RxSight, Inc. (RXST) Earnings Call Transcript & Summary

Thank you for standing by. At this time, I would like to welcome everyone to the RxSight First Quarter 2025 Earnings Conference Call. [Operator Instructions] I would now like to turn the conference over to Oliver Moravcevic, Vice President of Investor Relations. Please go ahead, sir.

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 its financial results for the 3 months ending March 31st, 2025, and reiterated its full year guidance. 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 view as of today, May 7, 2025, 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. 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. 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'll turn the call over to our President and Chief Executive Officer, Dr. Ron Kurtz. Ron?

Good afternoon, everyone, and thank you for joining us. As we discussed during our pre-announcement just over a month ago, the first quarter brought an unusual combination of macroeconomic headwinds and competitive disruptions that led to our first top line miss since becoming a public company in Q3 2021. Although interest in our technology remains high, as evidenced by continued strong LDD demand, we experienced a first-time year-over-year drop in the LALs per LDD metric. I'd like to now share some of our recent analysis, which has helped us develop targeted programs focused on same-store procedure growth, while also continuing to develop the broader opportunity via the addition of new customers and markets. Unsurprisingly, the vast majority of respondents to our customer survey conducted in early April cited negative macroeconomic headwinds as the key reason for reduced LAL procedure volumes in Q1. These findings are consistent with preliminary reports from third-party data aggregators that also suggested reductions in overall cataract procedures and trade downs to lower-priced premium procedures. Given that approximately 75% of LAL patients are drawn from candidates, who would otherwise consider lower-cost options like monofocal or toric lenses, it's not surprising that LALs were also affected by temporary negative wealth effects and uncertainty. While macro trends worsened in early April, there were signs of improved stabilization later in the month, which were also observed in our procedure volumes. Competitive trialing was also commonly cited by customers with many commenting that the major multifocal offerings were now essentially equivalent across manufacturers. Even though we expect these competitive pressures to persist over the next several months, we also believe they signal an opportunity for the LAL to offer a compelling alternative to what is rapidly becoming a plethora of undifferentiated multifocal offerings. Finally, even though almost all practices expressed a desire to expand their LAL and LAL+ volumes, workload challenges and a desire for additional clinical and marketing guidance were also noted. To address this, we are refining our clinical education and marketing support to better meet existing practice and doctor requirements to drive procedure growth. As we invest in these efforts, we also remain focused on advancing innovation to drive greater clinical value and customer engagement. We are pleased to share that we are ahead of schedule in launching a previously announced software update that includes both a unique spherical aberration treatment option, as well as new LDD procedure monitoring features, both of which support our enhanced clinical education and marketing efforts. While the ability to customize spherical aberration and other so-called higher order aberrations has been available in corneal refractive surgery for nearly 2 decades. This new LDD capability represents the first such application in cataract surgery, opening the door for further improvements in clinical results compared to fixed IOL technology. Although perhaps less groundbreaking, the additional LDD procedure monitoring features provide surgeons with new tools to ensure adherence to best clinical practices. Such upgrades enable us to not only to reconnect with our customers and showcase new functionalities, but also deepen relationships, identify growth opportunities within existing practices and embed our technology more fully in their clinical workflows. Looking ahead, our product innovation pipeline remains robust. Recently, we secured approval for very low diopter LAL powers that will now match those already available for LAL+. We look forward to continuing to develop the LAL family of lenses along with continued software and LDD enhancements that broaden the patient populations that can benefit from customization -- customized visual outcomes. We believe these innovations are also key to enhancing productivity at new customer sites, as surgeons and practices are more likely to recognize RxSight's adjustable technology as a significant long-term growth driver. By capturing these strategic placements promptly, RxSight ensures a strong foundation for sustained future growth, while the practice sees faster revenue and practice appreciation. Though these placements have traditionally been to individual offices, we are also encouraged by the growing third-party light treatment service center business models that, though still modest contributors to our total procedures, have significant potential to expand access and utilization of our technology, ultimately benefiting more surgeons and patients. On the international front, we recently received full regulatory approval for our LAL, LAL+ and LDD products in South Korea, a market we believe can become highly engaged with our technology. Additionally, following last month's announcement of EU, LDD and LAL approvals, we now expect U.K. approval in the second quarter and have multiple additional international regulatory submissions in process. As always, the near-term focus remains on delivering excellent clinical outcomes, laying the groundwork for expanded commercialization, both internationally and in the U.S. With that, I'll turn things over to Shelley to take us through the financial results for the quarter and reaffirmed guidance.

Thank you, Ron. Good afternoon, everyone. Consistent with our April 2nd, 2025, pre-announcement, RxSight generated first quarter 2025 revenue of $37.9 million, up 28% compared to the $29.5 million in the year ago quarter and down 6% compared to $40.2 million in the fourth quarter of 2024. During the quarter, we sold 27,579 LALs and generated $27.2 million in LAL revenue, up 37% compared to the first quarter of 2024 and down 5% compared to the fourth quarter of 2024. In the first quarter of this year, LAL revenue represented 72% of total revenue, an increase from 67% and 71% in the first and fourth quarters of 2024, respectively. During the first quarter of 2025, we sold 73 LDDs up 11% compared to the 66 units in the year ago quarter. On a sequential basis, our LDD units sold during the first quarter were down 12% compared to the seasonally strong capital equipment fourth quarter with the sale of 83 LDDs. During the quarter, LDD sales generated revenue of $9.4 million, up 8% compared to the first quarter of 2024 and down 12% versus the strong fourth quarter of 2024. As of March 31st, 2025, our LDD installed base stood at 1,044 units, up 43% and 8% versus the first and fourth quarters of 2024, respectively. Gross margin in the first quarter of 2025 was 74.8% compared to 70.1% and 71.6% in the first and fourth quarters of 2024, respectively. The increased gross margin was primarily due to lower LAL costs and mix. Because we consign LAL inventory, we recognize the LAL cost of goods sold about 9 months after we build product. Throughout 2024, we ramped up production to stock LAL+ inventory at ASCs. Because most of the LAL cost is fixed overhead, the higher volume production benefited gross margin at the end of 2024 and the first quarter of 2025. In addition, the shift in product mix benefited the first quarter of 2025 with a higher-margin LAL revenue advancing to 72% of revenue from 67% in the first quarter of 2024 and 71% in the fourth quarter of 2024. SG&A expenses in the first quarter of 2025 were $28.6 million, representing an increase of $5.3 million or 23% versus $23.3 million in the year ago quarter. This year-over-year increase was primarily due to an increase in personnel costs, expanded collection of registry data with the full rollout of LAL+ during 2024 and increased stock-based compensation expense. On a sequential basis, SG&A expenses increased 2%, primarily due to higher personnel costs. During the first quarter of this year, R&D expenses rose 29% to $10.4 million compared to $8 million in the first quarter of 2024. This year-over-year change primarily reflects an increase in salaries and stock-based compensation. Compared to the fourth quarter of 2024, R&D expenses in the first quarter rose by 13%, also primarily driven by increases in salaries and stock-based compensation. We reported a GAAP net loss in the first quarter of 2025 of $8.2 million or a loss of $0.20 per basic and diluted share using weighted average shares outstanding of 40.5 million shares. This compares to a GAAP net loss of $9.1 million or $0.25 per share on a basic and diluted basis in the first quarter of 2024. Note also that stock-based compensation in the first quarter of 2025 was $7.1 million, resulting in a non-GAAP loss of $1.1 million or a loss of $0.03 per basic and diluted share. Please refer to the unaudited non-GAAP reconciliation and disclosure included in today's press release for more comparative information. We ended the quarter of 2025 with cash, cash equivalents and short-term investments of $229.3 million compared to $207.2 million on December 31st, 2024. First quarter cash use is generally high, as our employees earn a portion of their compensation in performance-based bonuses, which are accrued during the year and paid in the first quarter of each year. Moving on to our 2025 outlook. We are reiterating our full year 2025 guidance for revenue, gross margin and operating expenses that we provided on April 2nd as follows. Revenue of $160 million to $175 implying year-over-year growth of 14% to 25% and assuming recovery of LAL volumes in the second half of the year. While the early signs of stabilization in April, along with our continued clinical and marketing efforts, as described by Ron, are encouraging, we expect macroeconomic pressures and competitive trends to persist through the second quarter with stronger recovery in LAL procedure volume anticipated in the second half of 2025. Gross margin of 71% to 73%, representing an implied increase of 30 basis points to 230 basis points compared to 2024. We are maintaining our gross margin guidance of 71% to 73% despite gross margin of 74.8% reported in the first quarter because a significant portion of our LAL cost of goods sold is fixed, the anticipated benefit to gross margin from higher production LAL volume in 2025 will now be reduced given the revised revenue outlook. Operating expenses of $150 million to $160 million, representing an increase of 10% to 18% over 2024. As Ron already indicated, our spending will be centered on strengthening our clinical education and marketing programs to better support practice needs and drive higher LAL procedure adoption and continued investment in R&D. Note that the operating expense estimate includes non-cash stock-based compensation expenses between $27 million and $30 million. While our guidance includes targeted investments aimed to support and reinvigorate LAL procedure growth, we continue to be committed to carefully managing operating expenses. With $229.3 million in cash, cash equivalents and short-term investments, we remain well capitalized, and our strong cash position supports our continued progress toward cash flow breakeven. And with that, I'll turn the call back to Ron.

Thank you, Shelley. We believe that the actions we have and will be taking position us to reaccelerate LAL growth, which has been mostly responsible for expanding the premium IOL category over the past several years. The ability of our differentiated technology to meet the needs of doctors and patients was on full display at the recent meeting of the American Society of Cataract and Refractive Surgery, which also provided us with a timely check-in with many of our current and future customers both in the scientific sessions and on the exhibitor floor, the more than 40 physician presentations and 2 numerous to count informal references to the light adjustable lens strongly reaffirmed the distinct position our technology continues to hold within the premium IOL market and within cataract surgery more broadly. While there were many highlights for the LAL and LAL+, we noted a study by Lee et al that retrospectively compared visual outcomes of cataract surgery in over 150 patients implanted with either the LAL or LAL+ or a multifocal IOL at a large academic ophthalmology department. While about 3x as many LAL and LAL+ patients had a -- have had previous corneal refractive surgery compared to the multifocal group, both binocular distance and near visual acuity without glasses was found to be statistically better with an adjustable lens, with more than twice the number of patients attaining 20/20 distance and J1 reading vision than with the fixed multifocal IOL. When coupled with the growing body of data now being collected and experienced by numerous clinicians, these results and the overall excitement and engagement we observed at the meeting reinforce our conviction that the precision and customization afforded by postoperative adjustability are shaping both the present and future of premium cataract surgery. In closing, although the first quarter presented meaningful challenges that may persist in the near term, our confidence in RxSight's long-term growth trajectory remains unwavering. We believe the premium IOL market is undergoing a structural shift with commoditized fixed IOLs competing in a relatively stagnant market, while our differentiated customized solution drives expanded premium volumes and in turn, greater surgeon focus. As we move through 2025, our team remains highly focused on executing our plan, energized by the opportunity ahead and committed to delivering lasting values for patients, surgeons and shareholders alike. With that, I'll ask the operator to open the call for questions.

[Operator Instructions] Your first question comes from the line of Ryan Zimmerman with BTIG.

This is Izzy on for Ryan. I was hoping to start out discussing the pace and scale of your redoubled commercial efforts. I was curious when we might start to see contributions from these start to pay off.

Yes. I think as we discussed, taking into account the macro environment and the competitive trialings, we expect those to be in the back half of the year that we would start to see impact from those.

Understood. And as we think about the broader macro environment, I understand that the focus is still on the U.S., but I was curious how you're thinking about the pacing or the timing with which you want to expand internationally.

Yes. I don't think that the macro environment impacts our pacing internationally, which obviously is initially focused on continued regulatory approvals and then initial market experience. We're starting from such a low base that we wouldn't expect to see significant impact from the macro environment, except for -- there may be special cases in certain markets that we'll stay attuned to.

Your next question comes from the line of Young Li with Jefferies.

I guess, I wanted to ask a little bit about the comments you made on April. It sounded like early April trends were still pretty choppy and rough, but it got better later on. Can you maybe talk a little bit more about what you're seeing sort of in more recent periods?

Yes. I don't think I would go too far beyond what we've already commented. I think that, obviously, April was -- there were a lot of things going on at the macro level in April. But overall, those by the end, had roughly stabilized. And that was something that we also saw in our numbers. Do you want to add anything, Shelley? No.

Great. That's very helpful. I guess, I wanted to ask a little bit about the guidance. There's a lot of moving parts here with competitive trialing and 2Q dynamics versus second half. Is there any incremental color you can provide just on the quarterly cadence for the rest of the year?

Yes. We don't give quarterly guidance just annual, and we don't break it out by LAL and LDD. But I think what we have said is we would expect the number of LDDs that we sell during the year continue to be higher than 2024. And typically, the second quarter is a very strong quarter for us seasonally. But with everything going on with macroeconomics, trialing and whatnot, what we are cautioning investors to keep in mind is the environment is so much different than it's been in past years and that we expect the LAL volume mostly to increase in the second half of the year. And that just represents a transition hopefully out of this kind of macroeconomic environment and the uncertainty around it as patients get more certain about how the economics are going to affect them personally. And that makes a difference as well as the fact that we have to give time for some of the new marketing initiatives we're using to help our customers sell in this kind of environment and also to -- we'll have opportunities, as Ron said, to touch customers, as we do our new software upgrade. It has some really nice features. It gives us an opportunity to come in and train and offer value to our customers, as we do that, and that always has some benefit to us. Would you add anything to that, Ron?

No.

Your next question comes from the line of Patrick Wood with Morgan Stanley.

Two quick ones. First, I'd love to dig in a little bit more on the workload challenges that you mentioned. Is -- because I would have thought like the premium IOL side dropping a little bit might have freed up a little bit of consultation time. So like what is it that's eating up the time for the customers so much that you're speaking to? What's kind of blowing out that time that's making things hard at the moment?

Yes. I just want to clarify, Patrick, you said the workload challenges, right?

Yes.

Yes. So I think that this is not necessarily something that's brand new. It's something that's been going on for a while, just staffing challenges in practices that we certainly picked up in our survey. And that's going to be a little bit practice to practice dependent, but that was definitely one of the items that was -- that we saw in the responses to our survey. And so, that's really what we were referring to.

Got you. That's handy. And then just as a quick follow-up. For the H2 macro factors getting better, I mean, what was the sort of thought process in embedding that within the guide? I mean, is it more that you can engage with the customers more so you can pull things around that side? Why -- not to sound sort of provocative, but why would we expect that sort of 70-year-old cohort to feel much better about the world in the second half relative to the first?

Well, I don't know that we're necessarily expecting that they're going to feel that much better. But I do feel that there's some normalization that probably has already occurred to some extent. Now remember, cataract surgery is something that patients generally can put off for a little bit of time, but ultimately, they're going to have to do something. And one of the things that we try to emphasize, and we'll continue to do so is that this is an investment that is for that person's rest of their life and that there's not many things other than vision that can have a direct impact on so many aspects of their -- of the quality of life. So we're -- we anticipate that over time, that will become more apparent even if we don't see a wholesale turnaround in the macro environment.

Your next question comes from the line of Steve Lichtman with Oppenheimer.

Ron, you mentioned workflow and wanting to support your customers through education and other marketing initiatives. Can you talk a little bit more about sort of what that entails?

Yes. So Steve, what we've -- we've learned a lot over the last 4.5 years of commercialization. And to some extent, we've been able to disseminate that knowledge to our customers, but we still see gaps. And we think that we can do an even better job of translating all the pearls that you learn when you develop -- when there's a new technology, a new -- really a new clinical capability that hasn't existed before. There are many subtle things that are either clinical pearls or practice pearls that have to be first learned and then disseminated. And we continue to collect those and are now taking the opportunity to more fully compile them in a format that our customers, who may not all have made use of them can -- to be able to be applying those best practices.

Got it. That's helpful. And then just as a follow-up, the strong gross margin for the year and understanding the cadence, Shelley, but for the year as well as the balance sheet suggests you got some flexibility on OpEx reinvestment. So any thought about adding more sort of feet on the street or anything else in terms of being even more aggressive, especially in light of sort of the competitive trialing environment?

No, I think it's a good question. We have rightsized the OpEx to the size of revenue, right, at the low end. And I think one of the things that we did is we did not drop as much of the gross margin impact to the bottom line, as we did in -- as a percent as we did in our initial guidance when we expected revenue to be higher. I think that if we can continue to make progress, particularly in the second half, that any kind of additional reinvestment would be in sales and marketing. I think that the R&D line is pretty fixed to where we're expecting right now. But if we could put more into sales and marketing, we saw the benefit from that, we would as well. I wouldn't expect us to put more money than we budgeted into the international side just because in the initial phases of international introduction, it's very focused on key opinion leaders.

Your next question comes from the line of David Saxon with Needham & Company.

Good afternoon, Ron and Shelley. Maybe I'll start with you, Shelley, on the P&L. So gross margin, almost 75%, obviously, really strong. Can you quantify the benefit you saw from the volume leverage, as a result from the LAL+ production last year? I guess, do you think some of that benefit might spill into the second quarter? And then just given kind of the back half weighting of the year and the guidance, I guess, why wouldn't you see similar volume leverage for the full year, assuming that cadence plays out?

Yes. I think that's a really good question. We'll see some spillover into the second quarter. But I think the most important part of our guidance relative to the first quarter actual results is that we increased production a lot to stock the ASCs in 2024. Had we kept at our initial guidance with a higher revenue number, we probably would have produced to fulfill both orders, as well as increases to new customers in their ASCs at probably a pretty comparable level, but we're also reducing the production this year in 2025, and we started that at the end of the first quarter to recognize, one, we wouldn't sell as much during the year. And also, we went into the year, right, because you've got to have inventory with a little bit -- with an inventory consistent with our original guidance. So we cut back to that as well. But I think that, that will primarily be effective in the third and fourth quarters, where you see the lower gross margins to come between the 71% and 73%.

Okay. That's helpful. And then on international, congrats on South Korea. It looks like U.K. is in the near term. So can you quantify the premium IOL volumes in those markets? I think the U.S. is around 1 million. Would love to hear what the combined South Korea, U.K. and you can throw Europe in there. And then I guess, how are you thinking about tariffs, as you prepare to launch in those regions?

Yes. I don't have those numbers off the top of my head, but Oliver could certainly pull those. I would say typically in the OUS market that premium volume as a percent of total cataract surgery is closer to 10%, but higher in these specific countries. But that would be a follow-up we need to do. I'd need to pull some reports to get that to you. But the reason we think about these regions are really about their potential as much as anything else. Among the 20 countries or so that we think have potential value, a number of good countries in Asia. Korea is certainly one of them as well and Japan, China ultimately and a few smaller countries within the EU, predominantly in Germany, which is very strong for premium, it would be Spain, Italy -- Spain, Italy, France and then, of course, U.K. that are the most penetrated and where we'll start our penetration. And I think that one of the things Ron always says to me, and I'll let him talk about that, particularly when he's in Asia, the ASCs and doctors' offices are just superb, and they're very, very focused on quality. And I think that's very important because that's what we offer to customers. Would you add anything about that, Ron, at all?

Yes. I think that, again, ophthalmology is an international field. It's very similar across the developed world in Asia and Europe. Specifically, South Korea is a little bit smaller market than overall in cataracts than Canada, but has been -- there have been some ups and downs in the market due to changes in some of the reimbursement rules in the last several years. But overall, it's a very strong private pay market in a number of fields. And we think that there's -- that there'll be a lot of interest in the LAL there. Similarly, Europe is a large market overall. Total cataract market is somewhat larger than the U.S., but the premium market has been smaller, as Shelley mentioned. And there'll be -- and we'll take a targeted approach there.

Okay. Great. And then just on the tariff part of the question, will the LAL and LDD be exempt? Or is there some impact there?

Yes. We did have our tax accountants look at Canada because we're currently selling into Canada. Like very often, pharmaceuticals and medical devices are exempt. Now of course, with the administration coming in and saying that pharmaceuticals coming in from China are going to be subject to taxes coming into the U.S. I don't know about other countries yet. And of course, it is a back and forth number, whether any country would have a retaliatory tariff on med device and pharma. But where we're going so far, it's -- these -- our products have been exempt from tariffs.

And of course, on the other side of the tariff equation, we produce everything in the U.S. and most of our suppliers are also in the U.S.

Your next question comes from the line of Adam Maeder with Piper Sandler.

Two for me. Just one quick one on international. And just wondering if there's any update, Ron or Shelley, in terms of the commercial strategy for those geographies? Will you be going direct or partnering with the distributor? And then I had a follow-up.

So that will be -- that's a market-by-market decision. Some markets, including South Korea, require a distributor. And so, we do have one. The other markets, where there's not, we'll make the decision whether we'll be direct or not. Currently, we use a distributor in Canada.

Okay. That's helpful, Ron. I appreciate the color. And then for the follow-up, I'm admittedly newer to the story, but I just wanted to level set on the freestanding LDD treatment center initiative that you guys have. When did the initiative start? How far along are you in terms of number of sites or customers that use the option, volumes that come from those freestanding sites? And just how you think about some of those metrics trending going forward?

Sure. So actually, the idea of treatment centers for offering LDD services, again, these are third parties. That idea has been around for several years. And there are -- there have been a few successful ones, more individually based in certain regions. I would say it's caught more -- as our market awareness has grown about the light adjustable lens, then certainly, there's been more interest amongst surgeons on figuring out how they can get access if they wanted to not necessarily purchase an LDD or offer the light treatment centers in their own clinics. And there can be various reasons for that. And certainly, we saw in -- we've seen in other areas of ophthalmology, specifically LASIK, where center models have been successfully implemented. So currently, there are several efforts out there, and we're -- we're certainly working with them and see them as good partners. But there -- it's still early in the rollout. But we do see there's some natural advantages for certain customers, and we see this as a promising area.

Your next question comes from the line of Robbie Marcus with JPMorgan.

Two for me. First, Shelley, I just want to make sure I heard you right. I think you said second quarter will be below the low end of the range. Does that mean we're looking at something less than $38 million in sales in 2Q?

Oh, I didn't get that specific at all. I didn't give guidance on the second quarter. What I did say is that as we go through the year, I would expect second quarter to not be the type of quarter we've typically seen with a big uptick and that most of the growth on the LAL side will happen in the second half. What Ron did say is that we saw encouraging signs as we exited April in terms of volume getting better. And so, I'm just being cautionary on the second quarter, just given the macroeconomics and some market turmoil and giving us time for consumers to not necessarily -- they haven't been harmed, but people tend to stand still until they know how something is going to affect them. So we think more of that will happen in the second half and also that trialing will start to abate in the third quarter.

Great. I appreciate the clarification. And maybe just to continue on that thought, what makes you think that trialing will abate in third quarter and sales will -- and the macro will pick up? Just simply, you have Bausch + Lomb, who's reentering the market after a pause. I imagine they'll sample for a while. Alcon is launching. Why wouldn't it continue for a long time? And given the lower guidance, do you think it's prudent to assume a stoppage in third quarter?

So Ron, why don't you start and then I think I said to abate, but not absolute stoppage.

Yes. I mean I think we're in a -- we've sort of exited an era when there was a single player that dominated the market. We now have multiple players with -- in terms of fixed IOLs, particularly multifocal IOLs that have very similar offerings. And we anticipate that, that will return to what used to be the case, where there was more competitive back and forth. But recall that 3/4 of our volume for LALs comes from non-multifocal IOL patients, patients who would have otherwise gotten a monofocal or a toric lens. And so, we would -- again, we're not ignoring that there will continue to be competition and that there is going to continue to be a more complicated macro environment. But we think that it won't be quite as dramatic as what we saw over the last 6 to 9 months when we had that pretty dramatic change in what had been existing in the premium space.

Your next question comes from the line of Larry Biegelsen with Wells Fargo.

I think, Ron and Shelley, I think what a lot of people are trying to understand is how derisked the updated guidance is. So for my question, you did 28% growth in Q1. You talked about on your Q4 call was in late February. So March, it seems like it really deteriorated. And you said April actually worsened before it stabilized. So are you willing to give us any color on how March and April were relative to, call it, the guidance range or the midpoint of the Q2 to Q4 guidance, which is 17% or so implied. Any color on where March and April were relative to the updated guidance range? And I had one follow-up.

Yes. So I'll start with March and then make commentary that you made about April. In March, what we saw is that typically March approaches or is at 45% of the total volume for the first quarter. And you see that uptick in March, as you lead into the seasonally strong second quarter. We didn't see that in March. It wasn't any worse than January or February. It was certainly up a bit. And that -- but it was more 1/3, 1/3, 1/3. And that was kind of one of the things that was unexpected in the first quarter as well. Of course, a lot more turmoil economically and macroeconomically in the -- in that March time period. I didn't say that April was worse. What we said is April, and maybe I misspoke, but we saw recovery in the second part of April towards the end of April. So it was better than March, right? But we saw that more in the second half of April rather than in the entire quarter, right? So I think that, that was positive as well. In terms of our overall guidance, if I think about the low end of the guidance, and I'm just going to provide 2 bookmarks, the low end of guidance, even though we're expecting more LDD sales, which I think is very positive, the way I thought about the low end of guidance when we gave it is that we would sell more LDDs but the same-store sales would remain relatively stagnant to the first quarter, which we haven't seen that so far. So that's good news. And that most of the LAL increase in volume would come from newer customers, people, who installed in the second half of '24 and installs in 2025. So that's kind of that end of the bookmark. As we go through to the high end of the guidance, what we hope to see is 2 things. One is that consumers get used to the turmoil or maybe it even ends, and therefore, they have more confidence in upgrading to a premium IOL rather than staying with the monofocal or even a toric. And so, that is certainly a part of it, as well as the fact that the competitive pricing on the premiums in terms of trialing can't go on forever, right? So that is one of our premises as well and that we continue to see that in part because at some point in time, doctors will realize that, as Ron said, the multifocal IOLs are not all that different from each other. And the reason is they go less and less multifocality, as they introduce new products. And that goes down in glare and halo, but they're all moving in the same direction as well. Would you add anything to that on trialing, Ron?

No. Again, I think this is something that we've seen over the years in the field, and there is this waning that typically is in about a 6-month time frame. So that's within the time frame that we've discussed.

Your next question comes from the line of Craig Bijou with Bank of America.

Just one from me. And I appreciate the comments on the LDDs and you still expect LDD growth or LDD placements to be above '24 in '25. But I wanted to get a sense for have you heard or have you had discussions with some of the practices that are in your funnel thinking about purchasing an LDD? And if they have any concerns on a softer premium IOL market and whether that could have some impact on the timing or maybe the deferral of purchasing an LDD until they see that pick up?

Well, I guess the way I would answer that would be that while that's certainly a possible reaction, it's -- given that a large fraction of the LAL patients come from non-premium, if you wanted to grow your premium, not adopting the LAL would be the opposite of what you would want to do. So we think there's a strong rationale to actually adopt the technology now and take the opportunity of perhaps a softer market to incorporate that into your practice.

Your next question comes from the line of Tom Stephan with Stifel.

I'll start with a big picture question. I know there's obviously a lot of macro and competitive factors, but the main kind of investor concern we hear right now is if the U.S. could be, I guess, nearing or approaching some sort of saturation point. Ron or Shelley, your reaction to that or thoughts to that, maybe notably given, Shelley, I think you've said the class of 2024's adoption curve has been a little slower than prior classes. Maybe if you can talk about that.

So I just want to make sure I understand the question, Tom. You're talking about reaching a ceiling for LAL?

Correct. LAL either on a per surgeon basis or adoption kind of within the context of the 10,000 cataract surgeons in the U.S. either/or kind of just big picture.

Yes. Again, I just don't have -- I don't see a good argument for that based on the overall penetration of the technology. We're currently sitting at maybe somewhere between 10% and 12% where there are many, many surgeons, I would say, even most who are just getting familiar with the LAL and the potential. So while I understand the concern, I think that, that's still something that is going to be in the later years. I think there are better ways that we can certainly address the market, and we've talked about some of them. Some of those doctors are going to be better addressed through an open access model, and some of them will be traditional -- more traditional methods. But this is the best -- premium IOLs are the best way for practices to resist the continued negative onslaught of reimbursement cuts that they're seeing in all other aspects of their practice. And the LAL has been the primary mechanism for growing premium overall. So I still see that in play for a long time to come.

That's helpful, Ron. Appreciate that. And then pivoting to the pipeline. I know you keep it pretty close to the vest, but I just want to ask what your view is on both a multifocal LAL and an accommodative LAL. I guess my question is, are these feasible technologies to begin with when considering, I guess, the BEs adjustability technology with LAL?

I mean, again, I think that adjustability affords benefits for all types of IOLs. And my view, and I think I've said this before, is that I think that the precision and customization that adjustability enables is something that will become -- if not a requirement, a very strong preference for any time there's in the premium space, where patients have the ability to upgrade for technology. So in that context, and as we've already kind of done with LAL+ and some of our expansions into the different power ranges, we're developing a family of lenses. And where that takes us is going to be guided by surgeon input and financial opportunity. Certainly, multifocals have a strong place in the market and accommodating IOLs have a strong interest in the market. And I think we've seen other efforts of -- towards accommodating IOLs recognize that in order to have a practical accommodating IOL, you likely need to have an adjustable IOL first. So I would -- we have a long runway of product pipeline activity for this technology. I'm certainly beyond my career. And I think that all the things that you mentioned are certainly possible.

Your next question comes from the line of Angela Kumirai with UBS Group.

I'm on for Danielle. So mine is just a follow-up on Larry's question. You said historically March represents about 45% of the quarter's revenue, and that is usually a good proxy of the ramp to 2Q, but that is not something that you saw this quarter. So I was just wondering, appreciating your comment on signs of improving stability in April, what level of visibility do you have into customer case schedules? Just want to get a sense of your confidence in being able to reach your renewed guidance. And then I have one follow-up.

So I just want to restate your question, Angela. So you're asking how do we have visibility into April numbers? Is that what your question is?

Yes. 2Q numbers.

Okay. So obviously, because we consign inventory, it's reported to us when the implant is made into the patient. So we see those usually within a few days of implant, as they get reported to us. We don't have visibility into a particular doctor's schedule. So we don't know what they have planned for the balance of the quarter, but we try and use some historical data, but we have stopped using it given our unique circumstances as well. And as we said, the low end of guidance assumes virtually no recovery in same-store sales. The higher end of the guidance obviously does so. And the only warning we have about second quarter is while we saw improvement in April, we would expect most of the growth to get beyond the low end of the guidance would happen in the second half. Did I answer your question?

Oh, yes. That is helpful. And then my second follow-up is just also a follow-up on Pat's question on workload challenges. What types of practices are making these comments? And what are you doing to release capacity there? Because our checks have sometimes showed doctors looking at the postoperative adjustment as a barrier to do more LALs. So any color on the practice profile for those making workload challenge comments would be helpful for us.

So I think that this is not a new observation that we've seen since we've introduced the technology. There have been kind of standard responses as people become first familiar and then start to consider adopting. Typically, the initial resistance is around piece of capital equipment and then a change in practice pattern that the technology involves. But these are not new. And so, we've developed over the last several years, good -- not only good explanations for how practices have adopted the technology successfully, but we have many, many examples of that, that we can refer new and potential practices to be able to see the benefits of making that commitment to this technology. And I would say it's not significantly different than every other new paradigm that comes -- has come into ophthalmology, which there's a -- these same objections are raised and then overcome.

Seeing no further questions at this time, I will turn the call back over to Ron Kurtz, CEO, for closing remarks.

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

Thank you.

This concludes today's conference call. Thank you all for joining, and you may now disconnect.