Craig Bijou, Medical Device Analyst for BofA . It's a pleasure to have RxSight here. From the company, Ron Kurtz, CEO, and Shelley Thunen, CFO. Ron, Shelley, thank you for coming.
Thank you very much for having us.
It's a bit of an abbreviated fireside chat, so I kinda wanna, you know, hit on the hot topics. ASCRS is obviously happened last weekend. You know, from what we've heard, there was a lot of buzz around you guys. You know, would just love to hear your feedback from the conference. You know, what the feedback from docs were, how does that compare to prior year conferences? You know, is there an acceleration and an interest in you guys and in your technology?
Yeah, well, thank you, Craig. I'd start off by saying that the ASCRS conference was very well attended. We heard from the organization that attendance was back to pre-pandemic levels and above 2019, that was good news. We certainly saw that on the exhibit floor. Our booth was busy for most of the time, and we had a number of presentations, both at the main meeting as well as in our booth. You know, overall, we've seen kinda continued growth and interest in the Light Adjustable Lens over the last couple years since we've been commercial. That's certainly was true again at the ASCRS meeting with just a larger presence. You went to a number of the main sessions.
Even if the LAL wasn't the topic of a talk, it was brought up as an option or as a potential solution for particular patients. That was nice, and that was reflected also in the booth. A lot of interest from both existing customers and surgeons as well as ones who are considering the technology.
That's great. I would love. You know, obviously your LDD, you know, the system growth has been very strong. LAL utilization also very strong. Love to kinda hear, you know, how docs are adopting your technology. What are the procedures, or what lenses are they kinda using LALs instead of in the premium market? You know, I guess, you know, how do you see that pattern of adoption? You know, once they do buy a system, you know, how much do they start using LALs as a percentage of their broader premium IOL portfolio?
Yeah. You know, I think that I'll start off by just saying that every practice is different, so it's very different. It's very difficult to generalize. However, over the last couple years, we've seen, you know, a general trend towards, you know, more interest in the LAL and faster adoption within the practice. Once a practice adopts the technology, especially now as we, you know, are into the customer profiles who are, you know, not necessarily the early. They're not the early adopters anymore. They're doctors who, or practices that are acquiring the technology because they've already observed how it's led to practice successes in their colleagues around the country. They're acquiring the technology to be able to offer it to as many patients as possible.
You know, they're coming in with that mindset, and then our team, our field teams are focused on making sure that they succeed as early as possible, and we've learned a lot over the last several years of commercialization. With respect to where patients are coming from, you know, it's interesting. The last couple years, we've done a customer survey. Actually, a third party has done a customer survey, and we've presented that at various meetings, looking at that question, where are LAL patients coming from? It's been very consistent the last couple of years that while we do, the majority of patients are coming from other premium IOLs, most of those, a large fraction of patients, about 40%, are actually coming from the monofocal market.
At first that might seem surprising. Why are patients who are not choosing a monofocal IOL with other premium IOLs, why are they choosing an LAL? If you look at the cataract population as a whole, about 40% of that population has some ocular comorbidity, some other condition that would make them a relatively less of a candidate for a multifocal IOL, which of course splits light and reduces contrast vision. Those might be patients who have had previous corneal refractive surgery. It might be patients who have glaucoma or other ocular conditions that already reduce their vision to some degree, and where you don't wanna add additional loss from a multifocal IOL.
That's, those patients are disproportionately becoming LAL patients and drawing new patients into the premium market. Again, we're offering for patients who otherwise would choose a toric IOL. About a third of our patients come from that group. We correct astigmatism about twice as well as a standard toric IOL, and also give the patient the ability to customize their vision postoperatively, larger value. The other patients who are coming from presbyopia-correcting IOLs, but may like the customization or the lack of optical side effects that are associated with multifocal lenses.
Do you, I mean, do you have visibility from, on a practice, you know, specific perspective on, you know, the percentage of LALs they do of their premium? I guess, you know, I know it varies by practice, but on average, are you seeing that gonna tick up? I guess what ultimately drives that increased percentage of, of what, you know, what lens they're using?
It's very. We don't have precise data on individual practices. The numbers that I mentioned to you, those are voice of customer.
Yeah.
You know, they're not based on quantitative accounting of what they're doing. You know, generally we, there's a range of adoption as you would expect. You know, a metric that the Street looks at and you can look at an aggregate level is the number of LALs per LDD per month that are being used. That has ticked up considerably over the last two years. You know, we don't manage the business to that number because it's an aggregate number, and we're really focused on at the doctor and the practice level, driving continued adoption. We don't.
You know, if a practice is doing five procedures, and we think that they can do more, we'll help them do more. If they're doing 20 procedures, we think they can do more, we'll help them do more for that as well.
Got it. Maybe that's a good segue. You guys reported Q1 results, yesterday. Just kinda, you know, on the seasonality patterns, you know, if you look at the numbers, you guys, you know, both LDDs and LALs, and, you know, the utilization was only down, you know, a minor amount compared to Q4, which, you know, was better than, you know, what we were expecting. But we'd love to just get a sense for how to think about that seasonality throughout the rest of the year on both the LDDs and, you know, the utilization, of LALs.
Okay. Yeah, Q1 was very strong for us. We sold 56 LDDs, and we ended the quarter with 456 installed base. The, you know, total number of LDDs year-over-year placed were up 40%. We had 10,523 LALs implanted, and that was up 153% from a year ago quarter. Of course, revenues at $17.5 million, which were up 96%, but also importantly up over 8% over Q4, which is typically your strongest quarter of the year, both for LDD capital equipment sales as well as for procedures. As we think about, you know, the balance of the year, you know, Q1 can be a little lighter than Q4, but we had a really great Q1, both on both sides of the business. Typically, Q2 is strong.
Q3 tends to be a little bit weaker, in that doctors are on vacation and patients sometimes are on vacation. Although this is an older population, right, 60 to 70, sometimes a little bit older and sometimes retired, they're still going on vacation with their families. You'll see that a little bit. Fourth quarter tends to be both the strongest for both capital as well as procedures. On the capital side, you know, at that point in time, the practice has really good visibility into their capital budget. They're gonna spend what they need to do to enter up the new year. Of course, there's a little bit of a backlog of procedures for that. We, because we've been relatively small, new to the market, we've been able to grow through that seasonality, right?
Typically, the way we look at it is what is the percentage increase from the previous quarter? You know, what we're looking for is sequential growth, certainly in the third quarter it'll tend to be maybe a little lower percentage coming off a good second quarter, fourth quarter, being the highest overall.
Got it. Helpful. Thank you. Couple of, I guess I'll call them topical questions, I think you've gotten them before. You know, the premium IOL market, there's been some noise about the strength of the demand, and I think it's more very sub-segment-
Right.
of the market focused. Would love to hear, you know, from a market perspective, you know, how is the premium IOL market, recognizing you guys are doing extremely well.
Yeah.
-you know, from a market perspective.
You wanna take that, Ron?
Sure. You know, I think what we always have to consider, the entire premium market. You know, in the U.S., the premium market consists primarily of presbyopia-correcting IOLs or PC-IOLs and toric or astigmatism-correcting IOLs, and then now adjustable IOLs. If we look historically, you know, the premium market in general has been much less sensitive to overall economic conditions than, say, other private pay ophthalmic procedures like LASIK, for instance, being the prototypical one. You know, if you go back both in 2000, 2008, LASIK, you mirrored the broader economic conditions almost exactly, and we were in that market in the 2000 range. The premium IOL market really hasn't.
You know, it's only been around for about 15 years or so, or 17 years. Even in the 2008, 2009 timeframe, you saw continued growth in the premium IOL space. What you did see is that, and sometimes this is misinterpreted because people focus on the PC or presbyopia-correcting IOL. You saw a leveling off of demand in the PC- IOL in 2008, 2009, but that really was due to the introduction of toric IOLs or astigmatism-correcting IOLs, which were growing at a very fast pace. The overall premium IOL market continued to grow.
What you also see is, and I think this is a more significant impact, is we've seen cyclical changes in the PC- IOL market as based on product cycle. Oftentimes you'll see, you know, new products introduced in the multifocal space on the promise that they're going to have fewer side effects, and therefore be more broadly accepted. Physicians will try those out. You'll see an increase in use, and then over a period of a year or two or three, the realization that those technologies still have the same side effect profile in there.
Then you'll see a waning and a movement to what we would call quality of vision. That would, in this context, we would see that as, you know, on the low end would be towards a toric IOL, and on the higher end, an adjustable IOL.
Yeah, can I just mention that, you know, this is a clinically driven sale, right? As well as the doctor and the practice having the opportunity to make more money in the patient pay segment. In addition, if you just look at the FDA comparative trials, our results are twice as good. Of course, John A. Vukich presented a paper at ASCRS with our latest phase IV data with 351 patients. Again, even though this is an all-comer, our results continue to get better. Patients have much better outcomes with our product, and we wouldn't expect to see this flipping around of product as well. With competitive products, there's no switching costs.
They can just try it out, whereas with ours, we do have piece of capital equipment, and they're committed to it. What they see is their patients are delighted, and they're getting the best results they possibly can. I think that we're not in that cyclical, you know, switching around that sometimes you see. Would you add anything to that, Ron?
No, I agree.
Okay.
Quality of vision ultimately wins out.
Great. Thank you, with that, you know, we're out of time.
Good.
Thank you, Ron, Shelley. Appreciate it.
Thank you for having us, Craig. Thank you very much.