EuroEyes International Eye Clinic Limited (1846) Earnings Call Transcript & Summary

Good afternoon, ladies and gentlemen. Welcome to EuroEyes 2025 Interim Results Presentation. It's our pleasure to introduce to you the management joining us today. They are Dr. Jörn Jörgensen, Chairman, Executive Directors and CEO; Dr. Markus Braun, Executive Director and CFO; and Mr. Marcus Bracklo, Non-Executive Director. [Operator Instructions] Now may I pass the time to Dr. Jörgensen to start the presentation, please.

Yes. Hello, everybody, and welcome here to our 2025 interim results from EuroEyes Clinic International. I'm happy to welcome you here and let you through all the results. And so I think let's get started. The next slide, please. Next slide. The first thing I would like to mention this morning is that we are going to have a new CFO. Dr. Markus Braun, who has been our CFO, CFO since 2019, have decided to leave the company, and he will be taken over by Marcus Bracklo. Dr. Braun have done a terribly good job by -- since 2019. And of course, we are very unhappy that he leave, but we have a very good replacement in Mr. Bracklo. Mr. Bracklo, he is also at the call today. And he has been at our company and we have known each other since 2008 and he has been nonexecutive since 2019. So you will hear more about that later on. Next, please. This year, the first half year has been a difficult year, while we have had turmoil in the world. Our refractive surgery is also something, have a lot to do with consumer confidence. And of course, when you have the war in Ukraine, when you have tax policy going on, in China and many other things, it is, let's see, it will spill over in consumer confidence. However, we think we have reached the bottom and it looks like we are going forward, and this has also been a very good first half year. Next one. We have -- you can say a refractive surgery as is our business. You can divide it in 2 parts. You can do the first businesses people up to the age of 40, where you do laser vision correction. And the other part is people older than 40 or 45, it is presbyopia treatment. EuroEyes have always chosen presbyopia treatment as a very significant part of our services, and we have really caught the trend. The trend in the last many years have been treatment of presbyopia, and we are very happy for that, that, that has been a good business for us. Laser vision correction has the last several years have a small downtrend, have something to do with young people in such an economical environment, they don't have that much money. And you can feel that immediately that they -- that's one of the places they save, it's on laser vision correction and such elective treatment. We have seen that in the U.S. We have seen that in China, and we have seen that in Europe. However, presbyopia, 45 plus. They have the money, they wish to pamper themselves. And this is something we see, it's really growing. So what you can see here, it's the highlight of the first 6 months. You see a record in revenue of HKD 377 million year-on-year at 2%. You see a growth in EBITDA of 10% to HKD 131 million and you -- so as you can see it in this way that we have 30% of our revenue go directly into the cash flow into the -- and the solid growth we have seen, especially in presbyopia treatment. So we are -- we did -- we have the trend there. And this trend will continue. You got a bigger and bigger pool of all people worldwide, everybody gets presbyopia when they are 40 plus. So it's a trend which will continue, and we have done most of this worldwide. We are very unique in the way that we cover the whole presbyopia area. We are covering the lens-based presbyopia with trifocal lenses where we have done most worldwide and by the acquisition of London Vision Clinic 3 years ago, we are also world champs in laser-based treatment of presbyopia with the help of Presbyond, London Vision clinic, and Professor Reinstein together with the company Carl Zeiss. It's also something which got more and more frequent treatment to perform. And we especially see that the treatment to perform, and we especially see that by young presbyopic people. The next one, so you see here, again, the CAGR in revenue of presbyopia treatment. You see here a beautiful CAGR of about 10%. And we are in the strong belief that this will go even faster. You will see a more strong growth there as we are able to cover also not only by lenses, but also by laser. And you also see here the last some years, you see new lenses coming on the market, will make it more safe and a better quality of vision. Next one. So again, to see here the revenue contribution from presbyopia, it's still 58% or 63% including Presybond. So you see 63% of our revenue is coming from these people, 40 plus. And -- but we are also recognizing now that the laser vision correction market is picking up. It has been down for some years ago, but we are seeing that picking up. And it's especially LASIK and ReLEx SMILE treatments. Next one. So again, here also EBIT and EBITDA, you see a 10% growth in EBITDA over this first half year. And this is something that we see that our low cost, when we have reached breakeven in every clinic. We see it picking up in EBITDA very quickly as we have low cost for producing the services we perform. Next one. Some special things, Denmark. Denmark have been very solid. Denmark is a market where we saw year-on-year growth [Technical Difficulty] also laser-based correction. Denmark you can see in this rate, 80% of our revenue is generated from trifocal lenses. Next one. And also U.K., our new clinic in Knightsbridge, we have seen here it was our flagship clinic next to Harrods, in Knightsbridge in London. We have seen it picking up in revenue growth, and we operate even despite we have a very high lease in this very good location. So year-on-year growth in London flagship clinic in terms of revenue 76%, so we are very happy with that. So we see that also here in lenses and then also in ICL. So you can say we're seeing also that trend is continuing here the last month. And as you just heard from me, it will spill over in the EBITDA immediately. So we have a very good team there, and we have [Technical Difficulty]. Next slide, please. Germany. Germany have been -- Germany is our most important market in the EuroEyes Group. And you also remember last time, that we had 2 new clinics, which came up. We had one in Wiesbaden, and that's next to Frankfurt, and we have one also in the Northern part in Germany in Kiel. And we see here in this clinic here with our construct and how we build it up, you see a breakeven within very short time, within half year, so it was something will add to our EBITDA in the next few years. So that was a very good decision to build up 2 clinics there. Next one. And also China, China has been a difficult market. Everybody knows the economy every -- especially now that the use, the young people unemployment rate, cannot get a job. And you see that in consumer confidence, we have been lucky that we have focused also so much on presbyopia, the 45 plus who have the money. And so you have seen here, we have HKD 75 million in the first half year, and we have seen a growth in lens exchange revenue of 5%. Next one. Yes. I will now hand it over here to Dr. Braun to go more in detail on the individual financial data.

Thank you very much, Dr. Jörgensen, for your introduction and the overview on the results. Perhaps we go to the next slide, please. Overall, I can only reassure on what Dr. Jörgensen said that it is on -- it was on the one hand, difficult first half year. There's a lot of turmoil on the tariffs, on the war in Ukraine and -- but affecting the consumer confidence. And we see very differentiated picture between our markets where we are active. Overall, I'm quite happy that we were able to increase our revenue by 2% compared to the first half year 2024 and we're also able to increase our margins -- gross profit margin up to 41.6%, EBITDA margin up to 35% again. Net profit was affected a little bit by the strong euro against the Hong Kong dollar. Without that effect, we would also see an increase in our net profit, net profit margin. And if I give a first very cautious picture on the second half and the full year. I believe also, as Dr. Jörgensen said, I think we have bottomed out, with those trends in presbyopia treatment, not only in lens exchange but also in addition with Presbyond, we see with the surgery numbers, we already have for July, August and then also forecasted for September and also the overall trends there and other measures we took on strengthening management teams, adjusting marketing activities and so on, that we will see significantly higher revenue increase in the second half, bringing us at least near to the levels of our 3-year outlook and with that revenue increase, we will also see, as usual in the past, an increase in our line figures in our gross profit and our EBITDA and our EBIT and also in our net profit. So I think we have had a difficult year -- difficult half year, which we managed quite good. And second half, we'll see an increase compared to last year. Next slide, please. As Dr. Jörgensen mentioned, Germany is still our most important market with 53% of the revenue generated there and U.K., Greater China, Denmark are always doing the rest with Greater China decreasing a little bit because of the strength of Denmark and U.K. But on the other hand, we are also working on getting realized in China. However, I think with global presence, we are still able to kind of hedge a little bit for the risks in the different market. And that was the way why we were able to achieve at least this 2% revenue growth. Next slide, please. If you look a little more into detail in Germany, we are very stable here. We have difficult times but with our strength in presbyopia treatment with the addition of the 2 new clinics in Wiesbaden and Kiel, with FreeVis in Mannheim, our acquisition from back in 2023, we are able to keep up there and also in our existing clinics, we have very promising signs that they are back on a growth path again. So again, also here, I expect good results also in the second half. And also to reiterate because that's the one thing we see in all of our markets presbyopia treatment is really on the rise. That's really the trend where we are well positioned as a market leader. We see that in Germany with a CAGR of 7% since 2021 and also now from 2024, 2023 -- 2025 we have seen an increase in the revenues there. Perhaps 2, 3 words on our new clinics in Wiesbaden and Kiel. They had a very good start. They have reached EBITDA breakeven and what's even more satisfying for me that's something we are regularly managing. So it wasn't 1 effect after the opening clinics, but we see that on a very regular basis, month on month that they are performing enough surgeries to reach EBITDA breakeven. And now we are working together with them to get them to the level to reach EBIT breakeven. Next slide, please. China, as Dr. Jörgensen said, difficult market, difficult economy, low consumer confidence, so we are happy that with our strength in presbyopia treatment, we are somewhat able to avoid the price war around myopia treatments with SMILE being sold quite cheap right now. In addition, we were one of the first clinics in China to receive the new VISUMAX 800 laser, which we had already had in use here in Europe for like 2 years now. They got the approval, I think, sometime in March. And so we had our first laser there up and running, I think, end of April, which helps us to differentiate a little bit against our competitors and which also helps us to ask for slightly higher prices also in the myopia business. But again, we are happy there to be on the forefront of giving the best treatments possible to our Chinese customers. Okay. Next slide. U.K., Dr. Jörgensen said already how good our Knightsbridge clinic is doing and I have to reiterate that I think last time we said that we expect to reach -- Knightsbridge clinic to reach breakeven within this year. I'm worried that for the last 3, 4 months, we were able to regularly reach EBITDA breakeven that it's really a persisting trend of surgery numbers and that we are not just stable on this level, but that's a team of the Knightsbridge clinic is very active and very successful in acquiring ever more surgeries per month. So that I'm looking forward to also reach an EBIT breakeven around on a monthly basis around end of this year, beginning of next year and the growing strength of our Knightsbridge clinic is also reflected in the surgery types because London Vision Clinic acquisition from back in 2022 was and is still in majority a laser clinic, doing lots of sales, but also doing the Presbyond treatment for presbyopia, which is the laser treatment as well. And here, you can see on the pie chart that we are now in U.K. up to roughly 41% of our treatments to presbyopic patients with the lens exchange increasing on the one hand, come from the Knightsbridge Clinic, which is primarily a lens clinic. But on the other hand, also coming from London Vision Clinic because we had a longer strategic meeting with the management team there back in the end of 2024 and decided that they should push also for cataract treatments a lot more and that's quite successful and we see increasing numbers there as well so that's also helping London Vision Clinic, so overall we are quite happy with the business development in the U.K. Next slide, please. Denmark really was -- has an impressive rebound from 2024 with revenues up 20%. We -- or the Danish team came up with some good marketing strategies, which were helping with this increase, and we are looking into that also to copy these ideas perhaps for our other countries. And that's even more impressive because we see a fierce competition in Denmark from other large clinic groups. And therefore, we are very happy that we were able to increase our revenue there again by 20%. Next slide, please. Having said all that and taking account 2% of revenue increase, I want to show again from a perspective of the number of surgeries, how important the lens exchange plus Presbyond area has become. You see over the last few years, the continuous increase in the number of presbyopia surgeries, while on the other hand, you also see what we are telling the decrease in laser vision correction. And on the other hand, you also see that the presbyopia treatment, they are the more expensive treatments. They are the profitable treatment. So for the group, I think it is a good trend, even though we are performing less surgeries in the first half of 2024. And with the decreased surgery numbers and the addition of the new clinics during the year 2024, taking full effect first time in 2025, that leads to a decrease in the capacity utilization rate, which from my perspective, isn't a bad thing in the first place. And on the other hand, we will also see an increase in this capacity utilization rate in the second half with picking up surgery numbers in our new clinics and also with the picking up surgery numbers in our existing clinic infrastructure as I said, when looking at just surgery numbers of July, August, I'm quite happy with that development. Next slide, please. Perhaps a little bit on the cost side here. We are happy that we were able to stabilize our salaries and doctors' fees. We still see huge differences in the ratio between the different countries, and we are working with the management teams of the countries to get that to a lower level. But with inflation and all that, we are happy that we were able to keep that ratio on a stable level. Depreciation has gone up slightly. Again, that's an effect driven by the new clinics being recognized now fully for the first time. And on the other hand, also driven by our purchase activities, especially for the VISUMAX 800, which is a great -- a great tool, giving our patients one of the best treatments possible. Raw materials and consumables, so really the direct cost coming from the surgery itself. They are on the downturn now of 0.4%, reflecting our strong framework contracts with our major suppliers. Sales expenses are up, and that's, from my perspective, really reflecting the difficult market environment we actually have. We need to spend more on marketing to generate the necessary number of leads, to generate the necessary number of patients for our growth. But on the other hand, with 11% sales ratio, I think we are still on a very modest level. We are always looking into this area. We are fiercely working with our service providers there to always adjust our marketing spend online and offline to make that most efficient, but we can't avoid that we need to spend more to generate our patient base. On the other hand, the area which isn't directly connected with our services, with our clinics the admin expense ratio or the admin expense is stable. Expense ratio is on the way down. So I'm very happy from a cost perspective that in these areas where we don't have a direct comp with our patients that we are able to control these very well. Next slide, please. As you all know, we have traditionally had a strong cash position facilitated by our business model of patients paying upfront. And in the first half of 2025, we were able to build up this cash to HKD 741 million. And as we already said in the past, we are willing to spend a lot of this cash on M&A deals, and we are working heavily on these deals. And let's see what we will see there in the future. Cash flow is also increasing, also reflecting our strength, our operational strength, also reflecting the fact that the new clinics have reached EBITDA breakeven quite quickly. We have -- and if you are looking at these figures, you still have to keep in mind that especially for the Kiel clinic, we only paid the majority of all the devices in this year. We also spent quite a lot on the VISUMAX 800, 2 machines for China and also exchanging our old VISUMAX 500 here in Germany at a few clinics. So I think from that perspective, it's even a little bit more impressive that we were able to build up our cash. Okay, next slide, please. Yes, at that point in time, I would like to hand over to Dr. Jörgensen, and he will give you a little bit of an outlook for -- I mean, I gave a little bit on this half, but also planning over the next few years on EuroEyes. Thank you very much.

Yes, I think everybody of you wish to know, I used to do that at every half year meeting or full year meeting. Everything what we are doing is organic growth. So it's nothing you can -- many companies come out with big growth rate, and this is from M&A and most of it -- but this is still here from our existing clinic where we are growing solid. So we have a solid growth in our existing market, and I think this is also very remarkable. So -- but how should it go on? We have been dealing with M&A since we saw each other last time, and it is very important for us. We have had many deals at the same time on the air. And I think you will hear more about that later on. We have a strong cash flow. Everything we are independent of authorities in a way that it's all out of the pocket. So we are not dependent on insurance company or government money. And -- but of course, we are a little dependent on consumer confidence. Next one. So you can see the 3 pillar is, of course, to consolidate and increase our -- let's see, our leadership in presbyopia. I think presbyopia will still also here the next 1 to 2 years be the main part. People today who are older than 40, they feel younger. They don't wish to be dependent on reading glasses. We used to say the 60s are the new 40s and they -- we have seen they wish to change something in their life, they wish to improve the quality of life. And there, we are seeing -- what we have seen in presybopia, it's only the beginning. So we will see more and more. And I'm happy we have this expertise. It's not easy. It's a lot of psychology. It's a lot of techniques, and it's a lot of good surgeon. And we have seen that here during presentation today from Dr. Braun that this is a big, big strong pillar although we also see the other is picking up. We have seen laser vision correction and LASIK, it have always gone up and down during the many years since it started in 1995. And we are probably now at the bottom. So this will come on top. This will come on top, and we have all the laser clinics ready, and we have the newest technology. So this will be fine. And M&A, I told you about M&A. Of course, I'm not allowed to give you any special information, it's very sensitive, but it is -- I can only say it's something where I have used, let's see it in this way, a lot of time since we saw it the last time on this topic. Next one. So how would the outlook be for the rest of the year and also for '26. I think revenue will go up as we have said here. And with the revenue, you will see even higher EBITDA, while all our costs have covered and it's going directly into the EBITDA. This is a beautiful, let's see, from our businesses, we have high onetime fixed costs, but when they are covered, we have low variable cost and this will also spill over in the net profit. So I'm very confident in that. And the next one -- so again, here, I think it is something I just have assigned that to again, to repeat myself, everything you saw today, it has been organic growth, very healthy it's nothing we have bought. It's really real, and you saw these high CAGR in trifocal lenses and presbyopia of 10% per year, very solid, very sustainable. And we will see that increasing even more. We are doctor-led group, and we are looking for, let's say, M&A deals among other doctors. Doctors always believe doctors. I have the feeling that many of the very good doctors, they wish to get in family with us, with EuroEyes, for we are doctor-owned clinic, and they more don't trust that much private equity. So it is something we will see. And I will tell more about that hopefully here within the next few months. Next one. Yes. And our model, our clear takeaway from today, you have a clinic group who have a solid growth and CAGR 10% presbyopia. Presbyopia market is going to continue. And you are very good hedged in a way, sometimes you see Asia is going a little down, but then you have an upturn in Europe. So we are not only dependent on one market, but we are an international group, and we will see an acceleration of this growth in the rest of 2025. As Mr. Braun told you already July, August, September are very promising. So I hope being able the beginning of next year, or maybe even before, sort of announcement to tell you good news. Next one. Yes, this was a little presentation today. And we are open to Q&A. So I will give the word to the speakers. Thank you.

[Operator Instructions] We have received a few questions already. Now let me read it out one by one. The first question comes from [ Roman Renchner ] of [ Crystal Equity ]. He has 3 questions here. The first one, what are the priority of Mr. Bracklo will take on in the short and medium term as the new CFO? Second, what is the plan and time spent between being the CFO of EuroEyes and being the Managing Director of Baigo Capital? And the third one, will Mr. Bracklo be long-term solution of EuroEyes or an interim medium-term solution with planned replacement over time once a new candidate is being found? May I pass the time to the management, please?

Yes. Many thanks. I think it's a very good question, the CFO of a company play a big, big role and maybe I will give the word to Mr. Bracklo, he can tell a little about himself. He has a very, very long track story in this. And I think his background is perfect to fulfill this role. Mr. Bracklo, maybe you can say some -- a few words.

Thank you, Dr. Jörgensen, for those words. And may I say that I very much look forward to working with you and the EuroEyes team in my new role. I think the first question related to the priorities that I would have as CFO. My main priority will be to support Dr. Jörgensen, the CEO, in executing on his strategic objectives, which he set out to you, which is to grow the company organically, point one; through opening of new clinics, point two; and through M&A. I think with my background, I used to be a partner at Pricewaterhouse. I used to be Managing Director of an investment bank, and I've had management roles in various healthcare companies. So I think I have the skill set to support him in executing that strategic vision and, if you like, strengthening and improving the growth trajectory of EuroEyes. Of course, there are many other things that will fall within the role of the CFO. But I think if I can pick a priority, that would be the one. The second question related to my other activities. Let me say, very clearly that I am 100% committed to full-time role as CFO of EuroEyes. The other commitments I have are nonexecutive in nature and are minor. It was specifically referred to Baigo Capital. So I will answer that. Baigo Capital is my -- the holding company from my personal investments. Looking after those investments does not -- is not a full-time activity. Baigo Capital used to manage, and that's maybe where the question comes from, a private equity fund, but that activity has ceased about 2, 3 years ago. So Baigo Capital is not a distraction. It's only my personal investment holding company. I hope that clarifies things. And as regards my commitment to EuroEyes, as Dr. Jörgensen says, I've been involved with the company since 2008, so I am a long commitment -- I have a long-time commitment to EuroEyes and serving it in the best way possible. That has been since the IPO in the role of a nonexecutive but now with the departure of Dr. Braun, it made a lot of sense given my background for me to take on the role of CFO. And I will take this role as long as Dr. Jörgensen and I believe that I'm the right answer for this particular job. This is not -- I would not call this an interim position, I would call this a long-term commitment. Of course, over time, things might change, you never know in the future, but I'm definitely here for the long haul. I hope that answers those questions. Thank you very much.

We have another question, a series of questions from . I will read it out one by one because all these question are related to different areas. The first question is growth versus guidance. On the last earnings call, Mr. -- Dr. Braun mentioned growth in the high-single to low-double digits for 2025, but reported revenue was up only 2.4%. Could you help me understand the driver behind this gap? And whether you will expect growth to accelerate in the second half?

Yes, thank you very much for the question. I think what we told was that over the next 3 years until 2028, we expect a CAGR of low 10s, low single -- high-single-digit, low-double-digit revenue growth. That doesn't mean that we hit that target every half year, and I try to give a little bit of an outlook already on the second half which has started very strong in July, August and which also reflects our activities on the one hand with the new clinics with growing their revenue, but also with the existing clinics to push for growth there as well and so I'm quite confident that at the end of the year, we will see growth CAGRs growth against 2024 very much in the range that we addressed last time.

The second question is to follow. CapEx. Could you share a bit more details on the CapEx this year. It looks relatively high given that there haven't been any clinic opening or major renovations in 2025 so far. And also, Mr. [ Roman Renchner ] also asked for more details on the PPE investment and the drivers behind the figures.

It is a little bit of a timing effect because you are right, where there were no major openings in 2025, but especially our clinic in Kiel was opened just at the end of 2024, doing the first surgeries in 2025. So at least part of the payments for this clinic spilt over to 2025 and is reflected in our cash flow. And on the other hand, as I said already, in the new VISUMAX 800 became approved I think in March 2025. We were among the first in China to receive 2 of these VISUMAX 800 by that catering the best services again to our case patients and also in Germany, we had some replacements of our older VISUMAX 500 with the new VISUMAX 800 size according to our framework contract and that also affected the CapEx line and also the PP&E line.

The third part of the question is about Hong Kong market. Would you be able to provide more insights into Hong Kong? What are the main challenges there? And how do you see the path and timing towards improvement?

Maybe I can say something about Hong Kong. Well, we were very positive as we went in to Hong Kong. I think we've got in Russell Street, a very prime location [Technical Difficulty] feel we should in Hong Kong, it's marketing. When you are in your clinic, you need to market yourself in a way where you can show you are there. And we have also, let's see been irritated from a participant on the market like try to find a hair in the soup. And this -- we had, had a small setback for being able to correct this, let's say, marketing issued in a way with 100% fulfill what is allowed for regulation issues in Hong Kong. So I think most of these have been marketing issues, but when you are a new clinic in a new area, you need being able to market yourself and say, we are here. It was not an acquisition from an old clinic who already have been in the market for a long time. So it was a new build up, a startup and -- but we are seeing numbers picking up, but not in the same, let's say, velocity as we have expected because of these, let's say, very restricted way to doing marketing in Hong Kong.

The fourth part of the question is about Germany. Some additional color on Germany would be very helpful. The numbers look a bit soft, especially consider Mr. Braun mentioned 70% up price increase in 2025 and the contributions from Wiesbaden and Kiel, which worsened in -- which were not included in the last year's base.

Yes, absolutely. I think what we see in Germany is picking up business, especially our July, August are very strong, the [ 70% ] price increase in trifocal lens exchange was implemented in the second quarter. So it didn't have full effect for the full first half year. And as I said, we are working very, very hard with our service providers in the marketing area to always adjust to the latest developments there to push the different clinics. We have also updated our management team and the management of our clinics in June. And we already see now in July, August that the figures in Germany are picking up. And as you know, I mean, Germany is our biggest market. And you can imagine I'm quite confident that we will get into the range of our 3-year forecast with the figures of the second half that's also driven by Germany.

The next question is about M&A. It's from Mr. [ Roman Renchner ] and [David Drenkel]. The question is like this. Could you expect some M&A to materialize in the second half or early 2026? How do you think about the appropriate price to pay for a private clinic? And how do you compare that to the opportunity to buy back your shares at the current valuation?

Well, I think we can expect something to happen. I told you before we have Mr. Bracklo and I and together with Mr. Braun, we have spent a lot of time this year on this topic. It has -- we have the cash. We have -- in a way, we have always been maybe too conservative during the year since we went IPO, but seeing in the back mirror, it has also been very good, while otherwise, we will have paid much too high prices. Now I think we are in the unique situation, interest went up, prices is coming considerably down, and we are sitting on the cash, and we have no debt and we are specialized. So we are maybe something too critical, but I think you can expect something what will happen. Otherwise, we will not have worked so hard. But of course, I cannot say more about it, but look at the wire then you will find out. That is point one. Point two, I think many of you here on this -- here today, you know the prices what's on M&A today and this is something which is the market standard. Let me say it go between multiple and EBITDA between 8 and 14 and depending on several factors, you will need to go in and pay when interest go down, private equity gain more power and have more money and the price will go up. So I think in the current environment, it's a good time to go out and buy. And we have had a share buyback. We have fulfilled that as we also said. So we are not in a buyback [Technical Difficulty] at the moment.

The next question comes from [indiscernible]. This question is the combined questions, which cover a lot of areas. It's like that. Why are you pursuing acquisitions? Why are you pursuing acquisitions in the America? Isn't there still enough room to grow in, for example, Europe or Asia where do you already have more experience? Could you also elaborate a bit more on satellite clinics. Do you have opening planned soon? Or how will this help improve margins? Are they really necessary given that the current utilization rate is already quite low?

Yes. Maybe I take over this as well. U.S., I think for everybody worldwide, U.S. is a very good market especially in one terms, when you are specialized on presbyopia treatment as we are, then of course, the U.S. is a very, very good market, while the refractive lens exchange and trifocal lenses is, I would say, but it's almost done so anyway. So we have been looking into the market, and we have made some big examination over there. And I still think it's a very, very good market. However, because of the current political situation, we -- although we were very far, we decided to take a step back to look and watch what all these taxes and all these turmoils would mean when you would take a big acquisition over in the U.S. And going to the next about utilization rate, why you wish to do M&A when you have utilization, right? Between 20% and 30%. Well, it's a good question. I wouldn't put so much in this utilization rate. You could never have 100% utilization rate. I would say, in a refractive eye clinic 70% or 60% when you shouldn't -- when you have 60% or 70% utilization rate, you will probably need to build a new clinic. While it's a long course, it's not only the operation. Utilization rate is minded in the operation theater but you have so many other activities before operation and after operation. So you cannot really use it. So I wouldn't say so much that we are growing local market. We are doing that. We are doing a lot more autonomy, like Mr. Braun has said, this year, we have put in a lot more autonomy in our existing clinic to push that forward. But we have seen when we are going to a new market like in Kiel, like also in Knightsbridge there the big clinic we did in Knightsbridge, where we have probably the most expensive of our lease at all. But we managed within 1 year or 1.5 year to get breakeven. So you cannot say it in this way. What makes EuroEyes really unique and I think you have no clinic worldwide who is in so many different countries in our area. And we -- and you will probably hear more about that in a short time. But I think this is what makes us unique. So I hope I answer your question about the U.S. and the utilization rate.

Thank you, Dr. Jörgensen. Due to the time constraint, let us take the last question, which is from Dr. [ Duranco ]. It's related to acquisition. Does the medium-term guidance include acquisitions? If yes, how much is expected to come from acquisitions?

The guidance doesn't include any M&A activities, that's really based on growing our existing clinics and possibly building new clinics or consultation centers. So all M&A would go on top. And sorry, Dr. Jörgensen, please go on.

No, no. I think it's a very important question. While -- when Dr. Braun is talking about 10% to 20% in terms of revenue or in EBITDA, it's on organic. That's only organic earning. That's not when we are going to announce something that we have bought something. Then you will see it's outstanding. So this is only -- and I think, again I can only say it in this way, when I see many of my competitors, they are coming with big, big growth rate. And a lot of this is that they bought something. So I can only say that this -- we have a solid track record here, presbyopia 10% revenue increase since the like 5 to 6 years. So it's stable.

Thank you. That's the end of the Q&A session. Would management like to share a few remarks before we conclude this webcast, please?

Well, yes, I would first say thanks to Dr. Braun for his contribution all these years. And I would say welcome to Mr. Bracklo, where we have worked together since 2008. And I think to take back to all the participants here who have been on the call today, and you can always reach out to me or the management. So many thanks for today, and have a nice day and a nice evening. .

Thank you, management. This concludes our presentation today. Should you have any further questions later on, please feel free to contact the IR team or STIG. Thank you for your participation. You may now disconnect. Thank you.