Okay. Hi, everyone. I am Simran Kaur. I am one of the med tech analysts here at Wells Fargo. I am pleased to host RxSight for a fireside chat this morning. With us from the company are CEO Aziz Mottiwala, CFO Mark Wilterding, and VP of Investor Relations, Oliver Moravcevic. Okay. Aziz, when we last spoke, you had only been in the CEO seat for about 2 weeks. Now that you have spent more time with customers and the organization, what is your diagnosis of what went wrong at RxSight, and what are the most important changes you need to make to get the business back on track?
Yeah. Well, first off, thanks for having us, and delighted to give an update on how things have been going. As you highlighted, the last handful of weeks since I have started, I have spent a lot of time out in the field talking to customers. It is probably where I spent most of my time really understanding the business and understanding what is working and what is not. I think I always start with everyone wants to talk about what is wrong. I think there are a lot of things that are going right as well, and I maybe start there. When we talk to customers and clinicians that are using our Light Adjustable Lens technology, what we hear pretty clearly, almost every single physician I talk to talks about the outcomes, and the fact that this device, this lens, gets outcomes that they cannot get anywhere else.
That is really the foundation of where we believe the long-term success of adjustability lies is the fact that it consistently delivers great outcomes. The other thing we hear is that they see an opportunity to continue to expand the types of patients that can benefit from Light Adjustable Lenses. We know that cataract surgery is the number 1 surgical procedure in the United States. It continues to grow, and we believe that patients are becoming more and more discerning. That is what we are hearing from clinicians, that the patients are more demanding, and they are going to want even better outcomes. That is where they see the opportunity for adjustable lenses. T hat gives us a great foundation to think about where we want to take things long term. Now, obviously, we are not where we want to be.
As you highlighted, there are some opportunities there, and I think they really lie in a few areas. One is when we look at the company as a whole, I do not think we were fully resourced to shift from this early trial of adjustable lenses into deep adoption. So one big focus is going to be orient the organization commercial footprint to driving depth of utilization with our almost 3,000 surgeon user base. Secondly, I think there is a bigger opportunity for education around how adjustable lenses get really unique and differentiated outcomes versus any other premium lens that is out there. T here is a big platform for education. Third, there is an opportunity for practice integration, talking about how you manage patient counseling, how you manage cost and economics. This would address maybe some of the barriers or perceived barriers that you hear out there.
The last thing we hear is that if I can magnify what I hear from doctors, their personal experience, if we can take that peer to peer and get that out there and being shared on the podium at conferences more broadly, I think that would have a huge impact on the utilization. We said it on the earnings call a couple of weeks in, the most profound thing I find, and what's really intriguing to me as I've moved in the seat is when you talk to surgeons, they say if they were going to get a cataract surgery, they'd get LAL. If they were doing it on their mom, their dad, or their friend, they'd do LAL. That perception is real. However, it doesn't play out as well in the marketplace, and that disconnect is something that's really intriguing and an opportunity for us to uncover.
Got it. That's incredibly helpful. Maybe just on the utilization point, I think one thing that may have concerned some people was that utilization in your most mature cohorts, the early LAL adopters, seem to almost plateau, if not decline towards the last few quarters. How are you communicating this message to those early accounts specifically? What's been the reception there?
Yeah. In actuality, some of the early accounts are doing still quite well. Right? Obviously, you can imagine the first people you talk to are some of your heavy users and early adopters, and I would say that many of them are actually still growing. I think when you take a step back, I think the impression that people have is when we look at the overall utilization across the base that we have, I've seen some flattening and some decline year-over-year. I think that's more sort of in that middle-of-the-pack user where we haven't really solidified the true patient opportunity. I'd say almost every user is going to use it in the most obvious patient, say, like a post-refractive patient, someone that's had, like, a LASIK or PRK surgery earlier, now they're coming in for cataract surgery.
A lot of folks use that, but then they think about who is the incremental patient. Our early adopters actually have expanded beyond that. They're thinking of patients that would otherwise not convert to premium. They've got a great system to convert them to premium with LAL. They might think about LAL versus, say, potentially a patient that might be otherwise a candidate for an EDOF lens, or maybe somebody that maybe came in thinking about a multifocal, but they're actually a better candidate for LAL.
We see those patient types and that pattern really nicely applied in our heavy user base. I think the opportunity is actually to take the experience where we're still seeing growth and upside in our early adopters, heavy users, and translate that into the next stage of users and almost create a playbook for the early users so we don't get that stalling effect from that early trial where people get excited, use it in some of the most obvious patients, and then sort of plateau. That's really the crux of what we said earlier, which is the company did a good job at getting that early foothold, but we really didn't have a plan on taking it from the early foothold to the broader patient opportunity. That's where we're going to spend a lot of our time going forward.
Got it. That's helpful. I guess that goes into one other question that I had was most ophthalmologists do agree LAL is the best technology for that post-refractive, post-RK patient. Maybe just to put a finer point there, is the opportunity more about leaning into and really owning that segment? Is it doing that and expanding beyond that into these other populations that you think RxSight can really, or LAL can really win that patient segment, aside from other technologies where a surgeon might concede something else is better?
It's one of those yes, and opportunities, meaning, yes, we should absolutely own the post-refractive patient. We're the only IOL that actually has no contraindication for that. It doesn't necessarily hold physicians back, but when you look at the actual labeling, we've actually had that removed as a restriction. That gives us an opportunity to own that segment for sure. I think that in talking to some of the clinicians I've talked to, speaking to a colleague that I've known for a long time in Florida recently said, "Well, if I'm using it there in that post-refractive patient, which would otherwise be a challenging patient for a multifocal EDOF, why wouldn't I use it on maybe a more straightforward patient?" Right? I'm getting great outcomes in a difficult patient. Why not get even better outcomes in a patient that's not as difficult?
Why only reserve this for these patient types? There's a huge educational opportunity there. We've got evidence that supports it. I give the other example is we're seeing a lot of uptake on EDOF lenses, and when you actually look at the visual performance of an LAL, it performs as well, if not better in some regards in terms of distance vision, and you can adjust for that near vision. Y ou actually can yield potential higher rate of spectacle independence, meaning lower percentage of patients having to wear glasses post-surgery. That's an example where you can translate what works in a very specific segment, like post-refractive, which is technically a more difficult case to maybe a broader patient opportunity.
Got it. We have always heard the clinical outcomes here are great. RxSight LAL adjustability is sort of the next frontier in this segment, in this technology. But one of the or 2 of the main areas of pushback that we typically hear is that there is a number of follow-up visits, high chair time, and then higher cost. Of course, none of these are new, but are you addressing any of these obstacles in a new way?
We talked about earlier, one of the areas of focus is what we call practice integration, which is essentially addressing these 2 perceived challenges. When we talk to early adopters and some of our heaviest users, they do not see these as barriers, right? They have optimized for the chair time. They have got an optometrist on staff that can do the adjustments, that can do a lot of these things. They can schedule this in clinic blocks where it is not interfering with surgical consults. It is obviously, if the surgeon is not doing it, the optometrist is doing it. It is not taking away from surgical time.
T here are ways to optimize the practice to really manage the patient flow. From a patient's perspective, if they can get a tailored outcome, they are more than willing to come back and make the visits to get exactly what they want. You are only getting a cataract surgery technically twice, right, but once in your life, across both eyes. So they are willing to make the commitment, and they are actually, regardless if it is a LAL or a multifocal or another premium lens, they are paying a high amount of money out of pocket. If they are going to make that investment, they are willing to make the commitment to get the outcome they want. So the practice integration and chair time is just about educating and building a playbook to make it easy for practices to figure out how to manage that.
From a cost perspective, I think that is much more of a perception than an issue. The reality is that because of the differentiated outcomes, physicians are actually able to charge a little bit more for LAL, and the physicians that really get this, it has actually transformed their practice. I was talking to a surgeon in Texas last week, and he said, look, he has been using LAL for about 2 years. He said prior to that, he did really well, but since he has adopted LAL, and it is his sort of first go-to for any premium lens, it has transformed the practice economics. He does better. He is able to charge a little bit more of a premium. He is able to absorb the visits because he has tailored the practice around it.
Patients are super happy because they are getting great outcomes, and the practice is doing exceptionally well because the economics are actually very favorable for the lens. I t is an example of where you can take something and say, "Oh, well, it is a little bit more expensive," but you are getting so much more value out of it. How do you customize that to the patient? From a patient perspective, it's at the margin, right? The willingness to pay. Once they've already made the decision to have premium surgery, the willingness to pay is pretty open at that point, right? $1,000 or $500 per eye here or there is not going to make a difference. They're actually going to then say, "I just want the best outcome if I'm going to make the investment.
Got it. That's helpful. On the Q2 call, you said the business was running a little better than prior quarters, early in Q3. Has that trend continued, and what are you seeing in the business today that gives you confidence or concern?
Mark.
Sure. Thank you as well for the invitation. Appreciate being here. I think what we said was that the business was tracking with expectations, and furthermore, that the feedback that we were getting from customers was very, very good in terms of the outcomes, the technology, the overall experience, et cetera. That too was quite positive. With respect to the quarter itself, kind of hard intra-quarter to give specifics, as you can imagine. September is an important month for us and for most, I think, in the third quarter as you're coming out of that kind of summer slowdown. We're watching that closely. We'll give a full update when we report Q3 results in early November.
Okay. Maybe Mark, if I could put a finer point on this. The prior team's framing had core sales down sequentially in Q3 and recovering toward Q1 levels in Q4, which would imply about flattish year-over-year growth in Q4. That was their view before Aziz arrived. From what you've seen so far, does that still feel like the right way to think about the business?
I think with respect to Q3, as I mentioned, there is typically some seasonality, and we anticipate that being in place this year as well. As far as Q4, I think it will be informed by what we see in September and the momentum that we exit the quarter with. We will be kind of using that as a basis to guide our expectations for the fourth quarter. To be clear, this is more about the longer term, not the next 1 to 2 quarters. I think some of the work that we are doing as we go through this assessment, which Aziz has talked about, is with the intention of positioning us for long-term growth.
So, focused on getting our U.S. business back on track and in the right trajectory, very focused on continuing to build this internal pipeline of products that we have been talking about more recently. Then third, I think, is really making sure that this collaboration agreement that we signed with Alcon in July goes according to plan. T hose are really our main focus, I would say, as we think about setting ourselves up for next year. But with respect to the remainder of this year, yeah, seasonality in Q3, and then we will see how that plays out and informs our vision on Q4.
Okay. Fair enough. But maybe as we do think about the remainder of the year and next year as well, one thing the prior administration has been consistently surprised by is competition. Competitors have gotten better, and TRULIGN has clearly had an effect. What are you seeing from competitors today, like PC-IOLs, and how are you thinking about new competition like EVO ICL and beyond?
Yeah, I think, to me, this is an area that as I have come in, that just quite openly, we can do way better, right. We can do significantly better in terms of how we plan for this. We know the IOL market is a competitive market. That is not new, right. New IOLs come out every year. W e need a plan for that. We need to be ready for that. We need to really position LAL as its own segment, and I think this is the biggest opportunity we have. When you look at new products coming out, where they are in terms of the innovation, it is incremental, right. The next IOL by any company is marginally better than the prior, and nothing that is being launched today can even touch the outcomes and tailorability that adjustable lenses have.
We really need to carve ourselves out and say, "Look, this is our own category." There's adjustable cataract surgery, and then there's everything else. If a new EDOF or a multifocal lens comes out, it's cannibalizing existing multifocal and EDOF business and not touching the LAL segment. I do not think we have done a good job of that today. We have sort of lumped ourselves into the whole premium category. Quite frankly, it's a disservice to the technology because, as you mentioned, when you talk to doctors, they will be the first people to tell you, "This is very different." We need to continue to hammer home that component that this is very different. I think that will allow us to, over time, and we are not there yet, but over time, insulate ourselves from these ebbs and flows that you get.
What we are seeing is because the market is moving to marginal, incremental innovation, I think companies are getting more and more aggressive about their launches. They are providing more free product at trial. You are seeing physicians, "Hey, I am going to give something a shot because I am getting it for free." The good thing about that is that is transient. They are going to go through their 10 or 15 free cases, and then they are going to move back to their normal behaviors. Even in those situations, we need to do a better job of carving out who are ideal patients, who are patients that, no matter what, should get LAL, and how do we make that segment disproportionately favorable to the technology we have, given the outcomes we deliver.
Got it. I guess how are you communicating this message to accounts that you do share with some of the larger competitors and the other IOL technologies in really differentiating LAL from other IOLs?
Yeah. I think this is part of a broader strategy, as Mark articulated, that we're formulating right now. As I said, I don't think we're there today. Been in the seat for about 6 weeks, so some more work to do for sure. But these are areas that I think you're highlighting are big opportunities for us. I think as we're diagnosing and understanding this, as Mark mentioned, our focus right now is to orient the business, get the right team in place, get the right structure in place, employ a strategy that's more durable to address these things, right? To address the perceived barriers in the market, to address the potential of competition in the future, to uncork the full potential of the technology, and really harness the fact that doctors love this technology. Like as you said, they say it's the best.
How do we have a robust strategy that's really focused on driving depth of utilization and then addressing each of these things? That's where we're spending our time today, and I think what folks can expect is, as we get into early 2027, we start to provide a glimpse of what we believe the year is going to look like when we resume giving guidance. I think that'll be on the back of here's the robust strategy and plan to address each of these things. I think you're calling out the right things. I think we see those as key opportunities and some early thinking on each of these, but more to come.
Got it. And there will be a plan to provide formal guidance on the Q4 call for 2027?
Absolutely.
Okay. Good to hear. Your pipeline is one thing that you mentioned earlier, and I think the Street and investors were very excited to kind of hear more from the company about things that you're working on and things that you're working on with Alcon. You have your internal pipeline products and the Alcon agreement. Do you think you need these new products to grow the business again, or are there things you can do before they come to market?
Yeah, I think those are mutually exclusive in the sense that the core business as it sits today has tremendous opportunity, and we believe that we can get that back on a growth trajectory. I actually think it's part of the strategy, is to continue to build the value of adjustability in the marketplace so that our future pipeline, our next-gen lenses, as well as the Alcon collaboration, can actually bear more fruit. I think these are both indicators. The excitement we're hearing from the clinician community around the next gen, the partnership with Alcon and all the positive feedback there are indicators that the market is moving towards adjustability. I think it goes back to one of the first things I said earlier was, patients are going to be more demanding.
I think that's what you're seeing, and patients are going to want more tailored outcomes, and we have an opportunity to help move the market that direction. We have that opportunity to do it with our current business and addressing all the things that we've talked about. The next-gen lens will allow us to do it in 2 ways. One is expand the potential patient population. There's some unique things in the design that can actually open up the funnel to more patients. Our other intention is to make it even more streamlined to get the outcomes, potentially reduce the number of visits, make the device even more surgeon-friendly. When you look at the Alcon agreement, this actually transforms the market long term, and it can actually allow us to penetrate the largest segment of patients.
When you look at the premium IOLs, and presbyopic or PC-IOLs, Alcon owns over 50% of that market share. If you think about it, all of a sudden now that has the potential to have adjustability. Right? When you think about the Alcon deal, I think a lot of people did the math on the upfronts, which are great. Right? A total of $200 million before we even sell anything, and then a 30% royalty. If you look at comps, I think what this tells you is the comps of the royalty and the upfronts are profound. They're probably almost 2x average med tech comps for these types of licensing deals. I think what that underscores is that this is the future.
This is a large strategic saying, "We need to be in this space, and we're willing to pay a premium to partner with the best people in the space." From our perspective, this allows us to get an infusion of capital that can be invested in the pipeline, invested in getting this to market sooner, and in the long term allows us to get a share of that upside. You get a 30% royalty and access to now over 50% of the TAM in premium cataract surgery, which is, I think, a little bit underappreciated when people are looking at the deal value. I think that's a big lever for us long term in terms of value creation. To go back to your critical point, all those things are predicated on us doing well right now and executing and driving adjustability now.
But the way I'd frame it for folks is grow the U.S. business near term, accelerate the next-gen lens development, and then the Alcon deal is a long-term opportunity to completely transform the cataract surgery market.
Got it. I think you've talked about these products being in the midterm. Could we start seeing these products come to market in 2028?
We haven't been specific yet on the exact timelines. I think as we announce this, we're fleshing out the development plans. You know, you've got to get these things to proof of concept and get there. Obviously, if I can get them out there as soon as possible, I would. And I think the guys at the office are tired of me saying, "Hey, how quickly can we get it?" So, I'd say more to come in terms of definitive timelines. We want to make sure that we put out timelines that are thoughtful, aggressive, but attainable. T hen as it pertains to the Alcon deal, it's a collaboration. So you are working with another party. T here's some coordination you have to do in terms of how we come to market, how we build that as a team with our colleagues at Alcon.
So more to come in terms of the timelines, but yeah, you can imagine, I'm not a patient person, but I want to get it right.
Okay. Fair enough. M aybe just back to kind of the prior question. It does sound like there is a path to return to growth in the U.S. and have some sort of sustainable or durable growth before you have these products come online. I think the prior administration believed that LALs could reach over a majority of the premium market. You referenced Alcon currently has a majority share of the premium market. Help us just reconcile kind of where you're able to reach as a standalone company before you have this Alcon agreement really kick into place and those products out there in the Alcon bag.
Yeah. I think you have to be really thoughtful in this situation, right? We see a product that has great potential. But I also think we have to be realistic about where the business sits today, right, which is flat to declining, and there's a lot of work to do to get it back on growth. Yes, can we get it back to a positive growth trajectory? Absolutely. But it is going to take a little bit of work, right? We're talking about a very robust strategy. It sounds straightforward, but you're orienting a complete commercial footprint, complete commercial overhaul to orient to this. This is what essentially was missed. I think the team did a great job prior of building that initial trial, building the initial trained user base very quickly.
The way I categorize is we just didn't shift gears soon enough to go to depth of utilization. To do that now and to do it in a way that, to your point, would be durable and allow us to grow for the long term, I think is going to take a little bit of work. To answer your question, what does that look like long term? I think that from a credibility and realistic standpoint, we need to focus on can we get 2027 on a positive growth trajectory? Can we get 2028? I think it's about consistently delivering, and then once we get that trajectory, having a better line of sight on what the full potential is. W e're really bullish. I'm excited about the potential. It's just a matter of time and making sure we're executing the strategy in a very thoughtful way.
I want to be ambitious, but I want to be really thoughtful near term about putting one foot in front of the other and saying, "Okay, let's get this on the right track. Let's build the credibility back, and then we can think about what the full potential is.
Okay. Can you return to year-over-year growth in 2027?
I think you're going to find out when we provide guidance in early 2027.
Okay. Fair enough. Maybe just help us think about key puts and takes for 2027, as investors are starting to look towards a year where it's really kind of under your helm. It feels like some of these commercial initiatives and things that you're doing to rightsize the business will really kick in. H ow should we think about utilization kind of starting to grow back again and what it looks like across both LDD placements, LAL volume growth, and even the international business, which has really started to flesh out, I think, this year, but really should start to ramp, I think, next year and beyond.
Yeah. I think the first and foremost thing is from a business perspective, I think the opportunity lies for us to be much more focused. I think what you're going to see is, as Mark alluded to earlier, just a sharp focus on LAL sales in the U.S. As it pertains to LDD, we'll still get some incremental LDD placements, but the focus is on repeat LAL utilization. That's it. If we sell LDDs, great. But we have a great user base. The user base we have already accounts for the vast majority of premium cataract surgery. I don't need to sell more LDDs to grow the marketplace. I just need to get into our current user base more often, more frequently, and execute the strategy we talked about. Number 2 is we want to advance the pipeline, and number 3 is Alcon.
Things like international are great tailwinds and opportunities, but I think a business like ours is going to benefit from just a sharp focus near term, get the U.S. business back on track, get next gen on a good trajectory, and make sure we nail this Alcon agreement and get to that proof of concept milestone as quickly as possible. Very simple strategy in terms of contextualizing 2027. I think we believe that we're putting a strategy together that will allow us to grow in 2027. I think there's a lot of work to be done to get there. I think that when you hear the physician base, when you hear all the dynamics in the market, that's very feasible. What are some of the maybe puts and takes on the opposite end? Look, we're making changes here at the end of the year.
The first quarter tends to have a lot of headwinds in terms of seasonality, patient willingness to pay when their deductibles are still there. So you're kind of coming into a big period of transition and then moving right into one of the toughest quarters of the year, the first quarter. I think it might be a little choppy there, but I think as we get further into 2027, as we have a solid commercial footprint, executing our strategy, I think we'll be on a much better trajectory. I think the fact that we're going to be really focused will benefit us in that.
Is it maybe fair for investors in the street to think about 2027 as sort of like a first half and a second half story as you work through some of the choppiness that you mentioned early on in the year and as some of those initiatives and the strategy starts to play out?
Yeah, I think I want to be thoughtful right now. I don't want to put guidance out there. Mark is going to kick me from his stool here. I think, when we get out there in 2027, we'll paint the picture of what to expect. So I want to be really thoughtful. I think what we're trying to do today is say, "Hey, look, we've got a plan. It's going to take a little bit of time. We believe it's going to be in a great spot," and more to come as we get to that. So, I know it's a little challenging.
Everyone's. Believe me, I would love to have every answer today, but I think that we want to be thoughtful about when we give those aspects and give people what to expect, that we have a lot of confidence behind it, that we can stand behind it. I just want to be really thoughtful about executing on our commitments at this point. I think that's an opportunity for the company. I think when you look at the choppiness over the last couple of years, that's been a big gap for us. One of the other factors I think as a management team we're really focused on is our credibility and our ability to deliver on what we say we're going to do.
That means we have to be really thoughtful about what we say and when we say it so that we can truly deliver on it.
Okay. Fair enough. Maybe just how are you thinking about the international opportunity? Is this more or less of a priority for you compared to the prior administration? I think the company, like I said before, has talked about international becoming a more significant contributor in 2027. Is that still the case?
Yeah. We haven't given specific guidance on what percentage and mix is going to be in 2027. I think when you look at international, there's tons of patients out there. Physicians are really keen on adjustability. They see their success that the U.S. surgeons are having, so there's great demand out there. The question is timing and when and how. I'll go back to my prior comment of, I think we'll benefit from a lot more focus. In terms of a prioritization, the first and foremost priority is get the U.S. business back online. If we do well there, then we can start thinking about incremental markets. As it pertains to where we sit today, I don't think that we'd be able to execute to the volumes we'd want internationally without really focusing on the U.S. business first. So there's a hierarchy of importance there.
It doesn't mean international is not an opportunity, but I think our first and foremost priority is U.S. business.
Okay. Correct me if I'm wrong, but I think on the last call, you said you've approved plans to double the U.S. sales force without a meaningful increase in OpEx. Just help us understand how you're thinking about the footprint of the commercial force, the strategy that you're putting in place there, and what's allowing you to fund that investment.
Yeah. I'll talk about the strategy, let Mark talk about how we're funding it. The idea is, first and foremost strategy is to go deeper in the accounts we have. The first thing you need to do to drive depth of utilization is be in front of the accounts more often. Frequency is the first lever you want to be able to execute on when you're driving a depth strategy with your user base. T hat's the goal with increasing the sales force size. Essentially, you've got a whole clinical team that's out there and then doubling actually the people that sell. W e're doubling that team. What this means is the territories get smaller.
Each person is responsible for fewer doctors, so they can get to those doctors more often, pay more custom attention, be in the practice, start educating the practice more purposefully, versus having to spend a lot of time in a large territory, large geography. Y ou're able to spend more time, higher frequency. You get more efficiency per person because they're not traveling across a large geography. If it's a smaller geography, we call it windshield time. Less time in the car, on a plane, more time in front of customers. T here's really 3 benefits there. You're in there more often, you're able to spend more time with the practice, and you're getting more efficiency of the sales rep time. Those are the 3 things we're employing, and that's all force multiplied into driving depth of utilization with our user base.
This group of people is going to be in existing accounts saying, "Hey, here's the next patient type. Let's talk about, okay, you're using post-refractive. Let's talk about a potential patient that would have not been in premium. Let's talk about a potential patient. You're thinking about a multifocal and why an LAL might be better for that particular patient." T hose are the types of conversations we can have if we're there more often. In terms of the economics, I'll let Mark speak to how we're doing that.
Yeah. Aziz has been a tremendous thought partner as we think through this. I think it comes down to resource reallocation and allocating resources to what we think is going to help us ultimately grow our LAL business the most. I think more holistically across the organization, there are certainly opportunities to be more disciplined and to introduce some more rigor into how we think about our expense base and our resource allocation. A gain, that's part of the assessment that we're working through now, but certainly some opportunities there and something that we'll go into more detail on as we progress through the year and into next year when we give 2027 guidance.
Yeah, I think just to reinforce that with Mark too, just to be clear, all the things we're talking about today, I actually believe we can do it on a much more efficient cost base than we're doing today. T hat might take a little time to step into, but I think we can be more rigorous and disciplined in our capital expenditure and being a little bit more thoughtful about how we're making investments into areas that are really going to move the needle for us. I think what to expect longer term is executing a strong commercial strategy, building a strong and robust pipeline, capitalizing on a great partnership opportunity, but also doing it in a more disciplined and thoughtful way in terms of resource allocation.
Okay. That's helpful. Maybe just on margins here. What are the key puts and takes that we should think about in 2027, but also beyond, as we start to think about the Alcon contribution? It sounds like a lot of the focus is going to be the U.S. business. I f the Street should be taking into account any international mix there and just maybe some of these efficiencies it looks like that you're starting to put into place, is that something that'll show up on both the gross margin line and operating margin line, or should we think about one or the other?
As Aziz started out the conversation talking about the things that have gone right for us as a company, I think when you look at the P&L, certainly margin is one of those things. A company that can generate gross margin in the mid 70% range like we have is pretty extraordinary. Our focus is on, at a minimum, maintaining that and looking for opportunities to improve over time. I do not know that it will be linear growth. There may be some puts and takes and ups and downs, but certainly that is something that we want to maintain at a minimum. I think when you look at the mix of our business as we do focus more on LALs, which are inherently higher margin, you should have some opportunity for that.
I think the other part of the P&L that we have not touched on yet, but that has been a positive, is our balance sheet. We have got a phenomenal balance sheet. We exited Q2 with about $210 million of cash, and we have got $60 million that came in from the Alcon collaboration agreement. B ack to Aziz's point earlier, really thinking through that thoughtfully in terms of resource allocation and deployment is another area of focus for us as we think about the P&L going forward.
Okay. Do you see a path to break even with the cash currently on the balance sheet, or are there scenarios where additional capital could be required before you get there?
That is the goal. We have not laid out a timeline for that, but our expectation and our anticipation is for break even at some point in the future.
Okay. We're almost out of time, so I'd like to give you the last word, Aziz, to say whatever you want to investors.
Yeah, no, I think it's been a great conversation, so thank you for your thoughtful questions. I think you hearing from Mark and I and representing the rest of the management team is our focus is very clear. Grow the U.S. business, advance the pipeline, and capitalize on what we think is a very robust agreement with Alcon that can transform the cataract surgery market. If you put all that together, what do you have? You have a potential to have a strong margin, durable revenue stream with some clear inflection points in the future, and done on the backdrop of higher discipline and rigor as it comes to capital allocation.
I think in the next 3-5 years, we'd like to be seen as a strong growth company with potential future outcomes to be able to transform the market we're in and be known as one that operates with a high degree of rigor and discipline as it applies to our ability to deploy our capital.
Great. Thank you.
Thanks.