Q1 2023 Sight Sciences Inc Earnings Call
This call presenting today are tight sciences, co founder and Chief Executive Officer, Paul, But Alley, Chief Financial Officer Ali Bauerlein, and head of corporate strategy, Tom long earlier today <unk> released financial results for the three months ended March 31, 2023, a copy of the press release is available on the Companys website at Investor.
<unk> Dot site Sciences Dot com.
I would like to remind everyone that comments made by management today and answers to questions will include forward looking statements within the meaning of the federal Securities laws. Those include statements related to <unk> Sciences anticipated financial performance and operating results and market opportunity business strategy and plans for developing and marketing new products.
Forward looking statements are based on estimates and assumptions as of today are neither promises nor guarantees and are subject to risks and uncertainties that may cause actual results to differ materially from those expressed or implied by these statements a description of some of the risks and uncertainties that could cause actual results to differ materially from those.
By the forward looking statements on this call can be found in the risk factors section of the annual report on Form 10-K filed with the Securities and Exchange Commission. The company undertakes no obligation to publicly update or revise any forward looking statements except as required by law.
I'll now turn the call over to Paul.
Thanks, Chris.
In the first quarter of 2023, we continue to penetrate and expand the glaucoma and dry eye markets. We generated total revenue of $18 8 million growing 26% compared to the first quarter of 2022 and in line with our expectations, our strong performance out of the gate and progress.
<unk> underlying business drivers, including surgeons trained on army positions us well to meet our financial and operating objectives for the year. We are reiterating our expectation for 2023 revenue to range between $89 million and $94 million.
First quarter surgical glaucoma revenue was $17 3 million up 25% compared to the same period in the prior year and dry <unk> revenue was $1 5 million representing growth of 47%.
We also came in below our $35 million average adjusted operating expense target health.
Healthy revenue growth strong gross margins and disciplined spending drove strong operating leverage improvement demonstrating further progress toward achieving cash flow breakeven in 2025 with a substantial cash cushion.
As I'll discuss in more detail later, our ambitious clinical program continues to chart new territory in glaucoma and dry eye, we expect to have near term Readouts for two landmark studies this year, where we seek to demonstrate the clinical superiority of both omni and tier care versus the existing therapeutic standards.
Care in glaucoma and dry eye two of the most prevalent diseases in eyecare, which taken together represent a total addressable market opportunities of over $16 billion.
Demonstrating clinical superiority with both omni and tier care is an ambitious clinical goal and represent our original mission and purpose to elevate patient care with transformative innovations that will create sustainable long term value.
Turning to our business units and surgical glaucoma. Our main objective is to provide surgeons with the best micro invasive solutions for their patients regardless of disease state or cataract status.
Our surgical glaucoma growth strategy focuses on three objectives. The first priority involves training more surgeons on our omni technology Surgeons continue to show strong interest in omni we trained over 150 U S. Surgeons in the first quarter, but have reached less than half of the estimated 5700 makes trained surgeons in the U S.
Leaving plenty of runway for us to continue to train more surgeons over the coming years.
When we train new surgeons, we further penetrate the legacy combination cataract mix segment since surgeons often select.
Patients with concomitant cataract, who are already on their operating rooms schedule for their first omni cases.
Our second objective increasing the utilization of omni among our trained surgeon base is a natural extension of our exceptional training program.
<unk> safety efficacy intuitive use and broad FDA cleared label provide us with a uniquely clear path to increase utilization by expanding use of our omni technology across the entire population of <unk> patients, including the $5 billion Standalone opportunity.
Once adept at using omni surgeons gained the necessary confidence to expand their usage to standalone cases, as well as more severe combination cataract cases.
Now that we have achieved broad customer adoption, increasing utilization among our existing surgeon base is a powerful growth lever the math is simple.
If each of our first quarter active accounts performed just one additional omni procedure per month annual revenue increases by $13 million, which.
<unk>, just 2% of the overall mix opportunity.
Our third objective is to drive adoption and utilization of scion amongst specific subsets of surgeons, who opt for a more basic goniotomy procedure Zion provides surgeons with a complementary technology to omni and has gained rapid adoption.
Our focus on constantly improving functionality and usability produced our next generation Omni technology. The recently launched Ergo series.
We successfully executed a smooth introduction and ergo has gained wide and enthusiastic adoption omni has established a new standard in glaucoma surgery.
Based on leading efficacy and usability are omni technology can greatly expand the use of mix omnis growth continues to outpace total migs market growth as a result of both share taking within the legacy combo cataract segment and market expansion into the Standalone segment as surgeons get more comfortable using omni.
Naturally increased usage.
Our analysis of nationwide third party claims data indicates strong growth in the Standalone <unk> segment in 2022 and index, we created to track relevant Standalone activity grew 26%.
Well ahead of the high single digit growth in overall mix.
To accelerate development of the Standalone Mig segment, we continue to execute our comprehensive market development program, leveraging targeted field resources comprehensive patient and physician education clinical evidence and marketing initiatives.
Our multicenter tray study illustrated the safety and efficacy of omni in patients with uncontrolled IOP. Despite a history of trabecular bypass stent implantation at the time of cataract surgery we.
We are seeing more surge and surgically intervening with omni in the stunted pseudo vacate patients, whose IOP has become uncontrolled.
We are pleased to see that our omni technology can be used to help improve the lives of the 1 million plus patients who have undergone combination cataract stent implantation and whose pressure may one day become uncontrolled.
Last month clinical ophthalmology published an extended follow up from a Romeo study involving seven centers and 72 mild to moderate glaucoma patients that demonstrated continued safety and effectiveness of our omni technology and both Standalone and combination cataract settings. After two years.
As a reminder, the FDA reviewed the 12 month results from the original Romeo study when clearing omnis expanded label in 2021. So it is very gratifying to see that there is growing evidence of omni is highly compelling one year safety and efficacy results maintained through two years and beyond.
Another important clinical program involves our study of the American Academy of Ophthalmology to Iris registry, which includes 9000 Migs cases. This study analyzes post surgical outcomes for the leading <unk> technologies in the U S including omni.
<unk> and hydrus.
We believe this data further supports our belief in the clinical superiority of omni we plan to present and publish these groundbreaking results, including comparative IOP and medication reduction outcomes at the one and two year marks at multiple medical meetings and in peer reviewed literature throughout 2023, including at the.
Crs meeting this weekend.
We believe the combination of increasing evidence of sustained clinical benefits from use of the omni surgical system at two years, coupled with a non implantable approach that does away with a lifelong concerns of indwelling metallic implants sets a new standard in glaucoma surgery for the future.
And striving to provide the best solutions for our customers. We developed the first Bladeless Goniotomy technology scion the second product in our surgical glaucoma portfolio, we launched ion last August the.
The usability procedural predictability elegance of the technique and its general interaction with the anatomy are the main factors cited by surgeons, who now use ion as Theyre Goniotomy technology of choice.
As we expected many of our scion users prioritize a simpler migs procedure and were not prior omni customers demonstrating that our portfolio approach has attracted new customers.
We have observed a significant positive impact from <unk> and omni accounts with existing goniotomy practices in terms of both overall revenue growth and increased omni usage.
Among accounts that ordered omni in the first quarter of 2022, and both omni and <unk> in the first quarter of 2023 revenue grew 39%.
These customers also increased their utilization of omni by 16% on average.
As intended <unk> has proven to be a complementary technology to omni and has enhanced our sales growth and commercial strength.
On the international front, our launch of direct operations in Germany, Our second direct O U S market has gone very well, Germany, and the U K or other direct O U S market are two of the largest international Migs market.
We will continue to prioritize expansion in our existing international markets. While also considering launches in other countries with attractive market access regulatory and commercial environments.
Before turning our attention to dry eye I want to take a moment to highlight the activities. We have scheduled for Crs This weekend in San Diego Tomorrow.
Tomorrow, we're hosting a surgical glaucoma investor symposium that will feature presentations from leading omni and Sai on surgeons, we have several other presentations featuring our technologies throughout the weekend you can find more information in our recent press releases.
Now turning to our dry eye business.
There are 14 million diagnosed evaporative dry eye sufferers in the U S. Our dry eye business has experienced rapid adoption. Despite lack of coverage by health insurance providers to.
The cash pay environment has not deterred, our over 1100 customers or the tens of thousands of patients who have sought treatment for <unk> disease with our tier care technology.
We have placed ourselves at the vanguard of a transformational shift in dry eye treatment away from eyedrops toward intervention procedures, we designed.
And our controlled launch of tier care to help us optimize the development of this large and underserved market.
We've accumulated numerous important findings that we will leverage to serve pent up demand, especially if we can achieve our market access goals.
I'd like to take a moment to recap the dry eye market and our transformative mission with tier care as we approach the readout. This summer of our pivotal Sahara RCT.
Ali artificial tears and daily prescription eyedrops are the gold standard treatment in dry eye today and collectively represent many billions of dollars of annual revenue for their manufacturers.
Restasis, our comparator and Sahara is the top selling dry eye therapeutic despite the significant commercial success of prescription eyedrops therapeutics. They don't address disease My Bohemian glands. The primary route underlying cause of dry eye for most patients estimated at 86% of all dry eye cases.
We designed tier care to set a new standard in dry eye treatment correspondingly, we designed our Sahara RCT to proved here care superiority over the prescription gold standard with input from eight payer medical directors if successful.
The comparative clinical benefits and health economic value of tier care will serve as the foundation of our market access strategy.
As a reminder, in the third quarter of 2022, we completed enrollment of Sahara, a 345 patient randomized masked multicenter superiority study comparing interventional procedural treatment with tier care to twice daily prescription eye drop treatment with Restasis.
Insurers have paid billions of dollars for Restasis and other dry eye medications Sahara has the potential to prove that our tiered technology can improve clinical outcomes for patients and bottom lines for payers. We are pleased to report that we completed our last six month patient follow up in April .
As a reminder, it can take several months to complete the data analysis, we plan to release top line results. This summer and present full results at a major medical meeting and publish these results in a leading medical journal later this year.
To summarize we continue to execute across our business generating strong growth in both surgical glaucoma and dry eye and advancing the underlying commercial clinical and market access drivers that will bolster further growth we.
We have built a solid foundation to continue training new customers and expand utilization.
Our plan for robust on growing growth, coupled with our top tier gross margins and disciplined operating expense spend are positioning us to improve operating leverage and keep us on a path to achieve positive cash flow in 2025.
I now have the pleasure of formally introducing Ali bauerlein, as our new Chief Financial Officer, I am thrilled to have Ali onboard a proven entrepreneur and exceptionally talented executive Ali brings public company CFO experience and a track record of co founding and leading a rapidly growing.
<unk> business through multiple phases of growth, culminating in over $350 million of annual revenue.
Ali is already making a positive impact at site in so many ways and is a perfect fit with our team. We're delighted to have Ali help us continue to scale the business, the right way and drive towards profitable growth.
<unk>.
Okay.
Thanks for that kind introduction, Paul and Hello, everyone. Thanks for joining us today I'm excited and proud to join the team and I look forward to meeting new faces and reconnecting with friends across the investment community in my new role.
Now, let's get into the numbers.
Total revenue for the first quarter was $18 8 million, representing 26% growth compared to the first quarter of 2022 as.
As a reminder, the first quarter is typically the slowest of the year for us.
Surgical glaucoma revenues for the first quarter were $17 3 million up 25% versus the comparable period.
We continue to show strong underlying growth fundamentals and customer retention and ordering facility.
Additionally, we saw strong new account additions and surgeon training activity.
Over 1000 customers ordered surgical glaucoma product in the first quarter up 26% compared to the prior year period.
Our commercial team did a tremendous job introducing our technology to customers in the first quarter.
Our customer acquisition funnel remains strong, creating great momentum for 2023.
We trained over 150 U S surgeons on omni and over 130 on scion during the first quarter.
Our dry eye revenues for the first quarter were $1 5 million up 47% compared to Q1 2022.
We grew our installed <unk> base to 1184 facilities as of March 31, 2023 versus 632 as of March 31 2022.
Gross margin for the first quarter was 84% compared to 80% in the prior year comparable period.
The increase was primarily due to the margin impact from our voluntary replacement of care care hub in the first quarter of 2020 Q.
Our operations team continues to perform well driving manufacturing efficiencies and top tier margin.
R&D expenses were $4 7 million compared to $5 6 million in the first quarter of 2022 and.
And SG&A expenses were $28 7 million compared to $28 4 million in the prior year period.
Total operating expenses for the first quarter were $33 3 million, a decrease of 2% compared to $34 million in the first quarter of 2022 and in line with our expectations.
We continue to drive focused spending.
Adjusted operating expense for the quarter was $29 7 million versus our stated 2023 quarterly average target of $35 million.
Our loss from operations for the first quarter was $17 6 million compared to a loss of $22 2 million in the first quarter of 2022.
We had a net loss of $17 1 million or <unk> 35 per share in the quarter compared to a net loss of $23 3 million or <unk> 49 per share for the first quarter of 2022.
We ended the quarter with $167 3 million of cash and cash equivalents and $35 million of long term debt before debt discount.
We've reduced cash usage by 20% compared to the first quarter of 2022.
As a reminder, the first quarter includes our annual employee bonus payments.
We expect cash usage to decrease in the second quarter due to higher revenue and the absence of bonus payments, partially offset by higher adjusted operating expenses.
Overall, we expect operating loss and cash usage will continue to decrease over time as our business model begins to flat that considerable operating leverage driven by our high gross margin and targeted operating spend.
Based on our solid start to the year and favorable trends, we are reaffirming our annual revenue guidance of 89% to $94 million.
We expect first half of 2023 revenue distribution will be similar to what we experienced in 2022.
We expect that average quarterly adjusted operating expense of approximately $35 million will allow us to achieve our plans for the year, but we expect second quarter adjusted operating expenses to be higher than the annual average given the timing of certain expenditures.
We continue to proactively manage our liquidity and operating expenses to maintain our strong cash position.
We recently filed a universal shelf S. Three registration statement for good corporate housekeeping, we do not intend to raise capital at this time.
We are confident that our robust growth trend market, leading positions in mix and mgd strong balance sheet, leading gross margins and disciplined spend will enable us to achieve our 30% medium term revenue growth target and positive free cash flow by year end 2025.
Maintaining a substantial cash cushion.
With that operator, you may open the line for questions Tom Fong, our head of corporate strategy will also join us for Q&A.
Okay.
As a reminder to ask a question. Please press star one on your telephone and wait for your name to be announced to withdraw. Your question. Please press star one again please.
Please limit your questions to one question and one follow up thank.
<unk>. Thank you please standby, while a cabal Q&A roster.
Our first question comes from the line of Matthew O'brien with PSP. Your line is now open.
Hey, this is Phil on for Matt Thanks for taking our questions just for starters.
I wanted to talk about a touch on the reimbursement changes. This year what are you seeing on that front, specifically as it relates to canal plus the of course, this year and perhaps the potential for Goniotomy down the road and what are you seeing on the developed customer.
Relation to retention rate for omni.
Yes, hi.
The first question regarding <unk> the reimbursement.
The change we have discussed in the past there was a review of the Cat one code.
Most commonly used cat one codes in Migs, a couple of years ago <unk>. Six 674 was one of those codes and bypass stenting was the other code that was reviewed by the rock and.
Following that review and analysis.
Included that the <unk> would be reduced sequentially over two years. So it got reduced from $9 $50 to $7 50 in the first year and $7 50 to 600 in the second year.
The $600 pro fee rate is something thats in effect as of.
January one of this year.
<unk>.
What does that mean perspective, if you think about it relative to other procedures, either a competing makes procedures and or cataract surgery alone the pro fee moving to 600, while it's never.
Something that surgeons facilities manufacturers get excited about the fee hasnt necessarily changed relative to anything else. So it's still north of cataract surgery alone.
It's still.
As a premium to to stenting and it was below Goniotomy last year and it remains below goniotomy. So relatively speaking it hasnt changed and we feel fine about overall, where where the reimbursement is.
Yes, I can take the second part of the question you had asked about retention rates were very pleased with the retention rates that we continue to see in the business. We're still continue to see in the high 90 percentile ranges for customer retention, which we really think is optimal and excellent and shows that true.
Benefit of our technologies and how much customers do.
Do you like to use the product. So I do want to reiterate that that continues to be a very strong metric for the company.
Oh, great glad to hear that.
For my follow up can you just expand a bit on the DTC pilot how is that progressing and what are your thoughts for that Q2 execution phase I believe it was.
Yes, sure I can take that question, we're still in the early stages of that we are on track, though as we said on the last call.
Q1 was really for us to design that program in Q2 was for us to do the trial of the direct to consumer initiative and we're in the midst of that it's too early for us to give a specific readout of results, but we really did this study and are doing this study because we believe there is.
Truong consumer interest and better treatments, both for glaucoma and dry eyes. So we're hoping to prove out that thesis and as we have more information to report we will let you guys know.
Great. Thanks, so much.
One moment for your next question.
And your next question comes from the line of Tom Stephane.
Your line is now open.
Great Hi, everyone. Thanks for taking the questions I'll start with the near term one just on.
Trends in market share Paul maybe if you can talk about what surgical glaucoma trends in the quarter looked like for you and maybe what that has looked like entering in <unk> anything you saw in the competitive environment broadly maybe.
Maybe any shifts you would call out where that develops and then there's just tack onto that I wanted to ask about market share.
A key competitor last night, I think reported flat quarter over quarter U S results.
Surgical glaucoma for you was down I think maybe in the high single digit range.
Just your thoughts there.
How how investors should be viewing that comparison, maybe just based on what you're seeing play out year to date, and then I have a follow up.
Yes, Hi, Tom I'll take the first question in terms of trends what were seeing I think we're I think we're seeing a.
Good operating environment.
Last year, there were a number of new new products that were introduced early in the year that kind of stabilize by the end of the year and I think we're.
We headed into first quarter of this year and are far more stable environment and I think our business performance is a reflection of it thats, both then and combo cataract as well as stand alone I think both business lines.
Omni is used in mild to moderate combo cataract is growing nicely and we continue to take share there as we have been for several years, our stand alone business.
These used in moderate stand alone and also in an advanced standalone prior to more invasive surgeries that that's picking up as well and again as I had mentioned in the prepared remarks.
Some of the data that we look at in the claims analysis. It does show that the Standalone market is indeed growing and we believe that were a key driver behind that growth. So.
We feel we feel great about the operating environment. We're in we feel great about the predictability and we feel great about the growth rates in both combo cataract as well as Standalone.
Okay got it and then.
Longer term question to pivot.
I just wanted to ask about Standalone glaucoma.
Something similar last call but.
Obviously, there is some new devices coming in.
Maybe over the next 12 months Standalone Stone is currently is rolling out and then.
<unk> delivery device in their notably trying to expand into the Standalone.
Migs market, so how should we be thinking about the impact that could have.
On mix more broadly is it fair to think about and I want to put words into your mouth.
Is it fair to think about these products in other companies' efforts towards expanding the interventional mindset call. It maybe as a net positive more broadly for the MC space. Thanks.
Yeah, Great Great question Tom.
First of all I do think that the standalone market estimated at $5 billion and it's in its infancy.
<unk> today I do believe that more companies more resources devoted to the significant education of the market.
To drive market development is is is a positive driver for everybody I do believe in that as it relates to our competitive positioning. We're obviously very passionate about about omni and what it can do for Standalone patient the clinical data speaks for itself, we have a growing body of clinical evidence.
And stand alone mild moderate and severe that's very compelling and it all goes back to our our reason for being and I think that.
That's on display.
Very clearly in Standalone cases, and Thats to offer surgeons something that it as minimally invasive a manner as possible can address as much of the underlying disease as possible and when we can offer surgeons that kind of technology that can comprehensively restore.
Diseased anatomy and restore outflow and do so more than any other technologies. We believe that we create a very competitive safety and efficacy proposition. So I'll just ask everybody to.
Imagine this youre sitting in the angle.
<unk> advanced your solution across the anterior chamber and you're now sitting in the era of corneal angle and you have options what should you do at that point for this standalone patient, we believe strongly that at that moment youre already in the eye that you should comprehensively address as much of the diseased underlying anatomy as possible and when.
When you do that you can hopefully mitigate the need or do away with the need altogether for meds. So thats our goal with omni we continue to iterate on the product and technology. So that we can make it more and more usable user friendly and more effective and ideally we can help surgeons get their patients.
<unk> of Meds, and so we have a strong bias that if youre going to do if youre going to go into the eye and do angle surgery on a standalone basis make it as comprehensive as humanly possible.
We do that with Amit.
Hey, Tom This is Tom I just wanted to.
Answer your question on market share as well in terms of.
Our growth this quarter this quarter year over year at 25%.
Was about seven times higher than that.
The other company that you referenced.
A quarter over quarter or year over year growth.
So I think we still we're still continuing to take a lot of share and mix overall and continue to develop the standalone snack segment.
Really appreciate that thanks, guys.
Thank you.
Okay.
Your next question comes from the line of Mike <unk> with William Blair. Your line is now open.
Great Hey, everyone. Thanks for taking the questions.
So maybe just to start here with one on <unk>.
Ergo series have the usability improvements help you reach a new segment of surgeons at all since it was launched maybe those that are more focused on <unk>.
Cedar efficiency than previous omni users such as maybe a higher volume cataract Surgeons for example.
Yes.
Question and yes, it's helped in multiple ways. It has helped with our existing customer base.
Optimize the surgical experience the handle the usability is better.
The tip of the device and the angle is better the catheter entry into the canal.
Is better and so just having <unk>.
Design the system to help make the procedure more reproducible helps.
Surgeons become even more confident in.
The restored outflow procedures that are omni technology facilitates so I'd say it made our current customer base happier I think it does help surgeons, who maybe had tried omni or maybe residential fellows and thought it a little a little challenging it can help them.
I'm more confident in it and lastly, importantly, anytime you've got a new product and.
And something exciting and new to talk about we have a very.
A significant commercial infrastructure very effective commercial sales force. It allows them to go in with something new to those surgeons, who might not have tried omni yet, but we're considering it and so I think that's that's been a nice advantage also.
Got it that makes sense and then maybe just one on tier care. If you guys were to see positive results from the six month readout.
But longer term data still but what would be the next steps. If any you guys would expect to take maybe in the remainder of the year and next year from.
Our regulatory or commercial standpoint.
Yes, so from a regulatory perspective.
We currently have a very nice label, we've already expanded the label of tier care could we use the results of Sahara is successful to expand the label further potentially.
Signs and symptoms indication potentially but that's not that's not the primary objective of the study the study is.
Oriented around supporting.
Payer decision, making.
And.
So in terms of timing expect.
This summer for us to announce a top line readout.
We are aiming to then submit for publication in a top tier journal again. This all assumes success.
But we would aim to submit in a top tier journal.
The late summer or early Q3 timeframe hopefully have a publication on the six month clinical outcomes in a top journal by end of year, and then with that data we would be.
To be very excited to go and have have very compelling discussions with with the clinical data as well as in parallel a health economic analysis in terms of how tier care not only can hopefully offer superior dry eye treatments for patients, but also help payers.
Payers and their bottom line. So it will be running data analysis in parallel this year and so by the end of the year will be ready to go to payers with this complete reimbursement package and early 2024, we'd be making the rounds with payers and that would obviously be a very exciting exercise and we would be quite aggressive.
The execution of that exercise.
Got it that's very helpful. Thanks, guys. Thanks.
And I see no further questions at this time I will now turn the call back over to Paul for Tommy CEO .
Yeah.
Thank you all for your interest in <unk> Sciences, we appreciate it and have a great rest of your day.
This concludes today's conference call. Thank you for your participation you may now disconnect have a good day.
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