Rxsight Inc (RXST) 2024 Q4 法說會逐字稿

Ladies and gentlemen, thank you for standing by. My name is Desiree. And I will be your conference operator today. At this time, I would like to welcome everyone to our Rxsight fourth quarter 2024 earnings conference call. (Operator Instructions)

I would now like to turn the conference over to Oliver Moravcevic, Vice President, Investor Relations. You may begin.

Thank you, operator. Presenting today are Rxsight President and Chief Executive Officer, Doctor Ron Kurtz; and Chief Financial Officer Shelley Thunen. Earlier today, Rxsight released financial results for the three months ended December 31, 2024. A copy of the press release is available on the company's website.

Before we begin, I would like to inform you that comments and responses to questions during today's call reflect management's views as of today, February 25, 2025. And we'll include forward-looking and opinion statements including including predictions, estimates, plans, expectations, and other information.

Actual results may differ materially from those expressed or implied as a result of certain risks and uncertainties. These risks and uncertainties are more fully described in our press release issued today and in our filings with the Securities and Exchange Commission or SEC. Our SEC filings can be found on our website or the SEC's website.

Investors are cautioned not to place undue reliance on forward-looking statements. And we disclaim any obligation to update or revise these forward-looking statements except as may be required by law. We will also discuss certain non-GAAP financial measures, disclosures regarding non-GAAP financial measures, including reconciliations with the most comparable GAAP measures can be found in the press release.

Please note that this conference call will be available for audio replay on our Investor Relations website. With that, I will turn the call over to our President and Chief Executive Officer, Doctor Ron Kurtz. Ron?

Good afternoon. And thank you for joining us. In a moment, Shelley will review the fourth quarter and full-year 2024 financial results, highlighting the key drivers of our performance. Following Shelly's review, I'll provide an update on the continued success of the Rxsight site system, our role in shaping the premium cataract market, and the major developments that are setting the stage for our next phase of growth.

With that, I'll turn the call over to Shelley.

Thank you, Ron. And good afternoon, everyone. Consistent with our January pre-announcement, Rxsight reported fourth quarter 2024 revenue of $40.2 million, up 41% compared to the year ago quarter. Growth was broad-based, driven by strong growth in LAL procedure volume and the continued expansion of our installed base of LDDs.

The positive momentum we saw throughout 2024 remains fueled by surgeons increasing appreciation of the clinical advantage and economic value of the Rxsight site system, particularly the benefits of post-operative adjustability.

LAL sales maintained strong growth in the fourth quarter of 2024, reflecting the increased preference amongst surgeons and patients for the enhanced clinical outcomes offered by our adjustable IOLs. We sold a record of 29,069 LALs in the period. up 61% from the fourth quarter of 2023.

These procedure volumes translated into LAL revenue of $28.5 million in the fourth quarter of 2024, up 60% compared to the year-ago quarter. In the fourth quarter of 2024, we sold 83 LDDs and generated $10.7 million in LDD revenue. We ended 2024 with an LDD installed base of 971 units, up 46% compared to the 666 units, installed at the end of 2023.

Higher LAL volume in the fourth quarter also led to an increased LAL revenue mix with LAL revenue accounting for 71% of total revenue, up from 62% in the fourth quarter of 2023. This shift in mix combined with LDD sales with a lower manufacturing cost and higher average selling price expanded our gross margin to 71.6% in the fourth quarter of 2024, up from 61.8% in the fourth quarter of 2023.

Fourth quarter of 2024, SG&A expenses were $28.2 million, up 33% versus the prior year period. This year-over-year increase in SG&A was primarily associated with increased expenses in sales and clinical personnel costs to support our growing installed base.

On a sequential basis, SG&A was up 10%, primarily due to increases in headcount and expenses related to higher sales volumes achieved in the fourth quarter. Research and development expenses for the fourth quarter of 2024 were $9.2 million, representing an increase of 25% year over year.

The change versus a year-ago period was primarily due to increased facility costs and associated increases in salaries and stock-based compensation. On a sequential basis, R&D expense remained relatively stable with a 4% increase compared to the third quarter of 2024.

We reported a net loss in the fourth quarter of 2024 of $5.9 million or a loss of $0.15 for basic and diluted share using weighted average shares outstanding of $40.4 million shares. In the year ago quarter, our net loss was $9.2 million or $0.26 per share on a basic and diluted basis using a weighted average of $36 million shares.

Note also that stock-based compensation in the fourth quarter of 2024 was $7.3 million, resulting in an adjusted net income of $1.3 million or $0.03 per basic and diluted share. In the interest of time, I'll provide a brief recap of full-year 2024 results. During the year, revenue grew 57% to $139.9 million, driven by a 78% increase in LAL revenue and a 24% increase in LDD revenue.

Our full-year 2024 gross profit margin was 70.7% compared to 60.4% in 2023. Total operating expenses were $135.8 million in 2024, an increase of 31% compared to 2023.

For the full-year 2024, we reported a net loss of $27.5 million or $0.71 versus a net loss of $48.6 million or $1.41 per share on a basic and diluted basis in 2023. Excluding the $24.6 million in stock-based compensation expense, our net loss in 2024 was $2.8 million or $0.07 per basic and diluted share.

Moving to the balance sheet, we ended the year with no debt and $237.2 million in cash equivalents and short-term investments. During 2024, we raised $107.5 million net of fees and expenses from our confidentially marketed public offering.

Turning to 2025 guidance, we are reaffirming the guidance we provided in January as we continue to expect 2025 full-year revenue to range between $185 million to $197 million representing year-over-year growth of 32% to 41%. Throughout the year, we expect typical seasonality with the first and third quarters seasonally weaker, while the second and fourth quarters are expected to be seasonally stronger.

Revenue contribution outside of North America is expected to remain nominal in 2025, with a more meaningful impact anticipated in 2026 and beyond. We expect our full-year 2025 gross margin to be in the range of 71% to 73%, reflecting a continued increase in revenue mix from the higher margin LAL procedure volume.

We continue to expect operating expenses to be between $165 million and $170 million which represents an increase of 22% to 25% over the prior year and reflects ongoing investments in sales and marketing, research, and development to achieve projected revenue increases in 2025 and the years beyond.

Investments are primarily in personnel with the largest expected increase similar to 2024. Headcount increases in our commercial team, which now numbers a bit over 200, with a focus on sales, education, installation, training, and clinical support.

Included in our costs, primarily in operating expenses, is non-cash stock-based compensation expense of approximately $22 million to $25 million.

With that, I'll turn the call back to Ron.

Thank you, Shelley. We believe that Rxsight's strong 2024 performance underscores the growing impact our proprietary adjustable IOL technology has had on the US premium IOL market during the last several years.

As indicated in our 2025 guidance, we believe Rxsight can durably grow as the power of adjustability becomes more widely recognized and accessible to doctors and patients through traditional and innovative adoption models both in the US and other key established premium IOL markets.

Since Rxsight went public and began scaling its US commercial team in Q3 2021, the new adjustable premium IOL category we created, has grown to approximately 10% of the overall US premium IOL market on a procedure volume basis through Q4 2024, with an even greater impact in revenue terms.

In fact, in 2024, we believed that adjustable premium IOLs accounted for nearly half of the overall growth of premium IOLs in the US, which may help explain the perceived stagnation in some legacy non-adjustable premium IOLs at the industry level.

Our 2024 customer survey reinforced previous findings and KOL commentaries that approximately 3 quarters of LAL cases come from the conversion of monofocal or toric IOL patients.

As a result, practices that adopted our technology are estimated to have increased overall US practice level premium revenue by approximately 10%, with even larger potential impact on their individual practices.

Doctors and practices increasingly recognize the importance of this expanding and durable revenue source as they face the dual challenges of demographically driven reimbursement declines and cyclically sensitive patient pay procedures like LASIK.

In this environment, the growth of high margin private pay LAL procedures that appeal to a more financially secure demographic will likely become even more critical to the financial sustainability of eye care providers in coming years.

With about 1,500 of the approximately 10,000 US cataract surgeons trained on our technology, we anticipate a long runway for continued LDD placements in offices serving cataract patients. Additionally, the growth of novel business models offering alternative approaches to deliver post-operative light treatments is expected to further expand access to adjustability for both surgeons and their patients.

Delivering consistent high-quality outcomes across doctors' practices and geographies is essential for long-term adoption and growth. We believe Rxsight's expanding set of clinical data validates the unique ability of our technology to meet this standard.

For example, our recently completed FDA post-approval study, which utilized the latest iteration of Rxsight technology, demonstrated that the odds of achieving very low levels of both residual sphere and cylinder with the LAL, were more than 14 times that of a monofocal IOL in eyes with modest preoperative corneal astigmatism.

This level of refractive precision also translated into more than a four-time increase in the odds of achieving uncorrected distance vision of 2020 or better in LALIs. These FDA study results further validate observations from real-world registry data, showing that both LAL and LAL+ patients achieved similarly excellent refractive and visual outcomes. Thereby, enabling doctors to customize their patients' binocular vision to meet and exceed their specific visual goals.

As we progress towards regulatory approvals in key markets in Asia and Europe, demonstrating that local doctors can replicate these outcomes is essential. A recent publication documenting LAL clinical results in a cohort of Japanese patients, which was also highly consistent with US data, exemplifies the efforts we will continue to pursue as we expand into new markets.

Additionally, our previously announced approval of an extended range of diopter powers for the LAL+ will likely have crossover relevance for the growing population of cataract patients in multiple countries with high degrees of myopia, including many who have previously undergone corneal refractive procedures.

We are also pleased to announce that we received FDA approval for an additional LDD functionality that builds on our clinical experience with aspheric optics. Scheduled for release in the second half of 2025, this enhancement will allow doctors to customize the asphericity of the LAL, something previously only possible through pre-operative selection of a specific fixed IOL.

While relatively modest in its initial capabilities, we believe this advancement opens the door for even higher levels of customization in cataract surgery, similar to advances seen in corneal refractive surgery over the past 20 years.

In summary, we believe that Rxsight's adjustable technology has already reshaped the premium cataract surgery market, offering the only IOL that allows post-operative vision customization. With this strong foundation in place, we are now focused on expanding access, accelerating adoption, and driving new innovations.

This next phase of growth will be fueled by the continued partnership between the dedicated Rxsight team and our insightful clinical partners worldwide. With momentum on our side, a clear strategic road map, and a growing community of passionate adopters, we believe Rxsight is well positioned for continued success.

We look forward to updating you on our progress throughout the year. and with that, I'll ask our operator to open the call for questions.

Thank you. We will now begin the question-and-answer session. (Operator Instructions)

Robbie Marcus, JP Morgan.

Hi. This is Lili. I'm for Robbie. Thanks so much for taking the question. Maybe we could start with LAL utilization and some of the trends that you've been seeing there lately. How do you think about utilization continuing to grow in 2025, now that we're sort of beyond the early adopter phase? And how would you say that utilization varies at some of your mature accounts versus your newer ones?

Okay. Good. Yeah, that's always been a subject of conversation. As it's an output of two numbers, the installed base of LDDs at the end of the previous quarter and then the number of LALs implanted in the current quarter. And that results in the number of LALs per LDD. So it's another measure that you know, the public can look at.

In the second quarter, it was 11 LALs per LDD. In the third quarter, it was down a bit around 8.7 and then back up again at 10.9 in the fourth quarter. So it's somewhat affected by the amount of newer LDDs we have in our mix as well as just overall growth in our penetration, as Ron said, we think about half the growth in the premium IOL market in 2024 came from the almost 100,000 LALs implanted in 2024.

So it is a measure that overall, we expect to grow, but it can fluctuate on seasonality. It can fluctuate a little bit if we have a very strong quarter of the previous quarter for LDD sales. But what I would say about this is that what we see when we look at our cohorts of LDD installs in 2021 and prior '22 and '23.

'24 is a little too early to look at because it takes about a year for an account to get to roughly the same number that the previous cohorts get in aggregate. What we've always seen is that is continued to grow, right?

And so, all of the cohorts end up in just about the same place of number of LALs per LDD. And that's been very consistent as we've been looking at this for the last couple of years. Of course, the class of '23 got to those same numbers a little faster obviously than the classes of '21 and '22.

And we expect that number to continue to be consistent. That being said, however, the distribution of how accounts act individually is obviously different. Sometimes we have very small accounts that don't do a lot of premium. But they use the LAL for the vast majority of their premium IOL cases.

Other times, we're relatively new in account. And they're still ramping up their LAL volume. So I think it's across the board. But even though these cohorts are relatively small, they seem to be acting consistently.

And we don't see a ceiling in a cohort. And we sometimes get that question. They all seem to be growing as well. And we would expect the number to continue to grow, but it might be variable quarter by quarter.

Would you add anything, Ron?

No, I would just reiterate, that's an output. It's not a key focus. Our key focus is obviously driving more LALs. And that can be accomplished, obviously, through driving more LDDs, but also increasing adoption within the -- in the account.

Thank you. Got it.

Ryan Zimmerman, BTIG.

Thank you. Thanks for taking the questions. And congrats on your progress this year. I guess, Ron, I was struck by the comments about the aspheric IOL. It's very interesting to hear about, obviously, new information.

As I think about those that may have an aspheric IOL need, would you say that those are younger, potentially myopic patients? I'm just curious kind of how to think about the initial sizing of that opportunity and when it may come to fruition?

So I would clarify that both the LAL and the LAL+ are already aspheric lenses that -- but the additional LDD functionality gives doctors the ability to actively modify that level of asphericity. And there are clinical situations where that's advantageous, different patient populations that may have more or less need for asphericity or benefit from asphericity, and that's really up to the physician.

Okay. On the pre-announcement, you had called this out. I think you called it out today too. The 15% of the potential position base is trained right now on LDD.

And I think you make that point just to show that there's sufficient runway ahead. But I'm wondering if you could kind of reflect on who the buyers are today versus a year ago and kind of the pace at which you would expect that adoption to continue to grow in 2025 and beyond?

Well, I think they're probably more alike than different people, ophthalmologists, and practices have different reasons for adopting at different times. And really, I think that we have a broad spectrum of practices that have our technology now. And we have a broad spectrum of practices that are still not yet adopted but hopefully will soon.

So I don't necessarily think that we've -- that it's a particular type of practice. We really see a cross section. And it becomes -- it comes down to -- does that individual practice or doctor want to adopt the technology and that decision can be based on a lot of different factors.

It can be based on technology advancements like we've had recently with LAL+ and the low diopter powers and now, with the aspheric functionality.

And that's an important way that we continue to drive adoption is to give the next group of doctors and practices a reason to adopt, also a reason for our teams to interact with practices that may already have our technology and may be considering how they want to expand their use of our technology in their practices.

So again, I think we're at such early innings that there's a lot of different types of practices that we're still reaching into.

Very helpful. Thank you for taking the question.

Thank you, Ryan.

Steve Lichtman, Oppenheimer.

Thank you. Good evening, guys. Just wanted to piggyback on the LDD enhancement, Ron. You mentioned opening the door to even more customization. Can you expand on that? What further advancements could we see as a result of this with the platform as you look out over the next few years?

Well, I would maybe not comment directly on that. But I think you can -- the folks in the ophthalmic community can look to corneal refractive surgery as an analogy where you know, initially when excimer lasers were approved, they were focused on the correction of the so-called lower order optical aberrations of sphere and cylinder.

And over time, that expanded to other corrections. Now of course, the sphere and cylinder are always the primary focus because they're the largest.

But there are discrete needs and benefits to being able to address other, the lower orders and the higher orders as well. And that's a -- there's always -- there may be additional requirements. But this is again, a first step in that direction in cataract surgery that I'm aware of.

Okay, great. Thanks, Ron. And then just in terms of the growth investments you're making this year on the OpEx side, can you give us an update on where the main areas of focus are as it relates to the commercial organization, marketing, some of the optometrist work?

Do you want to start there, Ron? Yes.

Sure. I would just comment that it's all of the above. We are always focused on providing the highest level of clinical training and support and overall field support. So we continue to add that as our customer base grows.

As we've talked about before, a key element is of expanding our adoption is education not only within our practices. But also to the wider community of eye care providers, which obviously includes as a big part is optometry.

And we have expanded our efforts in that space, both by attending both national but also regional meetings and providing additional support for our practices to be able to educate their local optometrists. So I think there are those all are important. I don't know if you want to add anything, Shelley.

I would just add something else. If you look at SG&A, the sales and marketing portion, of course, is primarily people and travel. And you know, we've expanded our commercial organization from about 10 to a bit over 200 in the years since we've gone public as well. That's to support not only new customers, but as well existing customers.

And the great part about the R&D roadmap that Ron lays out is that when our clinical people go in and our account managers go in, they usually have something new to offer. It might be a software upgrade. It might be additional training.

And so each of those are value added, and that adds up to our goal to get more fully penetrated in each one of those accounts. And of course, you know our goal remains to become 50% or greater of the total premium IOL market, first in the US and then globally.

Great. Thanks for the call.

Thank you, Steve.

David Saxon, Needham.

Great. Good afternoon, Ron and Shelly. Thanks for taking my questions and congrats on the quarter. I wanted to ask about top line guidance and specifically, about the cadence. Shelley, I heard kind of the comments about first and third quarter being the weakest.

But I wanted to kind of drill down on the first quarter sequential trends. Last year, you grew sequentially in the first quarter. Obviously, you've been seeing more of an impact from seasonality. So given we're kind of a little over halfway through the quarter, high-level expectations for sequential growth or decline in the first quarter relative to the fourth quarter.

Yeah. I -- it's always such a good question. And last year's seasonality kind of surprised us. And it's the first time in, at least my 30-plus years selling, being a CFO for a razor, razor blade company that the first half was seasonally stronger than the second half. And in particular, last year, we had a very strong seasonal Q1 and Q2 coming on top of that.

I guess none of one doesn't yet convince me that normal seasonality will prevail, which means that we're a bit larger. It's much harder to grow sequentially, each and every quarter, as our numbers have gotten larger.

And of course, we had a great fourth quarter as well. So while I don't give specifics in the first quarter, I expect that that will be a seasonally weaker quarter and third quarter again due to vacations. And second and fourth, the strongest quarters during the year.

Okay, very clear. Appreciate that color and then, in the script you talked about, I think 75% of LAL patients coming in from monofocal and [torque]. Acknowledging that's a large number, I wanted to ask on some of these premium, competitive launches, couple recent, one upcoming kind of?

Have you seen any impact from competitive trialing, and then with one coming up in a couple of months, kind of the expectations there, and anything material baked into guidance? Thanks so much.

Maybe I'll take that at a high level, David. The -- obviously when you get to even the percentage that we're of the market, approximately 10%, it's large enough to be impacted by competition.

Even if it's not direct competition, directed towards us, so I wouldn't be surprised if there's some impact. But I think it's going to be predominantly, yeah, focused on other similar technologies in the presbyopia correcting space.

Anything to add there?

Thank you.

Thank you.

Larry Biegelsen, Wells Fargo.

Hi, thanks. It's Lee, calling in for Larry. Thanks for taking the questions. I want to start out with the '25 guidance. If you think about the year, you just talked about the revenue, cadence, and the seasonality.

How should we think about cadence for gross margin, spending, and then, LDD versus LAL mix? Anything you can give color to on that? And I have a follow up.

Okay, great. Thank you very much, Lee. We have said when asked directly. And we said it publicly, do we expect LDD number sold to be higher than 2024? We've said yes.

And while we don't break out our revenue guidance by the two components of our product, LAL, like last year and the year before, is expected to grow faster and continue to become a more predominant portion of our revenue.

Of course, we never hold back LDP sales to manage gross margin. But naturally through that, you're going to have margin expansion. And mix will determine the margin in each quarter as well. And I think last year, we got a lot of cost savings out of the LDD this year. It's primarily driven by mix, and you know, more minor kind of cost savings, both at the LDD quite minor as well as on the LAL.

Great, that's helpful. And then, my follow up is just on R&D. So we estimate that you'll spend about $40 million or so, on R&D this year. Can you just talk a little bit more about where are you allocating those dollars? That is, where do you see opportunities for further innovation. Thank you.

Well, I would just say that as we're early innings in the commercial launch, in the US, incipient outside the US, I believe the same is true on the R&D pipeline. We're in early innings for the -- for this technology.

And we've got many, many years of advancements that will continue to benefit our customers. And we have the unique ability to continue to upgrade our technology in the field to provide really many years of benefits from their investments, both in terms of the cost of the LDD, but also their intellectual investments in the technology.

So, I wouldn't -- I don't think that there's any one thing that I would call out. But we're focused on continuing to drive innovation for the -- in this technology for many years to come.

Danielle Antalffy, UBS.

Hey. Good afternoon, guys. Thanks so much for taking the question. Shelley, this is probably a question for you. Just thinking about the margin cadence here, gross margin cadence, as we go through specifically, 2025.

But also, in the out years as much as you can help put out guideposts for us. As the LAL becomes a bigger piece of the mix here, how do we think -- how should we think about margin cadence and the upside opportunity there. And then, I have one quick follow up.

Great. You've seen tremendous margin expansion in the last year in 2024. It was a 100 basis points, so pretty terrific as well. You won't see that kind of big jump, that came in 2024, from pretty significant cost savings on the newer LDD, same functionality, where we took out some costs as well as continued volume increases in the LAL.

But I think you should see a regular cadence of gross margin expansion, might vary a little in a quarter depending on the number of LDDs we sell as a percent. If you had a very strong LDD quarter, it might be a little lower than -- it would have been, otherwise.

But I think you'll see consistent cadence in marginal improvements as I look at the company going way, way out, right? The LAL would be dominant, but we've still got a pretty big world to conquer on LDD sales and growing LAL sales.

So, the company could be an 80%-plus gross margin company. And I think that we'll continue to advance through that year over year. But I would never want to hold back sales of LDDs. But at real maturity I could see at 80%-plus.

Got you. Okay, that's helpful. And then wanted to follow up on a comment on that you made in the prepared remarks around, you're the centers that are figuring out business models or ways to unique ways to work this into their workflow in a way that's efficient and what have you.

So I guess the question here is how much are you seeing that be replicated and are you seeing other centers implement that is something unique about those centers that enables them to to implement those models? Or is that something that you expect to ultimately be replicated and implemented across your centers? Thanks so much.

Yeah. I think that just to clarify, it's not necessarily a new phenomenon. We've had LDD-focused treatment centers, whether they're informal, based on an individual practitioner or more formal. But you know, we do see more interest in that space.

I think it's analogous to again what happened previously, both with ambulatory surgery centers and with LASIK centers. And you know, it's not surprising that that this would occur as adjustability becomes a bigger part of the premium cataract space and net, net, it's -- we think it's a positive in that. It can give additional access to both doctors and patients.

Thank you so much.

Thomas Stephan, Stifel

Great. Hey guys, thanks for the questions. I'll start with the pipeline. And I guess Ron, just thinking specifically about LAL advancements, can you kind of elaborate on what this entails in terms of, I guess I'll call it the nature of the advancements? I know you mentioned early innings and upgrading technology in the field.

I mean, should we think about this is sort of improvements and upgrades like active shield for example? Or do we maybe think about new lenses on the horizon altogether like LAL+ as an example that I have to follow up?

Yeah. I would say it's all of the above. We've -- what if you look back at the advancements that we've done, some of them are to the optics. Some of them are to other functionality of the lens. And some of them are functionality or usability characteristics of the ancillary products like the light delivery device or our injector tools. So it's really all of the above.

And we try to respond to the requests of our customer base who we are very close with and collaborate with them to bring them those things that are going to be beneficial, maybe not to a large number of patients, but to beneficial enough. That it's a reason for them to continue to expand their offerings of the LAL or some derivative.

That's great color. Thanks, Ron. I appreciate that. And then Shelley, my second question, maybe for you. Just on guidance, I think it may very roughly imply that LAL utilization remains in the high single-digit range which is I think where you exited in the fourth quarter of '24.

Although that was a bit of a deceleration from 3Q to '24 year-over-year growth. So I guess my question is what gives you the confidence that utilization can at least hold steady in this high single digit year-over-year percent growth range. And then maybe, what's your level of conviction that utilization actually could re-accelerate throughout 2025? Thanks.

Well, I think the most important metric for us is the absolute number of LALs that are implanted. And I think that's the number one metric, right?

And certainly, we think as an outgrowth of that. That number of LALs per LDD is something that will continue to grow, although it might be variable quarter to quarter. And if we think about going back in the past when you're very small.

You know, it's just the law of large and small numbers, right? And so as long as we continue to have steady growth, consistent with our expectation of revenue, I think we're quite happy.

Super helpful. Thanks Shelley.

That concludes the question-and-answer session. I would like to turn the call back over to our CEO Ron Kurtz for closing remarks.

Great. Well, thank you all for your interest in our Rxsight. And we look forward to updating you on our progress in the future. Goodbye.

Ladies and gentlemen, this concludes today's conference call. You may now disconnect.