked about, MIEBO market share being sufficient to kind of achieve your objectives with that product. How are you seeing that market unfold and how do you think about just sustainability of that franchise as competition intensifies?
I think about it perhaps differently. I don't think the market's crowded. I think that the market is still very under-penetrated. There's still a tremendous amount of Americans who don't treat with prescription that should. We're nowhere near saturated, or we're not even scratching the surface. I think with MIEBO and XIIDRA, we have the two best-in-class therapies that are differentiated that offer ECPs the best options to treat a patient with dry eye. We want the market to expand. In terms of new entrants, and it sounds weird for me to say this, but I welcome them because they expand the market. When you have the best two medicines, market expansion is we get more than our fair share. MIEBO is a best-in-class product and is becoming the standard of care for dry eye, and we'll keep working on that.
Of course, we have the combination therapy in development we'll get data on in the second half of the year. That will be the next really innovation into the market where you have a multifactorial disease, you tend to see combination therapy as standard of care.
Maybe we just toggle over just the broader strategy for a second. Think about your portfolio. You serve really all corners of ophthalmic health. You've also talked about M&A as an area of interest. Where are some of the categories or how do you think about just your broader M&A strategy and what you'd be solve?
First, let's just say from a capital allocation perspective, our number one priority is delevering. We put out a target of 3.5x leverage by end of 2028. We will meet that because that's priority number one. Look, we've been making investments in our surgical business to really vertically integrate and be able to offer a comprehensive portfolio to our customers. A lot of the rest of the investment is in, frankly, intellectual property and opportunities for Yehia's team to develop new consumer products, new contact lenses. We do on our own, but we still have our EDOF lens coming. We have our Stellaris, our next generation phaco machine coming. Of course, pharma.
We have a very rich pipeline. In fact, hopefully, around the turn of the year or early next year, we'll be talking to you about our early retina programs in particularly geographic atrophy, which are early but really exciting.
As you think about the pipeline that sits in front of you, it is under that umbrella of capital allocation. I appreciate there's always a balance between growth and profitability, and you want to achieve the 600 basis points of margin expansion that you've set out. How did you think about the balance between sitting on this, probably one of the strongest pipelines in the company's history, with making sure you fully extract the value from that pipeline? Maybe it's not versus operating margin expansion. How did you think about the interplay between the two?
The reality is Vision 2027 is 650 basis points of margin improvement, but 50 basis points reinvested back into R&D. The second thing that Yehia's team has done extraordinarily well is really deploy AI to shift our R&D expenditures to clinical programs. When we arrived, we were spending what? 70%, 80% on maintenance of business and 20%, 30% on new product development. He's turned that upside down. We now spend 70%, 80% of our R&D budget on programs or new product development and 20%, 30% on programs because we use AI to do maintenance of business, regulatory filings, pharmacovigilance. Your team's even at labeling.
That's where we're getting the efficiency. We don't expect the margin improvement to come from R&D. We expect them to develop more products.
I know you laid out some specific targets for kind of the shape of the P&L, it would seem like with this new product launch, as you get a good amount of gross margin leverage that funds that necessary reinvestment.
Yeah. Well, first, let's be clear. On the targets for 2028, the pipeline is completely incremental because the only pipeline product that's in the numbers is ELIOS because w e hope to have it approved this year. Everything else comes in 2028 and 2029 and 2030. It's all incremental growth and product. Take a product like Project Halo. Because it was intentionally designed to be made on existing capital equipment, unlike every other big leap forward in contact lenses where you have this huge capital investment that has to be made to build capacity, we don't have to do that.
On day one, that lens, regardless of where we price it, will be margin accretive to the contact lens portfolio. It sounds very easy to say, but what his team accomplished was extraordinary to come through with a breakthrough material innovation that could launch at a high margin and not require capital expenditures.
It's good because this way when you get to the 2030 LRP, you won't have all of us complaining about why can't you continue to grow 5%-7% few things beyond that?
Yeah, I mean, we won't bat 1,000 in R&D. No one ever has. I hope we do, but no one ever has. We don't need to. Any one of these programs is game-changing to our top line and to our margin. I hope they're all successful, but even if a few don't develop as clear as one, two, three and approved, because that's never happened in my career, I think we have enough shots on goal that we're going to be successful.
As you think about that shift in the R&D investment away from being able to be more efficient with sustaining engineering and making dollars into the new product development side, if you were to maybe even a little further in terms of, sometimes you hear these characterizations, incremental, substantial, transformational, I know some consultant came up with. How do you think about the mix of that R&D as your development investment?
Well, I think just from an overall picture on the investment side, I think one of the areas that we are focusing on is if we would love to have everything is a breakthrough, first in class, nothing like. The fact is, some of it will be like that. This is our focus. For example, the material that you mentioned, I think this will be very innovative and at the forefront of innovation. Some others will be best in class, and this is also one of the targets for us. For us, important two things, clinical differentiation and huge unmet medical need. These are the two moving needles for us or the compass for us to develop the new product. For example, we develop another program in vision care, myopia.
We're not the first one to try to halt myopia progression, which is going to be even a much bigger problem than it is currently. By 2050, expected 50% of the population will suffer from myopia. We are targeting here to be best in class. If we look to the pharma pipeline, we are trying to get also to be at the forefront of innovations. First, ocular surface pain. Pain is the most common complaint at the ophthalmic and OD clinics. Nevertheless, there is no targeted products towards pain. Always towards surroundings of the pain complaint. Second, also, if we look to glaucoma, if successful, it will be the first-ever product to lower intraocular pressure and show functional improvement for glaucoma patients who lose their vision despite the use of intraocular pressure lowering. Obviously some other areas like the combination therapy, it's not be the first.
There are a lot of other combinations, but it's the first combination in dry eye. For us, it's going to be the best therapy for the patients because normally dry eye, it's usually a combination of different factors inside the eye. This is the concept of developing, is trying to really look at differentiation and unmet medical need.
I mean, you kind of wrap this all up. There's an incredible amount of momentum that you have, both in the core business, but also what looks to be, on a much longer term basis, the potential to reshape some of the markets that you serve and take significant share. I hate to ask a stock question. At the same time, you've got this sort of boogeyman of the retained Bausch ownership, and I know this is something it's not really within your direct control, but how do you kind of contextualize that for investors and any sort of your viewpoint, how we think about this sort of accelerating momentum but then this sort of lingering overhang?
Look, I think I hear that question in every investor meeting I'm in. I understand it's on top of mind of investors. You're right it's something I don't control. What I do control is operational performance and strategy. My focus is the best way to support BHC is to have the best execution and grow the fastest, improve our margins, and drive the pipeline. Every day I wake up and go to bed thinking about those things and not really worrying about the ownership.
Excellent. That's a great place to wrap up. I very much appreciate your participation and look forward to getting the next update in July.
Great. Thanks for having us.
Thank you very much.