Q3 2022 Rxsight Inc Earnings Call
The conference will begin shortly to raise your hand during Q&A you can dial star one one.
[music].
Hello, and thank you for standing by.
Welcome to the Rx side third quarter 2022 earnings conference call.
At this time all the 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.
We'll then hear an automated message advising you that your hand is right.
Please be advised that today's conference is being recorded.
I'd like to now hand, the conference over to your speaker today Alan.
Alex Wang assist.
Associate director of Investor Relations.
Thank you operator.
Presenting today are president and Chief Executive Officer of Rx site, Ron Kurtz, and Chief Financial Officer Shelley Thunen.
Earlier today, our excite released financial results for the three and nine months ended September 32022.
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 November seven 2022 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 earlier today and in our filings with the Securities and Exchange Commission or SEC.
Our SEC filings can be found on the companys 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 these 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 also be available for audio replay on the company's website with that I will now turn the call over to President and CEO , Dr. Ron Kurtz.
Good afternoon, and thank you for joining us the RSA team delivered record performance again this quarter further demonstrating the significant advantages that our unique technology provides to both patients and doctors our financial and operational results continue to highlight the potential of the light adjustable lens to reshape and expand the <unk>.
<unk> market as the <unk> is increasingly positioning by practices as the premium lens of choice for their patients.
On today's call Shelly is going to begin with a recap of the third quarter results and an overview of guidance for the fourth quarter after which I'll provide some additional color.
Thank you Ron and good afternoon, everyone.
<unk> finished the third quarter with total revenue of $12 6 million up 118% compared to the $5 $8 million in the third quarter of 2021 and up 11% compared to the 11 $4 million in the second quarter of this year.
We attribute this strong performance to the ongoing growth of our installed base of light delivery devices and the superior clinical outcomes of our L. L technology as well as the increase in cohesion and productivity of our recently expanded commercial team, which facilitates ldds sales and as Charl.
With helping new practices to become fully proficient and providers.
Providers of our technology.
Importantly, we delivered substantial sequential growth in a quarter that is usually seasonally softer for many medical device procedures overall, along with seasonally slower capital equipment purchases underscoring the continued strong demand for our technology.
In addition from our vantage point any impact to quarterly procedure volumes related to Covid, our practice staffing shortages were negligible.
Breaking up our performance by product line, we sold 49 Ltvs in the third quarter of 2022 up.
58% from the 31 units in the third quarter of 2021, and even with the second quarter of this year with.
We generated L. P D revenue in the third quarter of 2022, a $5 $7 million up 55% compared to $3 7 million.
In the third quarter of 2021, and even with the second quarter of this year.
Our LTV ASP was approximately $116000 in the third quarter down about 2% versus the year ago quarter and unchanged versus the second quarter of this year.
Adding third quarter 2022 L. D D unit placements, our installed base grew to $3 43 up 17% versus the second quarter of this year.
<unk> sales were also strong in the quarter with units up on a year over year and sequential basis.
We sold 6595 <unk> in the third quarter of 2022 up 234% from 1977 units in the same period last year and up 22% from the 5400 units in the second quarter of this year.
We generated revenue in the third quarter of $6 $5 million up 236% compared to $1 9 million in the year ago quarter and up 22% from the $5 3 million in the second quarter of this year.
Growing LEL adoption was also evident in our revenue mix.
In the third quarter of 2022 L. L revenue represented 52% of total revenue compared to 34% and 47% in the third quarter of 2021 and second quarter of 2022, respectively.
The favorable shift in revenue mix helped to drive a third quarter 2022, gross profit, which was $5 4 million or 42, 5% of revenue compared to $1 $3 million or 23% of revenue in the third quarter of 2021, and $4 $8 million or <unk> 40.
2% of revenue in the second quarter of this year.
Selling general and administrative expenses in the third quarter of 2022 were $14 $9 million up 64, 5% compared to the $9 $1 million in the year ago quarter, and up three 7% compared to the $14 $4 million in the <unk>.
Second quarter of 2022.
Quarter over quarter increase reflects primarily the 62% increase in our sales marketing and commercial head count at the end of the third quarter of 2021 compared to today as well as approximately $870000 and higher stock based compensation.
Three 7% sequential increase in SG&A for the second quarter of this year was related primarily to higher costs associated with our commercial head count.
Research and development expenses for the third quarter of 2022 for $6 $4 million up 18, 8% compared to $5 $4 million in the year ago quarter, and up three 2% compared to the $6 $2 million in the second quarter of 2022.
Our R&D costs, which include clinical and regulatory can fluctuate from quarter to quarter based upon material utilization and timing of clinical studies.
The sequential increase in the third quarter of 2022 was primarily due to increases in clinical study and regulatory.
We reported a net loss in the third quarter of two.
2022 of $16 $8 million or a loss of 61 cents per basic and diluted shares using a weighted average shares outstanding of 27 7 million shares in.
In the third quarter of 2021, our net loss was $12 $7 million or <unk> 68 per share 68 cents per share on basic and diluted basis.
Note also that stock based compensation in the third quarter of 2022 was $2 $9 million.
<unk> and a non-GAAP loss of $13 $9 million or a loss of <unk> 50 cents per basic and diluted share.
non-GAAP disclosure is included in today's press release to provide useful comparative information for investors.
Moving to the balance sheet, we ended the third quarter of 2022 with $112 $8 million in cash cash equivalents and short term investments.
Long term debt was $40 million.
Given our third quarter performance, we are raising our 2022 full year revenue guidance to a range of $47 million to $48 million versus prior guidance of $44 million to $46 million, our new guidance implies revenue growth of 108% to 100.
12% versus 2021.
We are raising our gross margin guidance to a range of 41% to 43% of revenue versus the prior guidance range of 37% to 38% of revenue.
While gross margin for the first nine months of 2022 was 42, 3% at the high end of our new full year guidance range. We expect continued gross margin pressure on the LTV and the fourth quarter and for mix in the quarter to be more heavily weighted toward ltd's sales, which is consistent with.
Usual capital equipment purchase seasonality patterns.
We continue to succeed in procuring the necessary materially girls to manufacture the L. D D and meet growing customer demand. However, we also continue to face supply chain constraints and inflationary pressures.
Acerbate it by lingering COVID-19 related shutdowns in China, and the war in Ukraine.
Our operation team monitors our supplier channels continuously and works closely with our suppliers to mitigate disruptions wherever possible.
Finally, we are revising our operating expense guidance range down to $86 million to $87 million from our previous guidance of $88 million to $90 million.
Our operating expenses are much higher for SG&A and R&D as we continue to grow our sales and field support team.
<unk> significantly in 2022.
Our annual revenue guidance implies fourth quarter, 2022 revenue guidance of $14 million to $15 million.
As noted earlier, we did not experienced seasonal softness and either procedures or capital equipment in the third quarter underscoring the growing enthusiasm for our products. Despite the strong third quarter results sequential revenue for the fourth quarter is still expected to be between 11% and 19%.
We do not expect the devastation caused by hurricane and to have a noticeable impact on L. L procedure volumes in the fourth quarter as Fortunately only four of our our excite customers in the affected regions were impacted two of which reopened within several days.
Florida is an important region their procedures represented approximately 5% of our business in the previous several quarters. However.
However, as we head into the winter months, we are mindful of the potential for a worse than usual, please susan or resurgence of Covid cases, which could pose some risk to near term cataract surgery schedules.
Our annual gross margin guidance implies fourth quarter guidance range of 41% to 43% and our annual operating expense guidance implies fourth quarter operating expenses of $24 million and $25 million with that ill turn the call back to Ron.
Thank you Shelly.
Our exit strategy is to execute an efficient razor razorblade business model that can generate sustained growth and margin expansion. Our third quarter results offer early support for that strategy, which we attribute to three distinct competitive advantages that set us apart from other premium Manuel providers.
One the <unk> offers the industry's most precise vision technology to our proprietary system delivers the highest quality of vision and three the <unk> is the only solution that is fully customizable to every patients individual preferences and needs.
Together these important intangible benefits create a formidable argument for selecting the Leo over competing products.
The recent American Academy of Ophthalmology annual meeting provided numerous opportunities for dissemination of these advantages and for Rx site to strengthen relationships with existing <unk> surgeons and to introduce our technology to potential new users our exhibit and presentations by users about our technology were well attended.
Making for a highly successful meeting.
Included in these presentations, where several from participants in our ongoing phase four study documenting real world experience with the <unk> since the introduction of active shield one year ago.
More than 78% of 139, <unk> corrected for distance achieved 2020 or better vision without glasses with well over 90% within a half day off to have the desired cylinder or sphere correction.
These results exceeded those of our FDA clinical trial, despite more than 20% of the phase four subjects, having had previous corneal refractive surgery, which generally makes is more difficult to treat successfully with premium my wells.
Moreover, the unique design of the all makes it particularly well suited for optimizing vision with both eyes are buying ocular approach that can reduce spectacle independence across a range of distances in the same phase four study of by not truly implanted patients, 85% achieved 2020 or better buying ocular distance.
Without glasses, while 97% where 2025 or better.
The vast majority also achieved excellent <unk> near vision without glasses with 75% reading at the J, one level and 89% reading at the <unk> level.
To put this in context, GE too can be compared to reading the small print used in footnotes with J, one being even smaller.
The <unk> symmetrically broadened depth of focus helps to facilitate these high quality by non fuel results.
Our L. L. Further enhances the patient experience by delivering the highest quality of vision.
Other premium wells are often associated with complaints of glare and halos and reduce contrast sensitivity because the <unk> design does not split light to different focal points patient enjoy patients enjoy excellent visual outcomes without increased rates of glare or halo or loss of contrast relative to our standard model quite well.
Adjustability is perhaps the most significant of the trio of core competitive strengths with other premium wells the Doctor must select a lens empower before surgery committing the patient to a specific visual approach and uncertainty as to whether their goals will be met if.
If it turns out that the doctors preoperative firewall prediction is not correct the patient either needs to use glasses or undergo a subsequent corneal procedure to reach their desired vision.
The <unk> eliminates this high Stakes preoperative decision, making since it's focusing power can be adjusted after surgery, when the patient's needs and desires can actually be evaluated and they have the opportunity to test drive their visual selections.
The result is high quality fully customize vision that is achieved with the patients active and ongoing involvement.
Our patient focused approach not only helps doctors deliver optimal care, but also helps them increase practice revenue and profitability surgeons can recommend the ohio with confidence knowing it will deliver high quality vision with few of the compromises that could otherwise undermine patient satisfaction and harm traffic building referrals.
And therefore help doctors expand their premium firewall practiced by appealing to even the most demanding patients who are seeking a truly premier outcome.
These topics are of significant interest to both new and prospective <unk> practices and we're covered and additional presentations that discussed discussed how practices position in market. The <unk> how to achieve optimize visual outcomes how to use the <unk> to enter the premium channel and pearls for managing <unk>.
Surgical and post operative planning.
We believe that new practices that efficiently integrate our technology will be consistent higher volume users over the longer term.
To facilitate this our clinical field and customer service teams conduct a thorough onboarding process that provides personalized hands on training and support to doctors and practice staff.
Our <unk> account managers quarterback this process, while also engaging with practices on an ongoing basis to assist with patient awareness and education programs patient flow processes data analysis analysis on outcomes and other referral and traffic building initiatives.
We believe this focus coordinated effort is helping new practices get up to speed more quickly and contributing to the triple digit growth we're experiencing in <unk> sales.
To summarize we believe Rx site is uniquely positioned in the high growth private pay premium firewall market and we remain very optimistic about the tremendous potential that lies ahead as our third quarter results demonstrate the <unk> is establishing a firm foothold in the market is more practices offer the benefits of adjustability.
We are succeeding because the <unk> is the industry's most precise technology capable of achieving superior visual outcomes that are customized to each patient's individuals' needs and preferences.
These potent competitive advantages form the cornerstone of our strategy to build a durable proprietary platform that serves the exacting needs of doctors and patients while growing a sustainable high margin business that creates long term shareholder value.
And now operator, please open the call for questions.
Thank you very much.
As a reminder to ask your question you will need to press Star one one on your telephone and then wait for your name to be enough.
Please standby, while we compile the question.
Our first question is with David Saxon from Needham and company David.
Yes, good afternoon, Hi, Brian Kelly, Thanks for taking the questions and congrats on the quarter.
Maybe I'll start with utilization I mean, it reached a year to date high even in a seasonally weak quarter. So maybe help frame how we should think about utilization trends as we enter 2020 free can.
Can you talk about utilization across new and existing accounts.
How quickly it takes a new account to get up.
Realization curve.
Yes, Thank you very much David.
Yes, we reach.
I have seven five <unk> per L. D D and as you know we don't run the business on that metric, but it is a very telling metric of our success and the ability to increase volume at all of our accounts.
And so as we look at.
<unk>.
The various kind of chunks of timeframes in which customers adopted the technology cause some obviously adopted during the height of COVID-19, some when coupled with back and forth and more recently in 2022, when it's been when it had less of an impact and so we see all of those groups.
To increase the slope is higher however for our customers that have adopted in 2022, and we think it's multifactorial right. Because you know some could be just the customer types. As we continue to grow some is the advancements in our technology because as you see from the data that Ron.
<unk> talked about the results continue to get better and of course as you think about it we have more referrals now with a larger installed base and most doctors do talk to payers as they make a decision to buy the technology, but I do think overall, our data shows that newer customers adopt.
More rapidly than they did let's say a year ago or two years ago that makes sense, given the marketplace and that they tend to get to higher volumes sooner.
And I think that's good news would you add anything to those trends from.
The only thing I would add is that also our sales force is.
Matured and grown over the last year end.
They certainly have.
The important role.
In both setting the expectation at the time of the sale of the LCD as well as quarterbacking, the on boarding process and continuing to reinforce.
Good best practices at each of the with the doctors and staff.
Okay. That's helpful. And then my second question is just on the P&L I mean, youre, bringing down the Opex guidance, which is nice so maybe talk about what's driving that leverage.
I know you added a lot of the a lot to the commercial team this year.
So how should we think about our rep hiring in 'twenty three.
Kind of.
Maybe what opex growth could.
It could be next year and how much leverage you might see thanks, so much and congrats on the quarter.
Thank you very much I'm going to let Ron Stewart and address the sales force.
Yes, as you noted David we expanded the sales force quite a bit in 'twenty one.
'twenty two.
We don't see.
A big change going forward, we'll continue to look geographically and see where.
There might be some fine tuning, especially with.
With account managers as we increased the installed base may cover more and more accounts.
Overall overall, we think we will.
Greta a reasonable position currently okay. Thank you Ron and so I think that that's important overall, because we probably won't be adding many people in the fourth quarter and so as we think about bringing down the amount that we're spending a portion of that is noncash stock based compensation and.
With the pressure of the stock is under as well as everybody else's stock the black shoals value of of options that we grant and Rs wheat ground is lower and so that tends to drive it down and then I think overall, we're being careful on spending despite the amount of investment that we make.
Great. Thanks, so much and congrats on the quarter. Thanks.
Thank you very much.
Thank you.
Our next question comes from Charles <unk> with Wells Fargo Charl.
Hi, Thanks for taking the question and congrats on the nice quarter.
I wanted to get some maybe early thoughts on 2023, I know, it's too soon to give any official guidance, but wondering if you might give any reaction. It looks like consensus is sitting around 80 million or it looks like that would be around 67% growth year over year versus the midpoint of your guidance.
Do you have any initial reaction to that number.
Yes.
We're not giving guidance until later for 2023, I don't think we're reacting to that but what I would say as we enter 2023 is the same strategy as we've employed this year.
First sell the LD D sell it and get those practices up and successful in using the technology and increasing the number of Leds used in each of our accounts. So I think as we think about 2023.
It's blocking and tackling on the topline the same as we've done this year and I think we've done that very successfully we've raised guidance now three times for this year.
Okay. Thank you and then maybe just a quick follow up on pivoting.
So it sounds like you said you werent, many staffing or COVID-19 challenges that you're seeing so far I was wondering either late in the quarter or early <unk>.
Early October so far have you seen any early impacts.
Around the macro uncertainty, whether it's like on the hospital side with capital budgets or or unlike the customers the patient side with India.
Like reticence to pay for a premium I O L.
So.
Charles as you know.
Almost all of our Ltvs are sold to individual practices, so they're they're not constrained as as much perhaps as those large hospital capital budgets.
<unk>.
That's not to say, it's easy but it's.
At least that's not typically constrained.
On the patient side I think it's always important to recall that our patient demographic is.
Older.
There tend to be.
People, who are at the peak of their earning potential or.
Soon thereafter.
Feel very active and focused on.
Optimizing their their vision for their particular lifestyles and they are willing to.
To pay.
For that for the best outcomes that they can achieve.
So we haven't.
No we have not anecdotally seen.
Any.
And in effect from some of the macro headwinds.
Not to say that we won't but both historically.
Historically that hasnt necessarily been the case with the premium <unk> market. If you go back to say 2008 2009.
Okay. Good to hear I appreciate it.
Thank you very much.
And our next question is from Ryan Zimmerman of <unk>.
Hi, Jim Hi, Thank you yeah. Thank you can you hear me okay.
Perfectly Ryan how are you.
Great. Congrats on the quarter guys are very very impressive.
I'd love to just.
Spend a moment on the short term first and then maybe talk about some of the other dynamics, but.
If you look at kind of the quarter over quarter growth that we've seen historically in the business from the third to the fourth quarter. It's been it's been very strong just seasonally speaking and so with the implied guidance Shelly I just would love to get your philosophy about your fourth quarter implied guide this quarter, given kind of what you've done historically and reminder.
Kind of the puts and takes on the fourth quarter that you are considering as we think about the fourth quarter.
Okay.
Yes.
It's kind of interesting I look back to the beginning of year, we guided from $40 million to $44 million on the top line and now we're guiding 47% to $48 million with somewhere in the range of 11 to 19.
18% sequential over Q3.
We think a lot of our own blocking tackling and the success that our doctors are having with their results in patients happiness is very important and it was important to the third quarter volume, but it's been a very surprise in Q3.
And the momentum and the strength in Q3 was pretty consistent throughout the quarter.
And so I think part of it is of course is one we don't want to get out over our skis and also did we pull some things in from fourth quarter, particularly on the OLED side and so I continue to look at that because frankly ive called seasonality wrong.
And so.
That's part of my thought process, because it's about the whole year and our momentum going into 2023.
And I think that we have not been hit by Covid much in the last two quarters.
And.
Where we are.
Just while fourth quarter tends to be very very strong we think about the holidays.
That can be different than what we've had before usually that doesn't impact us much but.
We continue to look at that as well.
And we haven't seen the flu season, yet and so we're hoping that doesn't impact us in terms of scheduled surgeries.
As well so.
That's kind of the thought process overall, 11% to 19% is pretty broad at the end of the year.
But we feel comfortable with that number.
Okay.
I appreciate that and then the gross margins are doing really really nicely just as the LLS scale, but I'd love to understand a little bit more about the gross margin expectations.
If we strip out the <unk> do you still kind of expect the LTV margins kind of in that mid <unk> range, maybe a little lower and what's what's the gating factor there for when that can actually start to improve.
And should we still think about your ltvs kind of carrying forward that kind of margin profile into next year.
Yes, I think that's a really good question as you know because of the supply chain constraints and inflation.
Our goal is always to sell capital in the 20% to 30% gross margin range, preferably a little higher but not so high that we.
Impede our sales.
It has decreased and were well below the low end.
Of that number right now with our current LGD.
You pay parts right now and then I think the and during that period of time that we've increased our production on the L. A L. We've brought down the costs on that so.
The effect of the <unk>, increasing as a percentage of revenue those decreasing cost.
Offset the pressure that we're getting from our existing LGD, but to get into the 20% to 30% range for our capital.
Spoken about are lower cost to manufacture L. D D.
And we hope to introduce that in the second half of 2023, now that subject to FDA approval, but just as importantly to supply chain.
That continues to be difficult.
Although we work very closely to bring those components in as well as the components that we're bringing in for our current product and Thats the strategy to improve the margin on the LTV side as we grow in the second half of next year.
And I think just the important thing to remind ourselves again is that it's the same functionality, but it was designed over a several year period.
To take out some of the cost.
And so that's an important initiative for us in terms of increasing margin, but just as importantly, continuing to grow our L. L.
Procedure volume that is what really drives margin.
Very helpful. Thank you and congrats again very exciting.
Thank you very much.
Thank you.
At this time I would like to turn it back to Dr. Curt for closing remarks.
Great well. Thank you all for your time and attention today and for your continued interest in our excite wish the best for the rest of the day. Thank you.
This concludes our program for the day. Thank you very much for your participation have a wonderful day.
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