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All right. Good morning, everyone. Thanks for joining us at the Stephens Conference. I'm Mason Carrico. I am the research analyst covering diagnostics in medtech. It's my pleasure this morning to be hosting STAAR Surgical. Joining us from the company is Patrick Williams, CEO, Connie Johnson, Director of Investor Relations. Great to have you both here. Thanks for coming.
Thank you. I got promoted CFO, technically.
CFO. Did I say that?
It's OK. Wishful thinking.
What did I say? CEO? Sorry about that.
Don't be sorry.
Just to set the stage here, yeah, Patrick, if you could give us an overview here, maybe the focus of STAAR Surgical, an overview of EVO.
Yeah, absolutely. So thanks for having us and welcome to covering medical devices, Mason. You know, I think the way that we think about it is STAAR Surgical essentially provides a treatment for distance vision correction, which we call myopia, and we do that through a lens-based approach as opposed to a cornea-based approach. Cornea-based approaches you have probably heard of: LASIK, PRK, SMILE. These are all procedures that currently exist on the market today that are well known by both doctors, MDs, ODs, as well as consumers to treat people, to get them out of their contacts and glasses, and so we call that myopia. We have a different approach. The company's been around for quite a long time. The original lens that we did, which we call a lens-based approach, is, think of it as an implantable contact lens.
It goes in the posterior chamber behind the iris or the color of your eye and in front of your natural crystalline lens, and the original implant of this started about 30 years ago. We had a first-generation product, which we call our Visian Lens , which was approved in the United States in 2006. We recently got our next-generation lens, which we call the EVO lens, EVO lens, and that was approved about three years ago, and then across the world, we have various different approval processes or dates, and notably, some of the big markets that we're in, Europe since kind of 2013, similar with China, and China is our largest market overall. We sell in basically 70 countries across the world. This is not a new product.
We have sold over 3 million of these lenses worldwide now, with most of that volume coming in the last couple of years, and notably, if you look at the company, revenue has come in the last four or five years from a high-growth standpoint. The refractive market is a market that has been historically growing at a decent pace. I would call it mid-single digit sort of globally, but 2024 has been a very challenging macroeconomic environment for refractive. LASIK procedures are down in the United States upwards of 20% on a year-over-year basis. In China, we have seen declines of probably 10% to 15%. Europe is probably still down -5% in some markets, maybe even -10%, but the thing about EVO and STAAR specifically is we continue to take market share.
So even in spite of all of that, we will end up growing our overall revenue this year north of 6-7% on a year-over-year basis. We continue to drive market share gains in all the major markets, including those markets that have been hit pretty hard on a macro standpoint. So we really view this as a transitory issue. After we announced our Q3 call, we saw a pretty significant dip in some of the markets, specifically China. But what I can tell you is, as quickly as those markets have gone down, we believe they can rebound. People are not choosing to get another refractive procedure. They're just choosing to stay in their contacts and glasses. And if you follow any of the companies that sell contact lenses, you'll see that they're having very, very good results on their contacts.
So again, you know, these things go through business cycles. We believe this is very transitory. The big question we get is, when do you think it's going to end? I'll give you a couple of data points. One is we just came back from a very strong, what I call our US Surgeon Summit, where we had over 100 doctors, both existing users and some new users. It was very well received, and maybe we can dive into that a little bit later. But at the same time, in China, which is probably about 60% plus of our overall revenue, we have seen what I would call a trough, we believe, in terms of where the market's going. When we exited the middle of August going into what I would call September and in October, we definitely saw some pretty big declines in the overall procedures happening.
But as we moved into October and November, I would call it we're seeing more of a steadiness. We're not growing at 10%, 15%, 20%, the end markets, but we're starting to see a little bit more flat. So you might be up a little bit one week, down a little bit the next week. But we're kind of holding our own now is what I would call it, which to me and to the rest of the STAAR team is a strong signal of potentially we're at a trough. Now, we all know that we had some recent events here in the United States related to the new administration coming in. We appreciate that that may create some uncertainty for people as we navigate that. But again, for us, really, we're doing everything we think that we should be doing. We're increasing surgeon confidence, et cetera.
We're driving down the diopter curve. We've got a lot of new things that are coming into play, which I know we'll talk about. But we continue to take market share. And I think as quickly as we saw some markets go one way, specifically China, I think it can rebound very quickly. And we have strong data points to show that.
That's encouraging. And maybe if we just start with the US, if we could just level set that market, I think there's 700,000 refractive procedures annually. When you look at EVO's label, I think it's 21 to 45 minus 3 or above. But you guys are targeting minus 6 or above. Could you help us understand what proportion of refractive surgeries generally fall in that area and age group that you're targeting?
Yeah, absolutely. I think one of the slides that I'll reference, it's up on our IR site. It's our Q3 earnings call deck was slide 14, and it's talking about this diopter curve thought process. EVO has historically been what I would call niched as the high myopia product for people that have very poor distance vision. And there's reasons why. As I mentioned, a cornea-based approach, in order to deliver the refractive correction that you need, you've got to remove more cornea. Well, in some instances, there's not enough cornea to remove, whether you have a thin cornea or if your diopter level is so high. If the diopter level is so high, the doctors are uncomfortable removing that much cornea. As you remove cornea, what happens?
You increase the severity and the frequency of such things as poor night vision, glare, halo effects, dry eye, which is a really big issue. Again, as you remove more cornea, you increase the severity and frequency of that. We don't do any of those things. And so we have been niched, I would say, to some degree as the high myopia company. And that's why doctors love us. When you do your channel checks, you'll hear people, doctors and patients speak glowingly about EVO. It's the best procedure. It's the highest patient satisfaction. The quality of vision is you just can't beat it, right? And so as we think about that, one of the things under new leadership with Tom Frinzi, our CEO, that came on board was focusing on what are we going to do to increase surgeon confidence, right?
So there's been a lot of focus on that. Again, slide 14, sorry, on our investor deck, there's a couple of points on there that we discuss. How are we going to increase surgeon confidence and measurement and size selection? During the Q3 call, we talked about the fact that we've now embarked and engaged with a doctor in terms of an AI algorithm that will help increase the predictability in both sizing and measuring and what we call vault or the positioning of the lens. I'm a big fan of clarity builds confidence. Confidence builds commitment. As we get more confidence from these doctors, these doctors will absolutely drive down the diopter curve.
And I remember as you were coming on board to reinitiate coverage, one of the questions you asked, Mason, was, is it as easy as them getting confident that there's nothing magical about them doing a minus 7 versus a minus 2 or three or four? No, it's the same procedure. It's exactly the same procedure. But the doctor needs to get rid of what we call the outliers. They need to be more comfortable with the procedure, especially in the measurement and the size selection. So there's been a full court press on that. We've made very big headway. I will end with the fact that actually one of the things we discussed is because the product's been around for so long, our original labeling handcuffs us in some ways.
The original biometer that was used 20 plus years ago to get the procedure approved in the United States, that biometer doesn't even exist anymore. There's actually a paper that's coming out, and it'll be in a nice, simple format. We discussed it actually at the U.S. Surgeon Summit. It was showed by one of the doctors that produced it. And it shows 9% or 10% of the most common biometers used across the globe. And it shows the differences on how they measure what we call the white-to-white, which is important when discerning the size of the lens. To put that into perspective, we have two lenses that are used 80% of the time. One's called a 12.6 mm. One's called a 13.2 mm. That stands for millimeters. The difference between 12.6 mm and 13.2 mm is 600 or a little over half a millimeter, which is 600 microns.
If you look at this paper, you will see that it lists out that some of these tape measures, as I call them, or biometers, they might be off by up to 300, 400, 500 microns compared to our original labeling. And so what this paper will do is provide an adjustment factor for the doctor so that when they measure with whatever biometer that they are using, they'll be able to put that into our OCOS calculator. And it'll actually, with this adjustment factor, give them the right lens. Again, clarity, which is what we're providing more and more, or the doctor's providing it through a paper, will build confidence. And confidence will drive that commitment of moving down the diopter curve. So a lot of good work being done there.
We're feeling very bullish about what can transpire over the next quarter, two quarters, three quarters, et cetera.
When it comes to those initiatives around sizing, AI solutions versus the paper that you're talking about here, is there one versus the other that you feel like is going to be more impactful? Are they synergistic? How are they being presented to doctors in that sense?
Yeah, I think there is some synergy for sure. But definitely, as I've said many times, and I know a lot of people have heard this, you know, the company in the first time in its history, at the J.P. Morgan pre-announcement we did earlier this year in 2024, we discussed the fact that we need to address and increase surgeon confidence and measurement and size selection. If you look at any of our investor decks, if you listen to any of our investor earnings calls, we've talked about that on every single one. So step one sometimes is acknowledging that you have a problem and acknowledging it to your customers, in this case, doctors. We need to remove that fiddle factor for them, right? Again, building clarity builds confidence. Confidence is commitment. And so yeah, the AI-based tools are helpful.
What those do is take big data and not only focus on measurement and size selection, which this paper is doing, but what they're doing is taking tens of thousands of records and figuring out what is the positioning of the lens, more predictability for the doctor. When I put the lens in, it is essentially free floating in the posterior chamber, right? It's tucked in a little bit into the ciliary bodies. So we call this thing called vault, which is essentially the distance between our lens, the EVO lens, and the natural crystalline lens. And you want to have a certain amount of vault for the doctors to feel comfortable.
More importantly, though, if you tell the doctor that's going to be a 500 vault or 500 micron distance, and it comes in at 400 or 600, the doctor might look at that and say, well, why is that? So again, what these AI tools have done is shown that they have much more predictability on determining the vault based on big data and the characteristics of the eyes, et cetera. So excuse me, that's one of the things that we're working on. We also have a head-to-head study that we will be getting enrollment here very shortly. And that head-to-head study is going to focus on quality of vision. And that quality of vision is going to show LASIK candidates or LASIK procedures as well as EVO procedures. And so we weren't able to do a contralateral. So these will be two separate cohorts that we will do.
It'll be some subjective measurements, which is, you know, what do you think your quality of vision is, et cetera, but there will be objective measurements, and that's probably what we're most excited about. We will do light scatters through the eye. Clearly, if you're doing a cornea-based procedure, especially as you move up the diopter curve, the more cornea you move, the more aberrations you're going to get as the light comes through the eye, going back to the retina, et cetera, so we're very excited about that paper. We think it's going to demonstrate, I think, what everyone talks about, but we'll do it in a clinical manner, so again, all of these are building blocks, and I think there are clearly we're prioritizing some over the other.
So you should assume that not only will this be used in the U.S., but we will be able to leverage this worldwide. So we're very excited about, again, where we're at in this stage and the things that we're working on.
And within the U.S., the Highway 93 customers, maybe just to start and give some background here, who are those customers? What are the commonalities? Why are you focusing on them?
So one of the things that we looked at was we know that we can go wider, we'll call it, right? We can go train more doctors. We decided that that's not necessarily the best path for us. Now, because I mentioned that a lens-based approach with EVO allows you to do patients that are not LASIK candidates. So maybe 10%, 15%, some will say 20% of the candidates that walk in the door are not LASIK candidates. I talked about thinner corneas. I talked about the higher myopia, the higher diopter you are, the more challenging it is to get a certainty on the refractive correction. Doctors love us. They monetize those patients with the EVO lens. We could go add Dr. 1001, 1002, so on and so forth.
But because we have some issues on that uncertainty that I talked about and the measurement and the size selection, which we're actively working on, we think it makes much more sense to dive deeper with existing doctors. And that was the advent of the Highway 93. It's probably Highway 101 now or something like that. We've added more doctors to it. I want to be clear. We're not turning away doctors that want to get trained. But we want to make sure that we really dive deeper. Getting back to one of the key questions you asked me when you were reinitiating was, well, what keeps a doctor from moving down the diopter curve? And could they literally wake up and start doing minus threes and minus fours and minus fives or minus ones in other parts of the world? Absolutely. And so that's why we did this.
We have an Autobahn one for Europe. And basically, no, we haven't nicknamed every single one. Every country is focused on diving deeper as opposed to going wider, right? Now, there's some countries where we have 20% plus market share, 70% in Japan, 20% plus in China. They're clearly going to go wider because they figured out a lot of that confidence on the doctor side, right? So we feel very good about that. And it's really about measuring for us. We use minus 8 internally as sort of a break-even point of identifying our doctors moving down the diopter curve as a percentage of the lenses they do below minus 8. Our average diopter in the U.S. on the spheric side is around minus 8, a little bit above that.
So we use that as a breakpoint to say, OK, a month ago, today, a month later, are they making progress of doing more lenses below minus 8? And that is a good indicator for us in terms of building their confidence and how quickly will they move down. The data that we see on some of these large accounts is they can move down very, very quickly.
How much of the refractive market procedures are the Highway 93 customers doing?
For the U.S. specifically, again, pretty small part of our overall business, about 5% of our overall revenue. About 50% of the U.S. revenue that comes in is from the Highway 93. The other 50% is from the other 400 or 500 doctors. These are not frequent users. We're talking about pretty small numbers in the grand scheme of things. We will do over 600,000 EVO lenses this year. The U.S. will be closer to around 20,000 lenses, right? Give or take, right, using $1,000 ASP. Again, small numbers, but about half of the revenue does come from the Highway 93. They are heavier volume users. They might have a slight discount to that kind of $1,000 average. From a unit standpoint, you're probably a little higher than 50% being contributed by the Highway 93.
OK. And on that point of price, you talked about being a bit flexible on price with these customers so surgeons can maintain their economics and potentially pass those cost savings on to the patient, put it closer from a pricing standpoint with LASIK. Could you just kind of walk through that dynamic with those customers, how that shakes out? What is the delta for the cost of a patient or the economics for a surgeon for these customers?
Yeah, so we've made some really good progress here. Again, because we were a year ago, we were at this conference, right? And we could probably go back and listen to that webcast. The differential between what they offered to their patients for LASIK versus EVO has come down quite a bit. When the product first came out, there was a lot of focus on high myopia, niche product. The doctors were charging these patients a lot, maybe $5,000 for a LASIK, excuse me, for a bilateral, and maybe $10,000 for EVO. We've moved down quite a bit. Right now, we're probably around $7,500 on average, maybe $8,000 on average, depending on the practice, compared to a $5,000 LASIK. So the doctors have recognized, and with our help, we have talked to them about you're making very good money off of our procedure.
Your gross profit on a per-procedure basis is higher with EVO than it is with LASIK. So please pass on some of that gross profit to your end patient because the conversation is going to be a much easier conversation for you to have, especially, doctor, as you move down the diopter curve. And you personally know that as you move down to the minus 3s and below that, even outside the United States, the clinical difference, of course, is not going to be as dramatic as the higher myopia. You're just cutting less cornea. And so I think for some doctors, even though they would agree that they would put it in their own eyes at a minus 2, a minus 3, and so on, for the patient, they can understand that maybe cost comes into play.
And so a lot of them have dropped their price, and they're more on parity. Apples to apples, we always describe it this way. If you charge $5,000 for a LASIK, I'm going to assume, especially if you're a new doctor coming out, we've got to amortize that piece of capital equipment, which is $400,000 or $500,000, getting all that prepped up. So we say there's about $1,000 of cost of goods. So you're making $4,000 contribution margin. Let's use that $1,000 lens price that we talked about. Two lenses, $2,000 of cost of goods. Apples to apples, you would need to charge $6,000 minus 2 of cost of goods to make that same $4,000 contribution margin, OK? And so doctors, again, are charging $7,500, $8,000.
I will tell you that we have pilots that are going on where we have major high-volume users of refractive, right, that are doing pilots where they're making the price exactly the same to see what changes in the time movement, the flow within their practice, and I can tell you that we're seeing EVO take even more market share in those practices. We're going to collect some more of that data, but we're going to be very excited to share some of that information because, again, it shows that we're isolating some of the variables and we're proving to the doctor that EVO, when all things are equal, patients will choose it and doctors will choose it.
Given the ASP here, how flexible are you willing to be with price beyond maybe where you are today?
Look, I think, you know, mostly it's volume. If you're willing to sign up big volume for us, I'm happy to give you some dollars there on the ASP. But more importantly, what we try to do is try to partner with these practices. It's not about just giving up the ASP. What I'd rather do is co-market with you is what we call it. What can I do to make your practice go forward? Office-based suites, the setting of care, what can we do to drive that forward? Again, I'll come back to the U.S. surgeon summit that we just had. There was a whole section on office-based suites. Is it right for you?
When a doctor makes a decision to put an office-based suite in, it changes the dynamic of their practice completely, not just for refractive with EVO, but for the other things that they offer, like cataract surgery, right? And so it's a very interesting momentum that's happening right now or movement that's happening within the ophthalmic industry, specifically for cataract refractive physicians. And so for us, I would rather co-market with you and figure out how we make EVO an easier delivery for you. How do we make EVO more ingrained in your day-to-day practice, make it more LASIK-like, if you want to call it that? So we have done some co-marketing things. We've published those or press-released those. And we talked about the fact, let's co-market together, right? SharpeVision up in Seattle, Dr. Lin down in IQ Laser Vision down in Southern California area.
These are very, very high-volume practices, and they're absolutely moving down the diopter curve. The more touch points we have, the more we talk to the doctors. We have our new experience center that just opened up. We actually had a couple of the doctors from IQ there. Dr. Patrick Pham was there. Had a good conversation with him, saw him at the U.S. Surgeon Summit. He's doing minus 3s as they walk in the door now. He wasn't doing that six months ago, right? Again, the momentum is absolutely building here, and we're feeling very good about the foundation that we're setting up.
And maybe that's a good transition into the FastLink customer agreements you were mentioning, right? Are there commonalities across all of those agreements? What are you typically shooting for? What are the commitments from each side?
So what we shoot for is market share or practice share, I should call it, right? We want to get 30%, 40%, 50% of your practice volume that comes in the door. We want to get minus 6 and above as a starting point. We believe if we get minus 6 and above, that's probably 40%-50% of your overall refractive volumes that are walking in the door. So we have what's called the FastLink. Thank you for mentioning that. That is a subset. I think we're past 12 now, and we continue to add some every day. This is an even more focused account that we're looking at. It's a high-volume account. It's an account, as we mentioned, that's giving us that 30%, 40%, 50% that's saying minus 6 and above, we will absolutely give it to you.
I encourage all of our doctors and sales reps and everyone out there across the world, the sooner you get onto the FastLink, the better economics you will probably get because at some point, we're going to start reducing some of that stuff, right? There's FOMO out there for sure. People want to see what's going on. And this is a cash-pay elective business. There's a lot of marketing that's involved with it. So we will spend marketing dollars with you, but it'll come with the promise of increasing your share count or your practice share. As well, we don't stop there. These will be annual commitments. But then we'll re-up them next year. And we're coming up on that. And we're going to be looking for increases. What's really affecting our growth right now worldwide are the macroeconomic headwinds. And this is completely transient, as I mentioned before.
We should probably talk about that a little bit more as we go through the questions. But we're feeling very good about our position right now, and we're starting to see a little bit of a leveling off, as I mentioned, like in China and some of the other markets, and we're growing tremendously in other markets, like Japan is crushing it. South Korea is doing really well. We've been very pleasantly surprised by, even though all the stuff that was going on in Europe with the wars, et cetera, whether it's the Ukrainian war, the Middle East war that's still going on, you know, we feel very good about the fact that that market is still growing at almost 10% with some really key practices that are doing well, as well as countries that are doing well.
At what point, at least in the U.S., as we kind of think about your market share climbing with practice share, however we want to talk about it, within these customers, at what point do you broaden? When does that decision get made? Is there a threshold? Where is it adding a few accounts at a time? I mean, how do you think about it?
Yeah, and it's one that we discuss internally quite a bit, like when do we want to start training more doctors? I think number one was I mentioned the opening up of our experience center, right, our EVO Experience Center. We literally just had the grand opening five weeks ago, four weeks ago, something like that. I think we've now had three sessions in there. We've got a session coming up in the next couple of weeks that's focused on optometrists, ODs. You know, people will use the word gatekeeper. I like using the word gate opener. There's no doubt that someone that's going and dealing with their eye care, they're going to go to an OD more often than not than an MD, an ophthalmologist that's doing refractive.
So we are bringing in a bunch of ODs into the practice where we'll teach them about what EVO is, show them the clinical literature, talk about the quality of vision. And really, our goal there is to make sure that they're not preconditioning any patient that walks into an MD's office to get a refractive procedure to think that LASIK is the only option. We need to grease the skids a little bit. And we're going to do that with these gate openers, the ODs. So we're very excited about that. We'll lay out some more metrics for everyone to understand that. But I could absolutely NVISIO N a lot of ODs coming through our offices. And in 2025, as we move into that, the experience center is going to get used quite a bit. So long answer to your question, we're getting very close to starting to probably expand.
I think the experience center is one way to do that so we can have a thoughtful, formalized corporate training program. And then at the same time, as we bring that on board, we can start looking and reinvigorating our brand awareness strategy, kind of going back to that. When we did brand awareness upwards of two years ago, what was happening was we were driving a ton of people into the practice. We were driving a ton. You look at any of the Google trends. You would say that that should have converted into revenue. And I've been in cash-pay elective businesses for quite some time now on medical device. And I'm very familiar with those Google trends. And I looked at those numbers, and I'm like, this is absolutely working. But we weren't seeing the revenue. The why? They were walking in and getting converted to LASIK.
Doctors were not confident in our procedure because they didn't have clarity on the biometer measuring that I talked about. That is starting to change. So as we see that movement coming out of this U.S. Surgeon Summit, we're feeling very good about when we can start turning on what you just said, which is an expansion beyond the doctors we have now, as well as going deeper with them very quickly, but then also augmenting that with consumer awareness. And so we're excited about what's coming up. We're just challenged right now with a market that's less people walking in the door. And so we just got to figure out how to, you know, at the right time, pull that trigger.
Right. And that's where I was actually going with my next one. You get the doctors confident. You maybe grease the skids, make ODs a bit more. You don't want to push them towards only LASIK. And then maybe at some point, you start ramping back up direct-to-patient marketing. And that ROI now should be a lot higher. OK.
Agreed.
Maybe, yeah, moving to the international business, and maybe just give us a high level across geographies, what you're seeing from a macro standpoint, where you encourage things, you know, looking better, maybe improving, staying the same?
Sure. Let me start with sort of the Middle East area, India, which we'll call South Asia, Europe, and then I'll move over to sort of traditional Asia. As I said, Europe has been a pleasant surprise to us. I think as energy prices there have become less volatile when the advent of the Ukraine-Russia war started, there's a lot more certainty around that, and when there's certainty for people, they tend to spend, right? Their consumer confidence goes up, and so we've seen some very nice rebound in the EU market in general. I think that augmented with the focus of the Autobahn 2.0, for instance, our focus on driving down the diopter curve, et cetera, has led to some very nice growth in Europe. India continues to do well. It's clearly a very large market.
We sell a lot of units there, but it's a fairly competitive market when it comes to a pricing standpoint. And so our ASP is probably one of the lowest ASPs worldwide there. And that's just the nature of the India economy from any business that I've been associated with that. But we continue to make good strides there. We've added quite a few people. We've brought on further distributorships there, et cetera. And we do sell through a distributor arrangement there. I think we have. I don't want to quote it. I want to say we maybe have three or four now. It might be five. But we have expanded that in order to broaden our reach. We had great meetings with our India partners, both distributors as well as our team, when we were at ESCRS, which was in September of this year.
And so we're feeling very, very good about that. Now I'll move to the U.S. We talked about quite a bit already. I would say that Europe is probably down. The refractive LASIK market is down 5% in some markets, 10% in some others. Yet we're growing at about 10% overall in EU. So again, we continue to take market share. We will grow multiples of the market. It's just the underlying market is not growing as it was. Let's move to Asia. Let me start with China because that's probably the big one that everyone is focused on. You know, China has historically grown for us, you know, 20%, 30%, 40% year over year. We had aspirations that it could grow 20% going forward.
But the underlying assumption of what the market was going to do was about a 10% growth, where we would grow 2X what the market was. The market's 10%-15% down, right? Now, as I said, as quickly as the China market can go one way, we think it can turn back the other way. It is the one market where we've seen it flip very quickly both ways, right? And so we have a lot of conviction that the market can come back quickly. We have over 20% market share in China. EVO is well known. One out of every four to five people that get a refractive procedure have EVO in their eyes. So we're not fighting the same brand awareness necessarily that we have in other parts of the markets, like the U.S.
So the ability for that China consumer to come back, we're feeling very good about. The question, of course, everyone wants to know is when, right? So what I can tell you is from a data point standpoint, as we look at the data, I mentioned the fact that, you know, when we finished our earnings call in Q3, we saw a significant drop-off in the middle of August going into September, even through September, a little bit in October. But as we started exiting October with Golden Week, as we talked about, we're starting to hear the Chinese government talk about stimulus. They just came out of their November meeting. They didn't address consumer stimulus specifically with plans. They kind of said, we're going to wait and see a little bit.
I think a lot of that has to do with the new administration here in the United States. And they're just keeping some dry powder to see what's going to happen and get more certainty around that. But what they did talk about was relieving some of the "hidden debt" that has been sitting in the municipalities. And so to me, that is a significant step because if you asked that question a year ago, there were a lot of questions. Does it exist? Does it not exist? Most world economists said the debt did exist. The Chinese government has recognized that and is saying we are going to make efforts to bring back these municipalities. You got to remember, this is a complete ecosystem. And what it drives is consumer confidence at the end of the day. The Chinese people are simply not spending money right now.
I look at it as sort of a vote with their pocketbooks. Again, they have the money. They have savings. We believe it'll come back. So as I said, as we moved into October and now into November, we're starting to see a little bit of, we can call it holding our own, but I'll call it more flattish. So the question is, do you expect the market to be down 10%-15% next year as it was in 2024? That would imply that the market is going to get worse going into next year. We're not seeing that right now. Now, do four to six weeks make a full trend? Not necessarily, right? But we are seeing some signs of hope there. And so I think when you combine stimulus with that, the ability to come back quickly, you know, we'll wait and see.
Look, it's early for us, which is why we have not talked about 2025 guidance. I think it's premature for us to do that. But, you know, we'll do it at the right time when we have clarity. And we want to make sure when we come to everyone that we do a similar philosophy we did this year, which is we want to mitigate or reduce downside revisions of our revenue. So even this year, we came out with $335-$340. We upped it to $340-$345 after Q2. And then we reaffirmed it in Q3. Even though our largest market, we took down from 10% revenue growth for the full year to 2% for the full year. So even in light of almost two-thirds of our revenue from China being reduced, we were still able to maintain because we've got nice upside in other areas.
I mentioned the E.U. The U.S. is still doing pretty decently. It's a small number, but what's really doing well to put a bow on this in the other Asia regions, South Korea is absolutely doing well. Japan is having an amazing refractive year right now. We are growing tremendously there, even in light of the fact that we do all of our business in yen and we're getting a headwind from the Chinese yen. Our units are tremendously up in Japan, so again, we are a market share taker. Things are going very well. We still produce cash, even in a downturn, and we believe that these markets are transitory, and we don't expect this to continue in perpetuity as we move through 2025 and beyond.
For some of the markets where you guys have seen a lot of market share gains, what is it that differentiates that landscape versus another market in terms of adoption? Is it simply surging confidence? Is it some structure to the market? And maybe across a few of your key geographies, just highlighting what's driven that?
It's a little bit of both. You know, some of it is time in the market for sure, right? You got to remember we've only been, you know, though we've had approval in the U.S., I would say a real focus on driving surgeon confidence has really only been 11 months now. Again, we added it for the first time in January of this year, and we've talked about it a lot, then you go to China. There's some structural differences between China and some other developed markets, so what does that mean? You know, China probably has the most favorable structure for us when it comes to large group settings. So for instance, the Aier Eye Hospital Group is probably the single biggest health care provider in the world, right? I don't know, 250-300 store office locations, hospitals, whatever you want to call them.
Those are physician employees, right, of the group, Aier. So their ability, and you know, one of the greatest things we did was sign up with them six, seven years ago, right? That was simply the most pivotal thing that started as a company was to align ourselves with that large health care provider in China. It allowed us to raise money, which we never have touched since, but we raised about $70 million in 2018 on the heels of that. And so their ability to have, and our ability to negotiate with them directly, our ability and their ability then to train their doctors on some of those nuances we talked about, right? They use a different biometer over there, right? They use ultrasound more.
But they were able to do that ubiquitously across all of their physician employees and all of those stored locations or hospital locations that I mentioned. So there are some structural things that helped move the needle faster there, OK? But we're not allowed to advertise there to the consumer. So you've got that as a headwind. So there's a little bit of a put and take there. Then you go to Europe. We can do a little bit more advertising in some countries, more direct to consumer. You have some structural benefits, i.e., groups, right, than in Europe, especially like in Spain and in Germany. You've got these groups that maybe there's six or seven groups that control, you know, 5%-10% of the market, right? When I say each, they each control 5%-10% of the market, right? So you can go to them.
And again, they can teach their employees how to do it. There's a great group in the Netherlands, For Your Eyes Only , that does. I think they have 13 offices now. You see a lot more of that where you've got these groups of doctors that expand into these larger groups. Then you get to the U.S. It's very different, right? I always talk about you've got consumer economics. You've got practice economics, doctor economics, and you've got practice economics. As I mentioned, the Aier group is the practice economics. And you have the doctor, their physician employees. In the U.S., the practice and the doctor are many times one and the same. And so we don't have these large groups, right? Now, some of them we are working with. NVISION is a very large group here in the United States.
They're one of the ones that are doing the pilot. We've been working very closely with them. These are the things that will move the needle for us. And when you start getting some of these high KOLs, these high users on board, it does take a little bit more time. We have some structural headwinds in the U.S. We haven't been here as long. But we get to advertise directly to the consumer in the U.S. And what I do know is that we're FDA approved. We've got a really good product. It delivers exactly, if not more than what we promised from the doctors. Very low, low adverse events. And so, you know, we just need a little bit of time to unseat the inertia of LASIK at the end of the day. We talked about the paper we're doing. So there's a lot of good momentum.
You know, for me, the silver lining is if there was any point in time where STAAR was putting all of these foundational building blocks together, why not have it when the macro environment is down? I'm not losing to LASIK on a day-in and day-out basis, right? These patients are going to come back into the marketplace, right? They're just choosing to stay in their contacts and glasses for now.
Yeah, I don't think that's a bad point to wrap it up here. Maybe if there's any questions from the audience? All right.
Perfect. Appreciate it.
Yeah. Thank you, guys.
Thank you.