RxSight Q2 2024 Earnings Call Transcript

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Provided by Quartr
August 5, 2024

Key Takeaways

  • RX Sight reported Q2 2024 revenue of $34.9 million, up 68% year-over-year, with LAL sales growing 92% to $23.8 million (68% of total) and LDD revenue rising 32% to $10.2 million, while the installed base expanded 55% to 810 units.
  • Gross margin improved to 69.5% in Q2 2024 versus 57.8% a year ago, driven by a higher-margin product mix, and the company maintained full-year gross margin guidance of 68%–70%.
  • RX Sight raised its full-year 2024 revenue guidance to $139–140 million (56%–57% growth) and increased operating expense guidance to $135–136 million, reflecting higher stock-based compensation and continued commercial and R&D investment.
  • LAL utilization per LDD reached a record 11 procedures per device per month in Q2, reflecting accelerated adoption among both new and existing customers supported by enhanced training and clinical teams.
  • The FDA approved an expansion of the LAL Plus spherical power range to –2.0 to +3.0 diopters, broadening patient eligibility—especially for highly myopic eyes—and expected to drive further device placements and procedure volume.
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Earnings Conference Call
RxSight Q2 2024
00:00 / 00:00

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Operator

Good day, and thank you for standing by. Welcome to the RxSight Second Quarter 2024 Earnings Conference Call. At this time, all participants are in a listen-only mode. After the speaker's presentation, there will be a question-and-answer session. To ask a question during the session, you will need to press star one one on your telephone. You will then hear an automated message advising that your hand is raised. To withdraw your question, please press star one one again. Please be advised that today's conference is being recorded. I would now like to hand the call over to your speaker, Oliver Moravcevic. Please go ahead.

Oliver Moravcevic
Oliver Moravcevic
VP of Investor Relations at RxSight

Thank you, Operator. Presenting today are RxSight President and Chief Executive Officer, Dr. Ron Kurtz, and Chief Financial Officer, Shelley Thunen. Earlier today, RxSight released financial results for the three months ended June 30th, 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, August 5th, 2024, and will include forward-looking and opinion statements, 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.

Oliver Moravcevic
Oliver Moravcevic
VP of Investor Relations at RxSight

Investors are cautioned not to place undue reliance on forward-looking statements, as 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, Dr. Ron Kurtz. Ron?

Ron Kurtz
Ron Kurtz
President and CEO at RxSight

Good afternoon, and thank you for joining us. In a moment, Shelley will provide details on our Q2 results, which set new benchmarks for LAL and LDD sales, as well as for overall revenue. While we congratulate and thank both our clinical practice partners and RxSight team members for these accomplishments, we also believe they support our long-term thesis that the unique ability to adjust our intraocular lens postoperatively elevates premium cataract surgery, enhancing precision, quality, and customization, and leading more patients to select a high-value premium procedure to achieve top-level clinical outcomes. For ophthalmic practices that have experienced persistent reductions in Medicare reimbursements, the LAL premium procedure provides a critical patient pay growth opportunity that is relatively resistant to fluctuations in the economy, unlike procedures such as LASIK that target a younger demographic.

Ron Kurtz
Ron Kurtz
President and CEO at RxSight

Following Shelley's review of our financial performance and guidance, I'll discuss how underlying trends and our continued focus on executions make us confident about RxSight's near, mid, and long-term opportunity.

Shelley Thunen
Shelley Thunen
CFO at RxSight

Thank you, Ron, and good afternoon, everyone. RxSight generated second quarter 2024 revenue of $34.9 million, up 68% compared to $20.8 million in the year-ago quarter, and up 18% compared to $29.5 million in the first quarter of 2024. During the quarter, we sold 24,214 LALs and generated $23.8 million in LAL revenue, up 92% and 20% compared to the same year-ago quarter and the first quarter of this year, respectively. In Q2 of this year, LAL revenue represented 68% of total revenue, an increase from 60% in the year-ago period and from 67% in the first quarter of 2024. We sold 78 LDDs in the second quarter, up 16% compared to 67 units in the year-ago period, and up 18% compared to 66 units in the first quarter of this year.

Shelley Thunen
Shelley Thunen
CFO at RxSight

During the period, LDD sales generated revenue of $10.2 million, up 32% versus the second quarter of 2023, and up 17% compared to the first quarter of 2024. As of June 30th, 2024, our LDD installed base stood at 810 units, up 55% and 11% versus the year-ago period and the first quarter of 2024, respectively. Gross margin in the second quarter of 2024 was 69.5% compared to 57.8% in the same year-ago quarter and 70.1% in the first quarter of 2024. The year-over-year increase reflects the shift in product mix, with a higher margin LAL revenue advancing to 68% of the total, as well as increased margins on our LDD.

Shelley Thunen
Shelley Thunen
CFO at RxSight

The sequential change of about 0.5% and within our guidance of annual gross margin of 68%-70% is due to a slightly lower average selling price for our LDD in the second quarter of just over $130,500 compared to an ASP of $132,000 in the first quarter of 2024. ASPs can vary slightly depending on customer mix, with $130,000 continuing to reflect ASP stability following the 10% LDD price increase we took in the third quarter of 2023. SG&A expenses in the second quarter of 2024 were $24.3 million, representing an increase of $6.1 million, or 33% versus $18.2 million in the year-ago quarter. This year-over-year change was due primarily to an increase in personnel costs and a higher stock-based compensation expense. On a sequential basis, SG&A expenses increased $1 million, or 4%, due to primarily higher stock-based compensation expense and higher personnel costs.

Shelley Thunen
Shelley Thunen
CFO at RxSight

During the second quarter of this year, R&D expenses rose 12% to $8.3 million, compared to $7.4 million in the second quarter of 2023. This year-over-year change was primarily attributable to increased facilities costs and increased stock-based compensation. Compared to the first quarter of 2024, R&D expenses in the second quarter increased by $300,000, or 3%, primarily driven by an increase in stock-based compensation. Our GAAP net loss in the second quarter of 2024 was $6.1 million, or a loss of $0.16 per basic and diluted share, using weighted average shares of 38.5 million shares. This compares to a GAAP net loss of $13.9 million, or $0.40 per share, on a basic and diluted basis in the second quarter of 2023.

Shelley Thunen
Shelley Thunen
CFO at RxSight

Moving to the balance sheet, we ended the second quarter of 2024 with cash, cash equivalents, and short-term investments of $233.3 million, compared to $125.4 million on March 31st, 2024. The change in cash balance includes $107.5 million net of fees and expenses from our May Confidentially Marketed Public Offering, or CMPO. Turning now to guidance. Based on our strong second quarter 2024 performance, we are increasing our revenue, operating expense, and non-cash expense guidance as follows. Full year 2024 revenue is now projected to be between $139 million and $140 million, an increase from our previous guidance of $132 million-$137 million. This represents year-over-year growth of 56%-57%. The revised revenue guidance reflects an increase of $11 million at the low end of the range and $5 million at the high end of the range, compared to our initial 2024 guidance set in January.

Shelley Thunen
Shelley Thunen
CFO at RxSight

For the remainder of the year, we continue to anticipate sequential quarterly growth, with a nominal increase in Q3, factoring in both a very strong second quarter and typical seasonality in the third quarter due to summer vacations taken by both patients and doctors. Operating expenses are projected to increase to between $135 million-$136 million, up from our previous guidance of $126 million-$130 million, or $7.5 million at the midpoint of guidance, and representing an increase of 30%-31% over 2023. The guidance increase is primarily due to higher non-cash stock-based compensation expense, with the remainder of the increase related to continued investment in sales and marketing and research and development.

Shelley Thunen
Shelley Thunen
CFO at RxSight

The non-cash stock-based compensation expenses are now expected to be between $29 million-$30 million, up from our previous guidance of $22 million-$25 million, representing an increase of $5 million at the top and $7 million at the bottom end of the range. The increase is due to stock options and restricted stock units, or RSUs, granted at higher per-share prices to date. As discussed last quarter, operating expense guidance includes continued efforts to leverage our commercial momentum, grow our educational programs, develop our product pipeline, and expand internationally as regulatory approvals are obtained. Finally, please note that our gross margin guidance range remains unchanged at 68%-70%, which at the midpoint remains 300 basis points higher than our initial 2024 guidance set in January.

Shelley Thunen
Shelley Thunen
CFO at RxSight

Our combined revenue and gross margin increases since our initial guidance in January of 2024, excluding the increase in operating expenses, which are largely non-cash, contribute an additional $7.5 million-$11 million to operating income. With that, I'll turn the call back to Ron.

Ron Kurtz
Ron Kurtz
President and CEO at RxSight

Thank you, Shelley. RxSight's strong Q2 performance, as well as our revised 2024 guidance, is based on our technology's ability to meet the clinical needs of patients and doctors, as well as the business needs of practices. While traditional cataract surgery with fixed intraocular lenses generally delivers good results, the unique ability to non-invasively modify the LAL after surgery, based on direct patient feedback, enables doctors to deliver a new level of precision and customization, thereby drawing more patients into the premium IOL category, which is the most significant opportunity for practices to offset long-term negative financial trends in their businesses. The aging of the population in the U.S. and other developed countries continues to put pressure on healthcare systems to reduce reimbursements to providers, particularly in eye care.

Ron Kurtz
Ron Kurtz
President and CEO at RxSight

Patient-pay procedures like LASIK that may offset some of these effects have proven to be inconsistent revenue replacements, as they appeal to a younger demographic whose decisions are easily deferred during downturns in the economy. In contrast, the expanding demographic of patients considering cataract surgery cannot easily defer the procedure indefinitely. Reduced vision interferes with daily activities, has been linked to an increased risk for falls, and recently was added as a modifiable risk factor for dementia. Driven by social, work, and lifestyle factors, this population has developed high expectations for vision without glasses and is best positioned financially to consider a patient-pay premium IOL procedure.

Ron Kurtz
Ron Kurtz
President and CEO at RxSight

The potential for practices to convert more patients from their most commonly performed but poorly reimbursed conventional cataract procedure to their highest revenue and highly profitable premium procedure is a major reason why these businesses have, and we believe will continue to invest in LDD technology and infrastructure for most, if not all, of their locations that serve cataract patients. With a total installed base of just over 800 LDDs in the U.S. and Canada, we believe we are still in the early phase of penetration of these clinical sites. As practices acquire and become familiar with adjustable lens technology, our focus is on continued growth in LAL procedures by leveraging the expanded human and physical infrastructure for postoperative light treatments.

Ron Kurtz
Ron Kurtz
President and CEO at RxSight

We continue to see growth in monthly utilization across the installed base, with the most recent expansion to 11 LALs per LDD per month in the seasonally strong second quarter, up from 10.1 LALs per LDD per month in Q1 of this year. We believe the growing clinical awareness and experience that has driven this trend over the last several years has been accelerated by our strategic clinical and marketing teams. These experts help practices effectively integrate and utilize adjustable technology to improve patient outcomes and grow profitable practice revenue. Continued technology development is another key mechanism for growing adoption, with the LAL+ being the latest example. Now midway through its rollout in the U.S., we continue to receive positive feedback from patients and doctors who appreciate its rapid visual rehabilitation and optical quality, with a growing body of data now being presented at clinical conferences.

Ron Kurtz
Ron Kurtz
President and CEO at RxSight

The addition of LAL+ also continues to be a catalyst for LDD sales, as practices see another reason to add adjustability to their product offerings. As part of our ongoing commitment to innovation, we are pleased to announce FDA approval for an extension of the spherical refractive power range for LAL+ from -2 to +3 diopters, providing RxSight with the broadest spherical power range of any astigmatism-correcting IOL in the U.S. When coupled with adjustability, this may be particularly useful in highly nearsighted eyes that also typically have less predictable outcomes after surgery. Commercial distribution of the expanded power range is anticipated toward the end of 2024. While our primary focus remains on fully developing the U.S. market, we continue to make progress towards expanding our international regulatory approvals in countries that have already adopted premium IOLs.

Ron Kurtz
Ron Kurtz
President and CEO at RxSight

Given that RxSight's adjustable IOL technology uniquely addresses globally relevant clinical and business needs, these markets can provide additional growth opportunities. Taken together, we believe we are very well positioned for sustained growth in the years to come and look forward to updating you on our continued progress. With that, I'll ask the operator to open the call for questions.

Operator

Certainly. As a reminder, to ask a question, please press star one one on your telephone and wait for your name to be announced. To withdraw your question, please press star one one again. Please stand by while we compile the Q&A roster. One moment for our first question. Our first question will be coming from Ryan Zimmerman of BTIG. Your line is open.

Ryan Zimmerman
Ryan Zimmerman
Managing Director of Equity Research at BTIG

Oh, good morning or good afternoon. Excuse me. A lot of earnings calls. I want to ask about the updated guidance or range with the PMA supplement, Ron, for the LAL. You know, I was reviewing the FDA data. You just talked about kind of where that range was before and versus now, the -2 to +3 diopters, and kind of what you size that opportunity to be as you think about expanded usage there.

Ron Kurtz
Ron Kurtz
President and CEO at RxSight

The power range prior to this approval was +4 to +30 diopters, which was already a broad range. This, of course, broadens the low end of the range, which, again, would be, you know, likely most clinically relevant to eyes that are highly myopic or nearsighted prior to cataract surgery. And so, you know, it's difficult to know exactly how many of those patients are going to be, you know, candidates for this power range. Certainly, it's something that we've been asked by our customers about, and we're very pleased that we have this approval now.

Ryan Zimmerman
Ryan Zimmerman
Managing Director of Equity Research at BTIG

Very nice. And maybe just switching gears to guidance a little bit. You know, as you think about the magnitude of your beats coupled with the size of the guidance increase, it looks like you're building in, you know, a little bit more expectation, particularly in third and fourth quarter, Shelley. And, you know, one of the things that stood out this quarter, which you noted, Ron, was the acceleration to 11 units per LDD per month, which really is a step up versus the prior year comparable period from 1Q-2Q 2023. So, you know, as you think about that increase in guidance, kind of what's underpinning those expectations is that higher utilization from the install base. Is there a pipeline, particularly within the LDD, you know, kind of funnel that you look to and see?

Ryan Zimmerman
Ryan Zimmerman
Managing Director of Equity Research at BTIG

Just help us understand kind of what's behind that increase in guidance, particularly in the back half of the year. Thanks for taking the questions.

Shelley Thunen
Shelley Thunen
CFO at RxSight

Thank you, Ryan. Yes, you are correct. In the second quarter of 2023, our usage was 9.2 LALs per LDD, and we accelerated that to 11 this quarter. And we have seen, you know, continuous improvement in that number. Sometimes in the Q3 number, it goes down a little bit because you have a really large base. But it also means that you can increase the number of absolute number of LALs in each quarter. And I think that that's, you know, one of the most important parts of our model. First, we need to sell an LDD, but second, we need to make our customers successful and their patients happy. And part of that is, one, adding procedures from new customers, having them accelerate a little bit more rapidly than we had customers do in 2021-2022.

Shelley Thunen
Shelley Thunen
CFO at RxSight

We started seeing that for customers installed in 2023 and again in 2024. So yes, LAL growth is, you know, as you know, and we've discussed before, an important component to increasing our revenue.

Ryan Zimmerman
Ryan Zimmerman
Managing Director of Equity Research at BTIG

Thank you for taking the questions.

Ron Kurtz
Ron Kurtz
President and CEO at RxSight

Thank you, Ryan.

Operator

Thank you. One moment for our next question. Our next question will be coming from Robbie Marcus of JPMorgan. Your line is open.

Robert Marcus
Robert Marcus
Managing Director of Equity Research at JPMorgan

Oh, great. Thanks for taking the questions. Congrats on a really nice quarter here.

Shelley Thunen
Shelley Thunen
CFO at RxSight

Thank you, Rob.

Robert Marcus
Robert Marcus
Managing Director of Equity Research at JPMorgan

Two for me. You know, there have been a lot of investor concerns after some conflicting sell-side research on sort of the health and the ability to grow on LDDs and LAL adoption. Clearly, in the quarter, you had a great LDD number and, as we just talked about, LAL adoption. Really, my question is sort of what are you seeing in the field? You know, Ron, you talked about halfway. Who's buying LDDs today? Where are they placing them? Are centers on their second or third units yet? Are they, you know, getting LDDs at multiple locations if they have multiple offices? Just help us think about, you know, sort of who's the incremental buyer here.

Robert Marcus
Robert Marcus
Managing Director of Equity Research at JPMorgan

You know, I have to imagine, based on the increase in utilization that you're seeing, new users ramp up much quicker than you did, you know, 2-3 years ago, and you're still seeing improvements in utilization from existing users. Any kind of color or segment or trends you can talk about in new versus existing users there would be great. Thanks.

Ron Kurtz
Ron Kurtz
President and CEO at RxSight

Thank you, Robbie. So maybe I'll take the first part and ask Shelley to talk a little bit about utilization trends. But, you know, I'm not sure qualitatively that there's, you know, a large difference. We're still at the early phase of penetration of the market. And so, you know, we have our new customers are, you know, similar to our previous customers. We continue to grow into the market. And, you know, why any one particular customer decides that this is the right time for them to adopt the LAL versus a previous time is really kind of idiosyncratic to that practice. And we can certainly influence that with our sales team. And, you know, as I mentioned, the more we move the technology forward, the more it gives people a reason to adopt.

Ron Kurtz
Ron Kurtz
President and CEO at RxSight

We don't see, in terms of, you know, where they're putting the LDDs, as we've noted before, there's LDD within an office is not a capacity limitation, so to throughput. So it would be, you know, highly unusual. I can't think of a case where an office would add, a practice would add an LDD to the same office. So they're almost always going to a new office that is serving, you know, what in that practice's mind serves a different patient population for them. They're either geographically different or, you know, demographically different in their local environment. And, you know, whether that practice is, you know, a smaller practice with a couple of offices or larger practices with many offices, that's, you know, really what they're doing. They're adding the LDDs to new offices that can then offer that technology to a new patient population.

Shelley Thunen
Shelley Thunen
CFO at RxSight

Thank you, Ron. As we move to LAL adoption, I think that, as you noted earlier, we have talked about adoption by different cohorts of install. Certainly, those folks in 2023 and 2024 have accelerated faster. But the important thing with that number also is that we have continued to see all cohorts continue to grow. And we think an important part of the component of newer customers getting going faster, obviously, is, one, we have more references. So a friend or a colleague is likely to have said to them, "Just get going. Do 5, 6, 7 patients in your first week," because you're going to see the results from a larger n than just one patient.

Shelley Thunen
Shelley Thunen
CFO at RxSight

That gives them confidence, as well as the fact that we continue to improve in our clinical training, in our account management training in terms of, you know, teaching them how to sell the technology, as well as how to integrate practice flow for them. Those are all important in adoption. As Ron said, each time we add a feature, function, even a software upgrade, it helps our customers continue to penetrate their market and also gives a new customer another reason to buy.

Shelley Thunen
Shelley Thunen
CFO at RxSight

You know, they're able to say, "Aha, I should be doing more of this now." And of course, you know, what we've seen in the last three years, consistent in each of the customer surveys that we've had run in the fall, is 40%-44% of LAL patients come from what would have been a monofocal patient, a patient that would not have gotten any premium. And then about another third, a little bit more than 1/3, come from toric lenses or astigmatism correction lenses, which they typically sell for less than half of the price of a PCIOL. So within a practice, they have more and more opportunity on the LAL, front. Would you add anything, Ron?

Robert Marcus
Robert Marcus
Managing Director of Equity Research at JPMorgan

Shelley, maybe just to follow up on that, what's your latest view on what percentage are coming from monofocal versus share conversion from premium IOL? It's one of the more attractive components of the story that you're actually expanding the market here. So just any color you could give and sort of the receptivity, is it nationally, you know, different pockets, anything you could give? Thanks a lot.

Shelley Thunen
Shelley Thunen
CFO at RxSight

So I will say that where the data comes from is the survey we've had run by a third party among our existing customers. And that's one of the questions they ask them, you know, and how much you charge for each and what your conversion rate is for each type of patient population. So the last time the survey was run was in the fall of 2023. We usually only run that annually. But the numbers have been very consistent and inching up a little bit. I think we started at 40%. Last year was 44%. That really is information that comes, you know, directly from the practice. Other information might be anecdotal at this point in time. I don't know if you see anything when you're out visiting customers, Ron, or not.

Ron Kurtz
Ron Kurtz
President and CEO at RxSight

I would, I haven't seen anything that would make me suspect that that number has changed.

Shelley Thunen
Shelley Thunen
CFO at RxSight

Okay.

Robert Marcus
Robert Marcus
Managing Director of Equity Research at JPMorgan

Great. Thank you very much.

Shelley Thunen
Shelley Thunen
CFO at RxSight

Thank you, Robbie.

Operator

One moment for our next question. Our next question will be coming from Steven Lichtman of Oppenheimer & Co. Inc. Your line is open.

Steven Lichtman
Steven Lichtman
Managing Director of Equity Research at Oppenheimer & Company

Thank you. Evening, everyone, and congratulations on the quarter. I wanted to start first with LAL+. You know, it does seem to be another opportunity to go after new customers. And Ron, you mentioned it being a door opener. Can you talk more about what you're seeing on that front? And for those surgeons, not yet customers, what they might see with LAL+ that would sort of pique their interest and convert over?

Ron Kurtz
Ron Kurtz
President and CEO at RxSight

You know, I would start by saying that, you know, LAL and LAL+ are both great quality lenses. They provide both the same degree of adjustability and are more similar than different. That's why we price the lenses the same, so that we're not, you know, we want the doctor to make the best choice for the patient. Feedback that we've received are things, you know, on the order of what you would expect from the optical design of the LAL+, which provides, you know, perhaps faster visual recovery, particularly for intermediate and tasks and near tasks. So, you know, that feedback is consistent with the optical design, which slightly extends the depth of focus relative to the LAL.

Shelley Thunen
Shelley Thunen
CFO at RxSight

So Ron, anecdotally, you know, Eric Weinberg, who's our Chief Commercial Officer, says every sale, when you have a new technology, which he's done multiple times, starts with a no, and then to a yes. And so you and he always say to us, every time we have a technological advance, right, it gives the customer who's been saying no an opportunity to say yes. And, you know, they do that without losing face. They can say, "Yeah, well, I've been waiting for this," or, "This is the reason." And that's important to our LDD sales as well as our LAL sales and existing practices.

Ron Kurtz
Ron Kurtz
President and CEO at RxSight

Yes. And I think it also establishes, you know, a record, you know, that we've carried through at previous companies and now here at RxSight, that we have a long-term plan for the technology that will continue to grow the benefits to whoever acquires the technology. And that's important because this is a, you know, we're entering into a long-term relationship with our customers.

Steven Lichtman
Steven Lichtman
Managing Director of Equity Research at Oppenheimer & Company

Great. And then just secondly, you know, you're getting SG&A leverage and, you know, you increased the non-stock-based comp SG&A by less than the revenue increase. So continuing to get leverage. But, you know, just given the strength of the balance sheet, any thoughts to, you know, accelerating investment on the commercial side, or is that not something in the near-term plans?

Shelley Thunen
Shelley Thunen
CFO at RxSight

Yes. You know, when we raised the money from the CMPO, and what we did say is that this gives us an opportunity to invest more in sales and marketing and also in R&D to accelerate our internal projects, which can take quite a while. And so we had talked about specific things such as additional education for our customers, reaching more out to the optometrist community and those efforts along with additional marketing and not marketing to our customers, not DTC.

Shelley Thunen
Shelley Thunen
CFO at RxSight

And so we had talked about that. And where you saw in the increase in OpEx, most of it was in stock-based compensation, but about $2 million in 2024 really relates to this additional ability to invest in the business. And what we said at that point in time is, while we'll always be careful with OpEx, it takes a while to get all these programs rolling. We would see more of the effect of these programs in 2025.

Steven Lichtman
Steven Lichtman
Managing Director of Equity Research at Oppenheimer & Company

Got it. Thanks, Ron and Shelley.

Shelley Thunen
Shelley Thunen
CFO at RxSight

Thank you.

Ron Kurtz
Ron Kurtz
President and CEO at RxSight

Thank you, Steven.

Operator

Thank you. One moment for our next question, which will be coming from David Saxon of Needham & Company. Your line is open.

David Saxon
David Saxon
Managing Director of Equity Research at Needham & Company

Great. Good afternoon, Ron and Shelley. Thanks for taking my questions. Maybe I'll start on the LDDs. Obviously, really strong placement number here in the second quarter. If I look to last year, in the third quarter, LDD placements were essentially flat sequentially. I heard, Shelley, your comments around third quarter modest sequential growth. But specifically for the LDD placements, should we be thinking about a similar sequential trend as we saw last year, so kind of flattish? Or is there any reason why seasonality would be more impactful this year and maybe cause LDD placements to dip sequentially?

Shelley Thunen
Shelley Thunen
CFO at RxSight

Yeah. I think that, you know, we did guide specifically that we would have a nominal increase in revenue in the third quarter. And I think that's very typical with seasonality. We do see seasonality both in capital equipment as well as in procedures. And so I would expect seasonality on the LDD front. And I think that if you go past when we were very early, we always have to log bigger and bigger numbers, right? And that's an important component in the overall growth story. It's still tremendously high growth, but wouldn't be as high as it was, say, two years ago.

Shelley Thunen
Shelley Thunen
CFO at RxSight

So I would suspect that we would have seasonality in LDDs while we're not providing specific guidance and that, you know, our most powerful growth is likely to come from LALs just because of the fact that we've added new customers, even though existing customers may have some effect from summer vacations both for themselves as well as for their patients.

David Saxon
David Saxon
Managing Director of Equity Research at Needham & Company

Okay. Got it. Very clear. Thanks for that, Shelley. And then I'll probably stick with you, Shelley. So gross margin was down sequentially. It sounds like that was really just around LDD pricing. The first half gross margin is something like 69.8%, so really at the top of the guidance range. I mean, it sounds like LAL mix is going to increase sequentially in the third quarter and, you know, maybe even so in the fourth quarter. So why not raise the gross margin guidance? Is there anything in the back half that would put pressure on gross margins, or is it really just conservatism? Thanks so much.

Shelley Thunen
Shelley Thunen
CFO at RxSight

I wouldn't call it exactly conservatism overall. I think that's a pretty narrow range for a company of our size. But I do think that other than mix, which, while it is the most important component of the gross margin, we also have things like period costs, right? We saw that in the fourth quarter of last year when people expected because of mix it would be a little higher. But you have certain things that customers don't pay for directly, like cartridge and what we see is at the end of the year, sometimes the ASCs order a little heavier, right, because they're not paying for that inventory. And we're rolling out the balance of our ASCs with LAL+ in the third and fourth quarter as well. Primarily in the third quarter, our inventory is quite balanced and we're able to fulfill the ASCs.

Shelley Thunen
Shelley Thunen
CFO at RxSight

That's really good news. We're also rolling out alongside our existing injector, a disposable injector. I think Ron talked about that a couple of quarters ago as well. We'll have some things like higher shipping costs. Those things can be one-time costs. Service can go up a little up and down in terms of the costs incurred in a quarter. I always try and leave room for some period costs as well as mix.

David Saxon
David Saxon
Managing Director of Equity Research at Needham & Company

Great. Thanks so much.

Operator

One moment for our next question. Our next question will be coming from Craig Bijou of Bank of America Securities. Your line is open.

Craig Bijou
Craig Bijou
Equity Research Analyst at Bank of America

Good afternoon. Thanks for taking the questions. Wanted to follow up on the LAL+ specifically. And you know, Ron, heard your comments on how it's driving LDD sales. And I'm not sure if, you know, with some of your commentary on utilization, if you talked about how LAL+ is impacting that. But I'm curious. I know you guys are agnostic given the price as to LAL or LAL+, but is it driving, you know, is utilization higher because you're seeing more LAL+ use or maybe just talk about how we should think about the mix from a doc perspective?

Ron Kurtz
Ron Kurtz
President and CEO at RxSight

Well, I mean, we certainly hope that utilization grows because of LAL+. I mean, we wouldn't have introduced it if we didn't think that. But I don't know that it really makes any difference, you know, what a doctor uses. We really just want them to use an adjustable lens, a light adjustable lens, whether that's an LAL original or an LAL+. And, you know, over, I think that, you know, different doctors have different opinions, have different, you know, different patient populations, and that will, you know, work itself out over time. But, you know, overall, we have, you know, continued very positive reviews both from the LAL as well as from the LAL+.

Craig Bijou
Craig Bijou
Equity Research Analyst at Bank of America

Okay. Thanks. Thanks, Ron. And then maybe following up on some of the international comments that you've been making, I know you've talked about it increasingly over the last few quarters. So, you know, any perspective on timing or some of the markets that you may be targeting? I know, I think we've talked about Asia before, but any perspective on, you know, market and timing of potential approval?

Ron Kurtz
Ron Kurtz
President and CEO at RxSight

You know, not in terms of market entry. Obviously, our focus right now is, as you mentioned, approvals. We're making progress. You know, I would hope that, you know, we'll continue to be able to update you, you know, as the year progresses. You know, regulatory approvals are not an exact science. So I'd like to give us a little bit more time as we continue to make progress.

Craig Bijou
Craig Bijou
Equity Research Analyst at Bank of America

Great. Thanks for taking the questions. Congrats on the quarter.

Ron Kurtz
Ron Kurtz
President and CEO at RxSight

Thank you.

Shelley Thunen
Shelley Thunen
CFO at RxSight

Thank you.

Operator

One moment for our next question. Our next question is coming from Larry Biegelsen of Wells Fargo. Your line is open.

Lawrence Biegelsen
Lawrence Biegelsen
Managing Director of Equity Research at Wells Fargo

Hey, guys. Thanks for taking the question and congrats on the quarter. Ron, I'm curious, you know, your share, and by the way, it looks like by our math, your share of premium IOLs is, you know, over 10% this quarter for the first time. I'm curious on that, you know, 40% number you talked about. Do you have, is there any evidence, you know, that are coming from monofocal? Is there any evidence that you're expanding the market? Because I'm looking at the Market Scope, you know, penetration numbers, and it's been pretty flat now for a few years. So why wouldn't, if you're at 10%, why wouldn't we see, you know, all else being equal, kind of a 400 basis point increase in premium IOL market if you're 10% and, you know, 40% are coming from monofocal?

Ron Kurtz
Ron Kurtz
President and CEO at RxSight

Well, you know, one is, you know, I haven't looked at those numbers. So I think that, you know, those numbers are likely directionally, but, you know, they're still going to be, you know, they may not fully capture our adoption in real time. But also, you know, there's definitional questions. So, you know, those surveys often look at premium IOLs versus, you know, what we would more define as premium cataract surgery. So it's possible that some procedures that are, you know, more broadly considered patient pay but don't involve a premium IOL, some of those may be converting to LAL. Again, I can't give specific reason without looking at the, you know, at the specific survey that you're referring to.

Lawrence Biegelsen
Lawrence Biegelsen
Managing Director of Equity Research at Wells Fargo

Fair enough. It was, you know, yeah. Yeah. Shelley, I don't know if you wanted to add something. I was just looking at the data that's in the Market Scope, you know, the newsletter.

Shelley Thunen
Shelley Thunen
CFO at RxSight

Yeah. No. And I think you and I have had, you know, a number of conversations about, you know, survey data in particular, and that's what some of the basis of Market Scope is as well. And we consider them probably the most accurate information that we have access to. And I think that some of it's determined after the fact, right? And so the projections aren't necessarily, and sometimes the after-the-fact numbers come around three months later, right, once everybody's reported and he's had a chance to talk to people. So we can't really comment on the overall market because we're not large enough yet, but we definitely know that we're building premium access and premium patients inside of our customers. And I think that that's very important to their success and their payback on the LDD.

Lawrence Biegelsen
Lawrence Biegelsen
Managing Director of Equity Research at Wells Fargo

All right. I'll leave it there. Thanks for taking the question. Congrats again.

Shelley Thunen
Shelley Thunen
CFO at RxSight

Thank you.

Ron Kurtz
Ron Kurtz
President and CEO at RxSight

Thank you.

Operator

One moment for our next question, which is coming from Tom Stephan of Stifel. Your line is open.

Thomas Stephan
Thomas Stephan
VP of Healthcare Equity Research at Stifel

Great. Hey, everyone. Thanks for the questions and congrats on the really nice quarter. Maybe just to start on LAL utilization growth, I think year-over-year growth accelerated for the first time in, I believe, well over a year based on our model's calculations. Ron or Shelley, can you talk about what specifically you're seeing that's driving this? And then maybe more importantly, you know, do you believe there is sustainability in this potential inflection that you saw in 2Q? You know, when we're tying out our model kind of real-time here, it seems like you expect in 3Q consistent year-over-year utilization growth. So, you know, maybe any comments on the sustainability would be very helpful.

Shelley Thunen
Shelley Thunen
CFO at RxSight

Yeah. I think that I'll start with sustainability rather than the absolute numbers. But what we do see, particularly when we look at our cohorts, you know, as we've talked about multiple times, that our cohort is the one I look at is based upon year of install. And those cohorts continue to grow. And I think that's an important component as well. Sometimes people ask us, what's the max in a practice? You know, we don't know the answer to that. And certainly these numbers are aggregated. And then, of course, the slope of the line in terms of adoption is higher for our newer customers. And if we think about it overall, that the most important thing we do with the LAL is continue to get adoption. Certainly, we have customers where we're probably less than 10% of their total volume because that's voice of customers.

Shelley Thunen
Shelley Thunen
CFO at RxSight

Others where we are approaching 100%. Nothing's absolutely 100%, but we're predominant in those practices. And our clinical people and our account managers, our LAL account managers, are tasked with working with their individual practices. They each have assignments of practices. They look at their volume. They come in and retrain if they need to. If new doctors are coming on, they do that. If they have a staff member that's been replaced, they make sure that they have all the digital tools that they need. And that's an important component of what we do is to be in front of the customer and make sure they understand the benefits as well as, you know, the fact that LAL+ came out, the fact that we have, you know, a new injector, the fact that we will be expanding the diopter range for LAL+.

Shelley Thunen
Shelley Thunen
CFO at RxSight

So I think that those are all things that give them an opportunity to call and to make sure that we're fulfilling the needs of our customers. So I think that that's an important component. And while we do see variability, right, you know, we were at, you know, 9.2 in the second quarter of 2023, 8.7 in the third, and that is not inconsistent with seasonality. And then up to 10.2 in the fourth quarter and then 10.1 in the first. And of course, fourth quarter is typically your strongest.

Shelley Thunen
Shelley Thunen
CFO at RxSight

And we had just a really strong quarter in the second quarter. And we think that that continued growth might be, you know, variable quarter to quarter, but overall the slope of the line is up and that's what we're working with. Our ultimate goal is to be 50% of the market. That's a long-term goal, but our first goal is to increase our penetration in each one of our accounts.

Thomas Stephan
Thomas Stephan
VP of Healthcare Equity Research at Stifel

That's great color. Thanks, Shelley. And then my follow-up was just on international and specifically Europe. Ron, maybe to pivot to you, you know, can you discuss the key differences compared to the U.S. that we should be mindful of in terms of the end market and the opportunity? I guess I'm just curious, you know, what specifically gives you sort of the confidence that your success in the U.S. can be replicated in Europe specifically? Thanks.

Ron Kurtz
Ron Kurtz
President and CEO at RxSight

Well, I think that, you know, as many of us who've been involved with launches in Europe, there's a, you know, it's a, it's really not a single market. It's multiple markets, individual markets that each have to be addressed individually. And so that does take some time. We also have a new regulatory environment in Europe, which, you know, many of the companies or all the companies are dealing with now. And so that also has added a layer of complexity. But at the end of the day, you know, clinical ophthalmology is the same across the entire country and across the globe, whether it's Europe or Asia. You know, there's a broad commonality in what patients want and how physicians react to technology.

Ron Kurtz
Ron Kurtz
President and CEO at RxSight

So it's certainly a positive, and it's been our experience that if you have success in the U.S., that that's a good harbinger for ultimate success outside the U.S. But because of these individual dynamics within regions, you know, that can be, that doesn't necessarily mean that that happens overnight.

Thomas Stephan
Thomas Stephan
VP of Healthcare Equity Research at Stifel

That's great. Thanks, Ron. Thanks, Shelley. Congrats again.

Shelley Thunen
Shelley Thunen
CFO at RxSight

Thank you.

Operator

We'd now like to turn the call back to Ron for closing remarks.

Ron Kurtz
Ron Kurtz
President and CEO at RxSight

Well, thank you all for your time and attention today. We appreciate your interest in our RxSight and look forward to updating you on our progress in future quarters. Goodbye.

Operator

This concludes today's conference call. Thank you for participating. You may now disconnect.

Executives
    • Oliver Moravcevic
      Oliver Moravcevic
      VP of Investor Relations
    • Ron Kurtz
      Ron Kurtz
      President and CEO
    • Shelley Thunen
      Shelley Thunen
      CFO
Analysts
    • Craig Bijou
      Equity Research Analyst at Bank of America
    • David Saxon
      Managing Director of Equity Research at Needham & Company
    • Lawrence Biegelsen
      Managing Director of Equity Research at Wells Fargo
    • Robert Marcus
      Managing Director of Equity Research at JPMorgan
    • Ryan Zimmerman
      Managing Director of Equity Research at BTIG
    • Steven Lichtman
      Managing Director of Equity Research at Oppenheimer & Company
    • Thomas Stephan
      VP of Healthcare Equity Research at Stifel
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