All right. Good morning, everyone. Thank you, guys, for attending the William Blair Growth Start Conference. Very pleased to have the team from STAAR Surgical here. My name is Margaret Kaiser. I am the medtech analyst here that covers STAAR. For a complete list of research disclosures and conflicts of interest, please see williamblair.com. I am going to turn it over to these guys, and we might have a chance for Q&A at the end. Thank you.
Great. Thanks, Margaret. I'm Steve Farrell, and you guys have the pleasure of hearing the first presentation ever that I've made as CEO of STAAR. Clicker.
Next one.
All right. Good start. Who are we? We are a 43-year-old company. Why is that important? It is important because we have got proven technology, and we have seen competitors come and go over the last 20 years, but we are still here. What are we? We are a global leader in ophthalmic surgery. We believe we are a superior solution to LASIK. Does that mean that LASIK is not a good solution? No, it does not. We think we are a better solution. Why do we think we are better? We are reversible. Our lens offers UV protection for the natural lens in the eye. Our product does not induce dry eye. Most importantly, we preserve the cornea. There is no tissue removal. There is no risk of ectasia, which is the thinning of the cornea. We have a rapid recovery from our surgery. We have got improved contrast, especially at night.
It results in straightforward calculations for future IOL implants. When we age and we need a replacement of the natural lens, we have not complicated that by adjusting the cornea. We have a global presence. We have a reach with 75 countries. We have a number one refractive share in Japan. There has been a lot of negative press on LASIK in Japan over the years, which is part of the reason for our rise. We have also been a global leader in entering the Japanese market. Over time, we do better. We have been in the Japanese market for a while. We have about a 12%, perhaps a little bit more, refractive share of the market globally. That number is a little bit hard because the data is not perfect. We have got a good solid share of the refractive market globally.
We have still got a lot of room to move. What are our keys to accelerating growth? Our keys to accelerating growth, we need some help from the macroeconomic tailwind. We are fortunate to be in an expanding market, and I am going to talk more about that. We are a discretionary purchase. That means that we are going to rise as things get better in the economy, and we are going to have some headwinds as things get tougher. The other key challenge for us to overcome is patients who are in glasses and contacts are reluctant to pursue a surgical solution. They are just nervous about it. That is something that we need to overcome. As the economy starts to improve, our performance will start to improve.
In terms of our geographic sales mix, about 8% of our sales are in the U.S., 51% are in China, 27% in the APAC. Lastly, we've got about 14% in EMEA. If you look at the bottom right of this slide, where you see we were approved in Korea, Japan, and China in 2013 and 2014, and then were not approved in the U.S. until 2022. Why is that important? There is a correlation. It is not a perfect correlation, but there is a correlation between how long we are in market and how much success we have from a penetration perspective. There are, of course, also specific challenges that we have in each country. Generally, the longer we are in a country, the more comfortable surgeons get and the more comfortable patients get. That word of mouth is perhaps the most important criteria for us as we expand.
I know there's been some concern of investors that our growth in the U.S. hasn't been rapid enough. That'll come. The reason it comes is we're continuing to pursue the strategy. Surgeons are getting more comfortable. As patients have positive experience with the EVO ICL, we'll start to reach an inflection point where we'll start to get growth that is more in line with what we hope and what we expect. We have a strong financial model, and we're well- positioned for a strong rebound. In 2024, we achieved $313.9 million of revenue. That was down a couple of 3% compared to fiscal year 2023. That's primarily as a result of some headwinds that we experienced in China. The China market for refractive surgery started coming down in kind of the middle of last year and continued to be weak through the end of last year.
It's starting to come back now. That is what has caused the reduction in our sales growth year- over- year 2024 over 2023. It is also what has caused us to have very minimal sales in the first quarter through our China distributors, first and second quarter. I would point you to the bottom what is possible. These are actually fiscal 2022 numbers where we achieved 78.5% gross margin, 15.4% operating margin, and 24.2% adjusted EBITDA margins. Why is that meaningful? It is meaningful because we have been there, and we think that we can get back there. It just takes time. The earnings profile of this business is very strong. Okay. There we go. What are EVO ICL's competitive advantages? I want to also spend a few minutes on the large and growing market opportunity. Again, I just want to reiterate, we do not think that LASIK is a bad procedure.
For the eyes, we think we've got a superior solution. What are the choices for patients who have myopia? They can wear glasses and contacts, but that creates a lifestyle limitation. They can choose a surgical option, which LASIK is obviously a primary surgical option. Why do we think we're better? If you look at the safety features on the right, we've got a reversible lens. We are not permanently altering the structure of the eye. We've got a lens that goes in front of the natural lens. We do less damage to the structure of the eye. We've got flexibility for future procedures. That's really important because as we age and need a replacement of the natural lens, we have not made alterations to the eye that complicate that procedure. We can treat eyes with a thin cornea.
Since we're a supplemental lens, we offer UV protection. We have really a very quick and easy procedure that's less invasive. Importantly, no corneal tissue is removed through our procedure, and our procedure does not cause dry eye syndrome. The Collamer difference, this is really the differentiator for us. We have a Collamer product that's made from collagen. It's biocompatible, and it's a material that's stable and quiet in the eye. It's been used in the eye for decades. We have an advantage in our Collamer product over the acrylic phakic IOLs. We've, in our history, experienced probably 20 different competitors in the phakic IOL space, and they've all had acrylic lenses.
We have a safety and effectiveness with our Collamer difference that has been sustainable for us and has been a real competitive advantage in the past, and we expect it to continue to be in the future. We've historically talked about 5.2 million procedures a year, which is the number of procedures for people who have myopia and have elected the surgical option. That's LASIK, PRK, SMILE, EVO ICL, or one of our acrylic competitors. We're starting to think about the market much more broadly and how can we get people out of glasses and out of contacts. We don't see this as a zero-sum game. We've historically fought for our portion of the 5.2 million procedures. We're starting to think more broadly about how can we connect with people who are in glasses or in contacts or untreated.
Bottom left of this slide, our estimated share, as I mentioned previously, of today's refractive procedure market is about 12%. We're at 70% in Japan. Very high quality there. There's surgeon confidence, and there is a negative bias against LASIK there. Do I expect that we'll be able to get to 70% in every market? No. That really shows what's possible. Recently, we've had some regulatory wins. We've had in China, both Toric and Sphere have been approved. That was a nice win for us. In Taiwan, the EVO ICL has been approved. In Brazil, we've received approval to lower the diopter range from - 6 to - 0.5. We've made really good progress from a regulatory perspective and are optimistic about the opportunities for our EVO+ or V5 in China when we roll that out in Q4 on a limited basis.
I referenced this earlier, but our opportunity is really much larger than the 5.2 million procedures. We welcome competitors into our space because it raises the awareness of the surgical options and of the lens option as a choice versus LASIK. There is a potential for 5.4 billion eyes. The myopia epidemic is just exploding. In the population that we serve, which is 21 to 45, there are 2.2 billion eyes, 1.1 billion people who are candidates for our procedure. I'd move to the right. Those people are mostly in glasses, contacts, or untreated. Moving to the right, where is the market? I'll start on the left with China and India. I know we've received some investor concern about our concentration in China. That's where a lot of the myopia patients are. That is an absolutely critical market for us.
It is a growing market, notwithstanding some of the inventory issues we've had kind of in the beginning of this year. It is generally a growing market. It is generally a very important market. It will continue to be a very important market for us. We've heard some noise or a lot of noise from investors around what we're doing in China and the tariff issue and the inventory issue. Is there going to be some big backlash because of the trade war here? Our perspective is this trade war situation, we believe, is a transitory issue. We expect that over time to pass. We are the best solution for the patients in China. We are not expecting a regulatory backlash. We were just recently approved for the EVO Toric and the Sphere in China. There was clearly an opportunity for the Chinese government to retaliate.
They did not do that. I think the reason they did not is because we are so important to the people in China. I would like to just remind you, and I am looking around the room. I am not sure there is anyone quite my age here. In the 1980s, there was a big backlash against China. I am sorry, against Japan, much like what is happening against China right now. The country moved past that. In fact, we are now currently at roughly 70% share of the market in China. If you go back to the 1980s and early 1990s, there was a lot of anti-Japan , not allowing the Japanese to buy real estate, do not buy Japanese cars. We heard a lot of that same rhetoric. That passed. We are expecting that to pass with the market in China also.
Moving to the right, India, the very big market. It's not big for us right now. That economy is growing 6% or 7% a year. Last quarter, I think it grew a little higher than that. That economy is growing. As wages increase and the per capita income increases, we expect India to be an important market for us. The U.S., it's not a huge market, but it's an absolutely critical market for us. We remain committed to that market. I think perhaps our biggest challenge there is surgeon confidence combined with the referral. We think we're going to hit an inflection point. We're not there. As patients have success and as surgeons have success, we think we're a great solution for the U.S. market.
This is a graphical representation of the 400 people who are, or 399, I guess, who have not made the surgical election. We've historically fought over that one in 400 people who make the surgical election. We're starting to think more broadly than just the people who make the surgical selection. We think a rising tide will lift all boats. Why do people not make the surgical election, at least in the U.S. where people have money? The primary reason is fear. People get various levels of concern over getting eye surgery, of getting any surgery. Getting eye surgery, there's just a higher level of concern. That is something that we need to overcome. One of the prime ways we overcome that is by word of mouth when people have a surgery and they realize, okay, this isn't that big a deal.
It wasn't painful. It was very quick. I think people have a perspective that eye surgery is a really scary thing. It is until you've had it done. Other things we need, we need some help from the economy. We've had some pretty intense headwinds over the last six or nine months, especially in China. We're seeing that come back. When we start to get tailwinds instead of headwinds, this is a discretionary spend. We should come back very strong. The market is excellent. The prevalence is growing for myopia. Why is it growing? It's growing because kids and adults are spending their whole day looking at phones and looking at computers. They're not outside where their eye is adjusting to distances. Myopia is expected to grow from 33% to 50%. I've worked in businesses that have had headwinds.
I've worked in businesses that have had tailwinds. Tailwinds are better. That's what we've got in terms of the myopia prevalence. This graph on the right is a graph of the diopter scale. Our global average is somewhere in that 8-10 range, depending on what data you look at in terms of our average diopter range. We are the clear choice for higher diopters. The reason we're the clear choice there is the amount of cornea that needs to be removed gets really intense when you get to kind of that 8, 9, 10, 12 range. We're the clear choice there. Something that's very important to us is we need to move down the diopter scale because that's where a lot of the patients are.
We're excited about what we believe is an inflection point that we're reaching in the U.S. where patients are starting to have word of mouth around the success that they've had with our procedure. All right, recent financial results. We can't sugarcoat this. They're bad. The first couple of quarters of this year have been very tough. Our net sales went from $77.4 million a year ago, excuse me, to $42.6 million in this year. That entire differential plus more is the reduction of China. I'll talk more about that on the next slide. Gross margins decreased from 78.9% to 65.8%. That's primarily the result of reduced production volume. We had some production variances because of the drop-off in China.
We have a ramp of our Switzerland manufacturing, which in the long run is going to be very good because we view our Switzerland facility as a tariff-free zone. We had some increased reserves for excess and obsolete inventory. We're expecting to be 75%-80% longer term in terms of our gross margin. We're in a depressed time right now because of lower volume and the manufacturing ramp in Switzerland. Bottom right, restructuring impairment and related charges of $22.7 million in the first quarter. We're going to have a number, I don't know what it is, also in the second quarter. This sounds like bad news, but it's really good news masquerading as bad news. Why is that? It's because we're in the process of reducing our SG&A to a $225 million run rate. We're taking out waste from the organization.
We completed most of the terminations from an employee perspective this week. Most of that's behind us. The team has responded extremely well to that. The cuts are never easy. They have a personal toll, which none of us like to do. It was necessary for the business. We're confident that we'll be exiting this year with a $225 million run rate. We're looking for other areas that we can save as well. Okay. I went too far. Okay, silver lining. Despite all the macroeconomic headwinds and Q1 was a tough year kind of or tough quarter globally, we were able to grow our ex-China business 9% year over year. If we're able to achieve 9% year over year growth in a very challenging economy, we should be able to achieve greater growth than that when we get some tailwinds.
We are very optimistic about the future because in a tough quarter, we achieved 9% year-over-year growth ex-China. Short-term tactical challenges have really been mostly addressed. When we have met with, it feels like 120 or so investors over the last month or so, they all want to talk about the management transition, China inventory, tariffs, cost control, Swiss manufacturing, and then the sales rebound. Those are kind of the key topics. Let me take them one by one. Management transition. We have streamlined that organization, and that is really complete. We have restructured the company, and that management piece is behind us. China inventory, we have got an excess level of inventory in China, partly because we were not close enough last year to our distributors, and we continued to grow our inventory and market.
We had a decrease in the demand in China, which created a gap. We have been working through that in the first six months of this year. We have been working very closely with our distributors. By the end of this month, the China inventory will be a non-issue. Tariffs, there has been a huge amount of noise. Every time there is a tweet, you see our stock move one way or the other. The reality is we have substantially mitigated the tariff risk because we have inventory in market that is going to get us through the end of this year, early next. We have our Switzerland manufacturing, which we believe will be tariff-free, which is currently ramping. There will be a little noise around tariffs from a financial perspective, but it is temporary. It is only on the ends.
There are a few products that in the next six or nine months, we won't have out in the market that we'll need to manufacture in the U.S. That is going to be kind of noise level immaterial. We've really resolved that tariff issue through, either the Swiss manufacturing or by getting inventory in-house. Improving cash flow. We've identified already all of the actions that we need to take to execute to get to a $225 million run rate. I am hoping that after this Q3, we do not need to talk about the management transition. We are not talking about China inventory. We are not talking about tariffs. We are not talking about SG&A. We might be talking still a little bit about Switzerland manufacturing because we are going to be ramping that. That is a good thing. Then we are mostly talking about the sales rebound, which we are already seeing.
We are expecting a meaningful lift in Q3 from China. We are expecting to have good results worldwide as well. What is the long-term investment thesis? Our tactical headwinds have substantially been addressed over the last three or four months by the team. The headwinds appear to be slowing. We have a really strong financial model. When we start getting some tailwinds, this business is going to really take off. Our Collamer technology is proven. It is difficult to replicate. It is difficult even for us to reproduce our polymer. We have been doing it for decades. The EVO ICL has a long track record in the eye. The prevalence of myopia is really just exploding and is expected to be about 50% of the market by 2050. We are expecting a return to our historical earnings and cash flow generation. We are dedicated to shareholder transparency and maximizing returns.
What does that mean? That means we're not up here to sell you. We're up here to tell you how we're thinking about the businesses, how we're thinking about the good things, how we're thinking about the bad things so that you can make the best investment decision. We think transparency with investors is absolutely critical. We want to earn your trust. We're excited that you're considering joining the STAAR team. I think I've got two and a half minutes left. I'd be happy to take any questions if anyone has any.
Maybe I'll just start out over here. I want to talk a little bit about some of the comments you've made recently about kind of market volumes and trends. Are you seeing any kind of improvement? Deceleration, I think, was actually more the comment that maybe we did hear.
At what point do you feel confident to be able to put a guidance range out there? Are there specific things that you're looking for to regain that confidence?
Sure. Let me answer the guidance question. We just went through all the moving parts. There are a lot of them and more. We are not, at least in the short term, going to provide guidance. That is different from providing insight to you to make good investment decisions. We want you to think about the business the way we think about the business, whether that's good, bad, indifferent. We want to educate you and help you understand how we're viewing the market and how we see things evolving in the market. Our objective is not to withhold guidance because we're hiding anything. It's because there are a lot of moving parts.
We do not want to be wrong. We want to earn your trust. That does not mean that we are not committed to being transparent. In terms of the growth, we feel very good about Q3, Q4. When you hear how the economy is moving up and down, you hear noise about China being soft, we are seeing reasonable demand there. A lot happens in the third month of any quarter. It is difficult to predict how this quarter is going to come out. I am very confident in the long run of the business. I am very confident in a Q3, a very good rebound off of where we have been in Q3 and Q4. I am very confident that our SG&A will be at a level that will allow us to return to profitability.
Great. Maybe just last question. We were just talking about it on the side.
You've been in the role for 90-odd days. I think we talked 93, 94. Maybe I know we heard the presentation. In terms of easy things that you want to shift maybe from a strategic perspective, where do you view that opportunity over the next couple of years? Thanks.
I think I talked about it a bit in the session. I think that getting people out of glasses and contacts is absolutely critical. As an organization, I would even see almost as an industry, we haven't been focused on that. We've just taken the population of people who've already made the election for the surgical option, and we've fought over those. I don't think we need to be fighting with our competitors.
I think we need to be figuring out how to make better solutions for the people who are selecting lifestyle-restricting options like glasses and contacts, or even worse, are not getting any help at all.
Okay. Very helpful. Really appreciate it. Wonderful. Congrats on the first presentation. I think you did well. We will be in the breakout in Genevieve. Appreciate it.
Appreciate it. Thank you.