Okay, great. Good afternoon, everyone. Tom Stephan with Stifel. Really excited to have RxSight here with us today. Ron, Mark, great to see you guys. Have about 25 minutes, so I'm going to jump right into Q&A. Sort of this first section of questions is more near-term LAL, and I'll start with the first quarter of 2026. Ron or Mark, for either of you, maybe if you can begin by talking about how LAL volumes in the quarter played out relative to expectations, notably as you think about puts and takes like the U.S. market, competition, weather, your commercial initiatives, et cetera.
I'm happy to take a shot at that, maybe Ron and I can tag team it a little bit. I'd say from a Q1 perspective, overall a good start to the year and pretty in line with our expectations, driven largely by LALs, which you mentioned. LDDs on a year-over-year basis still a headwind that we had to contend with, and what we expected coming into the year, obviously. Pleased with the volumes we saw in the first quarter. Nothing to speak of in terms of anything that was overly unique or any sort of issue from a weather perspective. I think you mentioned that in your question. Overall, pretty much in line, I'd say. Ron, anything else you want to tack on, though, to that?
Yeah, no, I think that, as you said, Mark, kind of what we expected, and we were overall pleased with the start of the year.
Got it. That's great. Zooming out a bit on the U.S. premium IOL market. Alcon did call out softer cataract volumes in 1Q, but also kind of concurrent with that was strong premium IOL penetration gains that actually imply by our math, U.S. premium IOL volumes may have been up on a year-over-year basis in the first quarter by high single digits, if not more. Are you guys, is RxSight seeing a similar healthy U.S. premium IOL landscape as you look at the environment so far this year?
It's obviously companies like Alcon that have more visibility on the overall market are in a better position to make those kind of comments. What we can see is that doctors are certainly focused on the premium IOL market. This is an area that they can try to resist the reductions in the reimbursed business that they've seen over the last several years, including this year. The premium space is at a high level of interest. The overall cataract market, as you noted, was down per some of the big players and third-party aggregators of data. We saw that last year, too. Again, it's a little hard for us to comment specifically about that. Does that reflect some different annual cadence that is developing? It's hard to know.
As you said, the impact of lower overall cataract volumes and at least maintained premium cataract cases is going to lead to a higher penetration just by default. Those will be things that we'll continue to look as the year plays out as we see potential impacts of macro conditions, et cetera.
Got it. That's great. To pivot a bit to competition. There were obviously new lenses at the end of 2024 and into 2025 that had an impact, a bit of an impact on LAL, maybe more from a trialing standpoint, and a free lens kind of sampling standpoint. This year some might argue there's more competition in the U.S. with PureSee rolling out, PanOptix Pro continuing to ramp, B&L coming back following the recall in the early parts of 2025, FineVision f rom BVI launching. Ron, maybe for you, as we sit here today, how do you view the potential impact of competition on LAL in 2026 versus what was experienced in 2025?
I think, Tom, what you're pointing out is something that's been a traditional way that fixed premium IOLs have competed, with new introductions of IOLs being leveraged through trialing and other programs to try to get changes in relative usage, especially given the market dominance of Alcon. Typically, what we've seen is that these things have a timescale to them. We saw that last year. There's initial interest, some would say hype, and then it kind of normalizes. At the end of the day, those fixed IOL offerings aren't bringing anything new to the table. They're bringing an equivalent technology, and not to minimize the importance of that for those companies to be able to offer equivalent technologies, but they're not differentiated in the same way that the LAL is.
Therefore, over time, we think that the clinical outcomes that the LAL affords is ultimately going to be what drives our adoption.
Got it. Mark, for you, remind us what guidance factors in, call it on the low ends, the midpoint, and the high end of the range with respect to competition. Does the midpoint of the range imply that competitive headwinds in 2026 are more subdued than 2025? Maybe if you can just give us a sense for what the company layers in terms of the competitive impacts this year on LAL.
Sure. Yeah, I think the range does reflect a variety of different outcomes from a competitive standpoint. Obviously, the low end of that total company guidance that we provided assumes more acute competitive headwinds and the high end assumes less so. It was set forth with the idea that could accommodate a variety of different outcomes, Tom.
Oh, okay. Got it. More acute this year relative to 2025 when you're talking about the low end of guidance, meaning does the midpoint imply that the competitive headwinds in 2026 are the same as 2025?
The expectation was at the time of setting guidance that there would be competition in the marketplace this year, and that I think it would be less of a headwind than we had to contend with in 2025.
Okay. Less than 2025 is what's factored into the midpoint.
Correct.
Okay. Got it. Perfect. Super helpful. Then, Mark, maybe sticking with you, or Ron, just on the second quarter of 2026, when I look at consensus, it implies essentially flat LAL utilization when compared to 1Q 2025, so on a sequential basis, despite a typical seasonality bump just in surgery volumes from 1Q to 2Q. Is there anything you're seeing or expect that would cause that usual seasonal increase from 1Q to 2Q to not occur this year for LAL?
I'm happy to take a stab at that. I think intra-quarter questions are always tricky, right? I don't think that's unique to RxSight. It's further complicated by the fact that we don't provide monthly or quarterly guidance. What I would say is that some of the factors that we've talked about already on this call, namely competition and the consumer, are things that we're keeping an eye on, and it's a very dynamic situation, especially from a macroeconomic perspective. I think we can all relate to that. Watching that carefully, anecdotally hearing things on doc calls, for instance, that the consumer is doing some belt-tightening and like I said, just monitoring that closely. Nothing beyond that I'd be able to share with you at this point in terms of intra-quarter trends, Tom.
Got it. No, makes perfect sense. That's helpful, Mark. I appreciate that. Then, thinking more long-term around LAL, I wanted to ask about the commercial initiatives. Ron, for you, can you just discuss a bit how the traction and success with the commercial initiatives that you implemented in the second half of last year are maybe trending relative to your expectations. What's working well, and maybe more importantly, what's proving to be a bit of a challenge, if anything?
I think that just by way of background, as you noted, mid-last year, we started to implement changes to focus on same-store sales, and to drive same-store sales as the growth engine for LAL, and have implemented a number of initiatives around that, both organizationally as well as programmatic. All kind of around the theme of providing more engagement with our customers and providing them with more tools to succeed with the technology. Both in terms of clinical tools, marketing tools. Some of those can be quite simple. The technology in and of itself provides an outcome measure with every procedure. Our technology works by measuring the outcome of the patient before and after an adjustment. We can provide that data to our clinicians. That is uniquely. Can't be really easily done with other technologies.
It's highly motivating because the clinical results are outstanding. What we've seen is that as we implement some of these programs, we're able to hone in on those ones that have the most impact, and that then puts us in a position to be able to scale those as we see the most successful or most impactful ones. That's the phase that we're in right now.
Got it. Really helpful. Appreciate that, Ron. Thinking about 2026, sort of the full year, I wanted to ask sort of about share. This year, I believe the midpoint of guidance implies low single-digit percent year-over-year growth in LAL, yet I would argue on a sequential basis in 4Q 2025 and 1Q 2026, you at least maintained, if not gained U.S. premium IOL share. Some nice recent performance at least. However, the low single-digit guide, again, at the midpoint likely does imply some share loss. Mark, maybe for you, talk about your level of confidence in RxSight taking share in 2026 and what the drivers are behind that.
Tom, we've never been overly focused on share. Our focus has always been on providing best-in-class outcomes for patients, and we think share follows naturally if we're able to do that. In a very short period of time, we've managed to take about 10% of the premium IOL market, and we're proud of that. We think that over time, that figure should grow as we continue to focus on outcomes, as I mentioned, and broaden the launch and adoption of this product, both here in the U.S. and eventually outside of the U.S. Over time, I think that is certainly something we aspire to and we see a pathway towards. I'd say share performance in any given quarter can be impacted by seasonality, competition trends, et cetera. Over the long- term, yes, we do anticipate that we can gain additional share.
Got it.
I would just add to that, just beyond strict volumetric share participation in the premium space, we're focused on two other things, which is growing the premium market. I think that if you look at the overall growth in premium that's occurred over the last five years, a lot of it is attributable to the LAL bringing in patients who either are coming from monofocal IOLs who didn't have a good alternative and now do, or converting from other premium IOLs, especially toric IOLs which are relatively low priced. When we look at "share," we also look at dollar value of share. If you do that, even today, we're at about 15% of the dollar share market in the U.S., so much higher than our volume percentage.
Continuing to build that higher level of premium within the space is important both for ourselves, but it's also important for our clinicians and practices as they start to hit their capacity limits. They want to focus on their most profitable procedures.
Got it. That's great. I think a good segue into maybe my last question on the LAL side, just on long-term share. Previously the company talked about becoming standard of care in premium IOLs. Mark, you mentioned it, but today you're 10% of the U.S. premium IOL market. Curious, Ron, maybe for you, if you can just talk about how RxSight views itself from an LAL growth standpoint over the next three to five years, or in terms of where that 10% share can go over that kind of intermediate term period. Importantly, what are the incremental catalysts that can help boost U.S. growth?
I would just maybe fine-tune a little bit the question, because I think the way that I've expressed it in the past is that we believe that adjustability is a standard that will become increasingly important in cataract surgery overall. That's because of the benefits that adjustability affords. We've been applying that with the LAL primarily in the part of the segment that focuses on quality of vision. Being able to provide both extremely high quality and refractive results and customization for patients that otherwise largely chose monofocal or enhanced monofocal or toric IOLs. That is the vast majority of cataract procedures, and again, that's where we're driving the overall premium growth. We'll continue to do that. There's a lot of opportunity to do that both here in the U.S. and OUS, as well as continuing to drive our product development.
Got it. That's great. Maybe in the last five, seven minutes or so, I wanted to spend some time on LDD. When we look at ASPs, they dipped a little bit on the LDD side in 4Q and 1Q relative to the earlier parts of 2025. Mark, a couple questions for you. Is that due to OUS distributor placements? Part two, can you give us a sense for how U.S. LDD placement pricing has trended in recent quarters as well?
Yeah. Good question, Tom. I'd say that, yes, you're correct in that LDD pricing dipped a little bit sequentially from Q3 to Q4, and as well from Q4 to Q1. Not out of line with our own expectations and what we communicated to the street, at least in terms of the dip from Q4 to Q1. Again, very much consistent with what we anticipated. I think it's commensurate with what you tend to see in capital equipment pricing in general, in that over time there is some drifting lower of ASP, and that's what we had factored into our assumptions. Not so much a reflection of OUS placements, especially late last year. I think as we go through the year, that has the potential to become a bit more of a factor.
As you look ahead to 2027 and as we ramp up our OUS launch, then I think that's potentially something to take into account. Thus far, it's more a reflection of the first thing I mentioned, just overall capital equipment pricing trends more than anything.
Got it. Makes perfect sense. Then on U.S. LDDs, the placements, LDDs of late have moderated a bit with the commercial shift focusing on same-store sales growth. Is it fair to think about LDD placement domestically as somewhat, I'll call it like deliberately measured and maybe not reflective of the true end market LDD demand? Maybe I'll start there and then I'll have a quick follow-up.
I don't know if measured is the right word, but certainly there has been a greater focus on account readiness and long-term success of the accounts that these LDDs are going into, and that's something we've learned over the years and have trained the teams in the field to really focus on. I think we've seen now again, three quarters of pretty consistent LDD sales, and that's Q3, Q4, and Q1 of this year. Our expectation is that continues, and that's consistent with the guidance that we had given earlier this year. You're right, our focus has been and will continue to be the same-store sales and the pull-through of LAL volumes in conjunction with these placed LDD units.
There will still be some, obviously, sales of LDDs going forward in the U.S. and also OUS, and Ron mentioned this earlier, where we're just starting to build that foundation and establish a presence in some of these key markets.
Got it. That's great. Last one on the LDD side. Mark, you've given some color on how to think about 2026 placements. More broadly speaking, Ron or Mark, for either of you, what will you be looking for in the U.S. that'll start to try to re-accelerate LDD placements? Is it certain utilization that you're trying to get back to? When can we expect maybe U.S. LDD placement focus to, again, re-accelerate?
Yeah, I think, actually, Tom, I think you've pointed out in the past that, and this is certainly our experience, that next wave of LDD acquirers or technology acquirers is always looking at who just came before them and how successful they are and how they've been able to implement the technology. Our focus has been, as we've been discussing, providing those success stories and making them applicable to that next group of acquirers. I would expect that cadence to go forward as well. That we're focused on making our current customers and recent customers successful as we establish that naturally will follow for additional growth and driving additional growth in the LDD base.
Perfect. Makes sense. I'll squeeze in one more question. Mark, for you, just on operating expenses, now expecting 2026 to be at the high end of the initial range. Can you discuss, I guess, if we should be interpreting that slight shift as more proactive from a position of strength as opposed to reactive to perhaps lower than expected demand? Maybe if you can just kind of contextualize that sort of slight change in the OpEx expectations for this year.
Sure Tom. I think it's more a reflection of us trying to be proactive and from a position of strength and taking a more deliberate approach to our investment and focusing it on our commercial strategy, which Ron talked about earlier. I think it does reflect the level of support that we think is necessary and required to scale LAL successfully, which we're obviously very committed to. I'd say more than anything going forward, we're definitely focused on continuing to balance our investment with discipline, but our priority, as you would expect, is to reignite the sustainable top-line growth. Again, that we think is largely a function of LAL sales. I think the benefit of that investment strategy shows up over time in the form of utilization, stronger account productivity, and a broader global foundation over time.
Perfect. All right, guys. Well, Mark, Ron, thank you so much for participating again this year. Always great to catch up and looking forward to speaking soon.
Thank you, Tom.
All right.
Thanks, Tom.
Have a good day. Bye.