Q2 2023 Sight Sciences Inc Earnings Call
Good day, and thank you for standing by and welcome to the Life Sciences second quarter 2023 earnings Conference call.
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I would now like to hand, the conference over to your Speaker today, Chuck Taylor investment Relations. Please go ahead Sir.
Thank you for participating in today's call presenting today are site Sciences co founder and Chief Executive Officer, Paul <unk>, Chief Financial Officer, Ali Bauerlein, and head of corporate strategy. Tom walked earlier today <unk> Sciences released financial results for the three months ended June 32023.
A copy of the press release is available on the company's web site at investors <unk> Sciences Dot com.
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.
These forward looking statements include statements related to <unk> Sciences anticipated financial performance and operating results market opportunity business strategy and plans for developing and marketing new products.
Forward looking statements are based on estimates and assumptions as of today.
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 indicated by the forward looking statements on this call can be.
Found in the risk factors section.
The annual report on Form 10-K for the year ended December 31, 2022 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 will now turn the call over to Paul.
Okay.
Thanks Tripp.
Our strong second quarter performance displayed the continued successful execution of our growth initiatives across surgical glaucoma and dry eye.
We generated record total revenue of $23 5 million growing 36% compared to the second quarter of 2022.
We saw great revenue growth in both of our businesses.
<unk> by strong commercial activity and expanding clinical evidence supporting the value proposition of our technologies.
Most notably we were thrilled to announce the success of Sahara our.
Our landmark device versus drug randomized controlled clinical trial, comparing interventional island procedures enabled by our tier care technology to restasis for the treatment of dry eye.
At the six month endpoint Interventional island procedures enabled by tier care technology were superior to Restasis, and improving tear breakup time or T. But.
The primary objective signs endpoint.
<unk> was also non inferior to restasis with respect to improvement in ocular surface disease index, our OSD I the primary subjective symptoms endpoint.
As importantly patients in the tier care group demonstrated clinically and statistically significant improvements of all 10 signs and symptoms endpoints measured at every observation interval.
We are extremely excited about these clinical results and believe they will lay the foundation for us to help physicians rethink how they treat dry eye and transform the market by moving away from daily prescription eyedrops and towards once or twice a year intervention will dry eye procedures.
An abstract of the six month phase one results from Sahara has been accepted by the American Academy of Optometry for presentation at its annual meeting in October we.
We look forward to discussing the Sahara data with payers as a key part of our efforts to establish reimbursement and fair patient access for tier care treatments.
To begin our surgical glaucoma discussion I would like to address the draft LCD for mix recently proposed by five backs that could impact sales of our omni and scion product.
These Max administer part B Medicare benefits for Medicare fee for service patients on behalf of CMS.
We believe these proposals have numerous serious flaws and would adversely affect Medicare patients and limit <unk> ability to provide proven effective treatments for their glaucoma patients if implemented as currently drafted and.
In particular, the proposed LCD as have not considered all the available clinical data demonstrating the benefits of omni procedures, which have been published and at least 18 peer reviewed publications.
Our extensive clinical data real world outcomes, and broad FDA label reinforced the safe and effective use of our omni technology in adult patients with primary open angle glaucoma.
G.
These five massive hosted public open comment meetings regarding the proposed LCD medical societies physicians and patients have provided overwhelming support for continued access to omni technology expressing the critical nature of the benefits enabled by <unk> and the importance of continued access to our omni technology.
To help preserve the vision of <unk> patients.
And our presentations at the Max open meetings, we reiterated the important role can alloplasty and trabecular <unk> play in the treatment of glaucoma and highlighted additional clinical data, which was not considered in the draft. LCD is specifically we presented results from the two year extension of our Multicenter Romeo study.
This important study demonstrated that the reductions in both intraocular pressure or IOP and glaucoma medication use and mild to moderate patients.
Patients treated with omni that we originally observed at 12 months extended out to 24 months.
This longer term data provides further evidence of the durability and efficacy of our omni technology.
We also presented 12 month results from Gemini, our prospective multicenter trial of omni in combination with cataract surgery and.
And Gemini, we observed significant reductions in both IOP and medication usage with omni compared to the historical cataract control.
Gemini had pre specified success criteria to exceed the IOP reduction due to cataract surgery alone as observed in the control arms of the pivotal Migs implant studies.
The prospective study successfully met its prespecified efficacy endpoint with statistically significantly greater IOP reduction at 12 months than the historical control arm.
Our presentations to the various Max further highlighted and described the consistency of positive outcomes observed across the published articles.
We appreciate the efforts made by all of the physicians patients societies and other stakeholders, who helped educate the max regarding the necessary and crucial role that our omni technology plays in the treatment of <unk>.
We would also like to thank all of the dedicated site employees, particularly in our clinical commercial and market access groups, who coordinated our exceptional response.
We do not believe there is a supportable basis for the implementation of these proposed LCD as they are currently drafted coverage criteria are based on published clinical evidence significant clinical benefits that are equivalent to our superior to other Medicare covered procedures.
Incentives clinical guidelines generally accepted standard of care and FDA clearance specific to glaucoma therapy, all of which favor and support continued coverage of the procedures enabled by omni technology.
We plan to continue to communicate with all stakeholders regarding the published clinical evidence and real world results supporting the safety and efficacy of our omni technology and the importance of continued and appropriate coverage to preserve access to these treatment options for patients.
We don't have visibility at this time as to when the Max will either revise withdraw our finalized their proposed LCD, but we believe we are providing clinical information sufficient to maintain coverage for procedures enabled by our omni technology.
In other news we were pleased to report in June that Cigna, one of the largest commercial health insurance companies in the United States with almost $15 million covered lives.
Revise their glaucoma surgical procedures coverage policy to include procedures performed with our omni technology as medically necessary and covered as of June 15th 2023.
This decision further validates omnis clinical importance, we are excited to bring the benefits of omni to the Cigna community.
Commercially our surgical glaucoma business growth continued to outpace the mixed market overall as more clinicians adopted our omni technology.
As evidenced by our record quarterly revenue commercial activity for the second quarter.
Exceeded our expectations.
Notably net account retention was particularly strong despite the current market considerations associated with the proposed LCD as.
It's clear that with continued market access we have a sticky stable and expandable revenue opportunity via our growing surgeon base.
Feedback from surgeons, who use omni continues to be very positive we attribute this customer stability and stickiness.
The differentiated consistency and degree of efficacy of our omni technology, it's exceptional usability and our commercial excellence.
Yes.
I would like to congratulate the graduating class of 2023, ophthalmic surgical residents and fellows.
Our outstanding strategic accounts team has worked hand in hand with over 160 of these new surgeons to develop their expertise using our technologies. We look forward to partnering with this latest generation of surgeons to improve the lives of patients with <unk> in the years to come.
Omni continues to perform well within the combo cataract segment, and we are encouraged by the market expansion and accelerating penetration, we're observing and Standalone mix.
Based on projected claims data from a third party analytics provider, we observed expanded standalone activity as measured by the growth in standalone patient visits involving CPT codes associated with omni.
While standalone procedure volumes remain modest compared to the combo cataract segment, we remain confident in our ability to drive increasing awareness and growth of our omni technology. In this segment through our comprehensive market development program, which leverages standalone clinical evidence targeted field resources.
Comprehensive patient and physician education and marketing initiatives.
The other product in our surgical glaucoma portfolio scion also contributed to our growth in the second quarter.
<unk> addresses the needs of surgeons seeking a simpler make solution for certain patients.
We are pleased with the positive industry reception for <unk>, although it is still a small overall contributor to total revenue.
Turning to our dry eye business.
We designed our care care technology to address the serious unmet needs of patients with evaporative dry eye and <unk> gland disease, or mgd, which is associated with up to 86% of dry eye cases.
Historically treatment for dry eye has been dominated by artificial tears and prescription eyedrops, both of which have clinical limitations and do not address the underlying causes of mgd.
We believe the phase one results observed in Sahara demonstrates that our <unk> technology should play a prominent role in the dry eye treatment paradigm.
During our controlled commercial launch we have experienced growing adoption of tier care as a self pay treatment option illustrating the pent up demand for a procedure that can offer safe and effective relief from Mgd.
We believe there is immense potential for our tier care technology with fair and appropriate reimbursement.
We are thrilled by the success of Sahara. The first of its kind head to head device first drug RCT comparing treatments using our tiered care technology to twice daily use of prescription eye drop treatment with Restasis.
In this trial 345 patients at 25 sites in 2014 States were randomized one to one between tier Karen Restasis groups.
<unk> achieved its primary clinical signed six month endpoint, demonstrating the superiority of interventional island procedures enabled by tier care over Restasis, eyedrops, and improving tear breakup time, a key measure of aqueous retention here stability and the tier films ability to protect the ocular surface.
Throughout the study intervention island procedures with tier care demonstrated clinically and statistically significant improvements of all 10 endpoints at every measurement interval evaluated to date, one week, one month three months and six months.
We designed the Sahara RCT with exacting standards to minimize potential bias and to ensure that the results. If successful would provide meaningful support for healthy payer coverage discussions.
These measures included setting the superiority endpoint at six months, rather than the one or three month periods common in dry eye studies. We did this intentionally to help ensure restasis had sufficient time to reach peak effect.
Endpoint assessments were carried out by assessors masked to treatment assignment to further minimize potential bias.
In coordination with the study's principal investigators we plan to submit phase one results from Sahara to leading peer reviewed journals. We are also preparing associated health economics, and outcomes research and a budget impact model for publication.
Successfully published we believe these articles will encourage doctors to revamp the treatment of dry eye disease, and provide payers with persuasive evidence to support patient access and reimbursement to.
To date payers have not received the rigorous RCT data for dry eye procedures that we believe Sahara provides.
Sahara highlights our commitment to rigorous clinical evidence and we are very pleased with the results I would like to recognize the exceptional efforts of our clinical team our team of investigators and all the patients involved with this important trial the.
The tier care technology was designed to intervene at the root cause of Mgd comprehensively and a user friendly way and has now demonstrated the ability to consistently produce best in class clinical outcomes in two rct's.
We look forward to advancing our care care market access strategy, expanding usage of our omni technology and improving the lives of patients suffering from chronic eye diseases.
I will now turn the call over to Ali to discuss our financial financials.
Thanks, Paul.
Excited by the progress we have made this quarter across both surgical glaucoma and dry eye.
Total revenue for the second quarter was $23 5 million, representing 36% growth compared to the second quarter of 2022.
Surgical glaucoma revenues for the second quarter were $21 4 million up 35% versus the comparable period.
Over 1100 customers ordered surgical glaucoma products in the second quarter up 30% compared to the prior year period.
Our commercial team did a tremendous job introducing our technology to new customers and maintaining strong relationships with existing customers in the second quarter, particularly given the uncertainty associated with the proposed LCD.
Our dry eye revenue for the second quarter was $2 1 million up 56% compared to the second quarter of 2022.
As we prepare to evolve care care beyond the controlled launch phase in the coming quarters, we would like to help investors better understand our dry eye business by introducing new operating metrics and a more targeted view of our core addressable market.
We see vast potential to improve the lives of patients across the spectrum of mild moderate and advanced dry eye disease.
Our market research indicates that approximately $17 8 million patients with dry eye disease. There are between 11, six and $15 5 million diagnosed <unk> patients in the in the U S.
Approximately 55% of these patients are six 4% to $8 5 million patients.
We'd be categorized with moderate to severe mgd and we believe these patients are the most likely candidates for treatments like care care, while patients with mild mgd can also benefit from treatments such as tier cure these patients and their eye care providers may not feel the same urgency to seek out a tier care.
Procedure until the patient symptoms progress.
Given the significant LGD patient population, we believe it is important to initially target the patients that doctors can most easily identify and are more likely to proactively seek treatment.
Consistent with the patient enrollment criteria in our <unk> pivotal RCT and the corresponding coverage. We will initially pursue in the United States. This core opportunity generally consists of moderate and advanced <unk> patients.
Assuming moderate patients receive one treatment per year and severe patients receive two treatments per year, resulting in an average of one three treatments per year and our current smartly. Its average selling price. This would yield a core addressable moderate to advanced treatment market of approximately $2 5 billion.
Currently over the counter and prescription eyedrops are the dominant treatment for dry eye, but the cost to payers and patients estimated to exceed $2 billion annually.
We believe the superior results from Sahara, coupled with ongoing technology enhancements could allow us to increase overall prices in the future. In addition, there are opportunities for us to pursue mild mgd patients over time and expand into new markets worldwide, which would further increase our opportunity.
We believe informative metrics to measure the performance of our dry ice segment, including dry eye active customers, which we define as the number of customers who have ordered island treatment units are smartly during the preceding three months period and the number of <unk> treatment units.
This data provides a broad picture of account activity and product utilization that we believe will be important as we expand.
For the second quarter of 2023, we had 370 active dry eye customers, 75% increase versus the second quarter of 2022. Additionally.
Additionally, we sold almost 6000 island treatment units in the quarter of 69% increase versus the prior year period.
Gross margin for the second quarter with 85, 6% compared to 84, 1% in the prior year period.
Gross margin improvement was attributed to improvement in both surgical glaucoma gross margin and dry high gross margin.
Surgical glaucoma gross margin improved primarily due to manufacturing efficiencies generated as a result of higher production volumes, partially offset by lower average selling prices due to product mix.
<unk> gross margin improved primarily due to an increased mix of higher gross margin smartly versus smart hub and higher average selling price of smart hub.
R&D expenses were $5 2 million compared to $5 9 million in the second quarter of 2022, and SG&A expenses were $30 1 million compared to $31 4 million in the prior year period.
Total operating expenses for the second quarter were $35 3 million, a decrease of 6% compared to $37 4 million in the second quarter of 2022 and in line with our expectations.
We continue to monitor monitor operating expenses closely and are pleased with the results.
Adjusted operating expenses for the quarter were $31 5 million.
As expected adjusted operating expenses were slightly higher than our estimated 2023 quarterly average target of $30 5 million given the timing of certain expenditures within the year.
Our loss from operations for the second quarter was $15 2 million compared to a loss of $22 9 million in the second quarter of 2022, we.
We had a net loss of $14 8 million or <unk> 30 per share in the quarter compared to a net loss of $23 8 million or <unk> 50 per share for the second quarter of 2022.
We ended the quarter with $154 5 million of cash and cash equivalents and $35 million of long term debt, excluding debt discounts and amortize debt issuance costs.
In July we terminated our unused $5 million debt revolver facilities since we have no intention to dry.
Demonstrating our progress to cash flow breakeven cash usage decreased to $12 8 million in the second quarter of 2023 compared to $17 7 million in the first quarter of 2023, and $18 5 million in the second quarter of 2022.
Overall, we expect operating loss and cash usage will continue to decrease over time as operating leverage increases driven by our high gross margins and targeted operating expense.
Based on our solid year to date results, we are reaffirming our annual revenue guidance of $89 million to $94 million.
We believe it is prudent to maintain our guidance range. Despite the solid year to date results, primarily due to the uncertainty associated with the proposed coverage changes in our surgical glaucoma segment in.
In addition, we expect the seasonality of our revenue to begin to align with typical industry pattern that seemed lower procedure volumes in the summer months.
We continue to expect that average quarterly adjusted operating expenses of approximately $35 million per quarter will allow us to achieve our plans for the year.
We continue to target approximately 30% revenue growth in the medium term and positive free cash flow by year end 2025, while maintaining a substantial cash position.
Our medium term financial outlook assumes that the seven Max continue to cover omni procedures largely to the extent they are currently covered.
With that operator, you may open the line for questions Tom long, our head of corporate strategy will also join us for Q&A.
Thank you Ali we will now conduct a question.
SAR one one on your telephone and wait for your name to be announced to withdraw your question. Please.
Star one again.
These standby, while we compile the Q&A roster.
Our first question comes from Craig Bijou from Bofa.
Go ahead Mike.
Thank you.
Good afternoon, everyone. Thank you for taking the questions.
So maybe just wanted to start.
Obviously you have this.
This overhang with with the Max and the LCD is and I. Appreciate the fact that you don't.
Know what timing.
What the timing is to get an update.
But maybe if we can.
If you could provide a little bit of color a little bit of color on.
What would happen.
If the LCD is where we're putting into place what are some of the options that you have.
If that were to happen and maybe just kind of how to think about the timing of some of those.
Sure be happy to take that question and first of all what I would say is I would remind everyone that we feel like.
We've done a very good job outlining our key to each of the Mac on why coverage should be maintained or our products and I think that that's really important for.
Investors to understand that we believe that the proposed LCD will not be put in place as they currently stand it will be revised in some capacity.
We don't have as we said in the prepared remarks visibility on exactly when the Max will decide to make a decision.
They could individually make decisions.
What they want to do for their coverage areas or they together could.
Get together as a CAC meeting again and have another discussion about options. There of course as we've said in our previous coverage of these issues. This is a significant portion of our surgical glaucoma revenue from 2022 are in the states covered by these Max <unk>.
We're 60% so.
That is a significant portion of our revenue at risk, but we believe that it is a low chance that these ltvs will move forward in their current form.
Our options if they do would be of course too.
To go through an appeals process.
Associated with those Ltvs.
We could also pursue an NCD or or other coding option. So those would really be our main options. If these do progress.
In the unlikely scenario of the feed performer.
Great. Thank you Ellie and I appreciate all of the color on the market opportunity for tiered care.
Would love to know that you have.
Strong data from Sahara.
The opportunity is kind of now out there in front of you would love to get your.
Updated thoughts or I know, it's early but feedback on answer her from from the docs.
What do you think it could do for.
For insurance coverage going forward and then I think you guys have talked about.
Similar growth between surgical glaucoma and dry eye going forward as part of your medium range plan. So there is that still the case or how should we think about the opportunity to grow the dry eye franchise in 'twenty four and beyond.
Yes, Hi, Craig I'll take the first part of that question and then maybe al can add on I think the feedback from Sahara from our investigators have been very very strong and there's a lot of excitement there's a lot of excitement internally here at <unk> Sciences.
I do want to remind everybody. So here is our second RCT, our first RCT, which was also very successful called Olympia.
<unk> tier care against the first mover, leading mgd procedure and last year published superiority of symptoms.
In that trial. This trial <unk> was another very ambitious study designed to transform treatment towards intervention procedures and away from drops artificial tears and prescription eyedrops very rigorously designed.
We spoke to a number of payer medical directors.
In advance of <unk>.
Barking on this journey, we wanted to make sure that the data that we would be able to provide payers. If the study was successful would be meaningful to them, making hopefully a positive coverage decisions.
We demonstrated.
As we've mentioned in the prepared remarks, very consistent improvements and all signs and all symptoms. The study was a success.
We demonstrated superiority to restasis and our primary sign endpoint of tear breakup time.
In terms of the plan.
We will be.
Publishing are submitting for publication.
Within the next few months hopefully by the September timeframe, we'll submit to a top journal at the very top journal.
And I care, we'd hope to get the publication.
By the end of the year, if all goes to plan and we are in parallel assembling a very strong payer relations team.
They are mapping out the strategy for 2024 in terms of which payers, we're going to target first.
<unk> 2024, hopefully with publication in hand, I'm not just the publication in terms of the clinical data, but also also health economics research and the budget impact model with those publications and a payer a strong payer relations team will be working hard in 2024 with payers to hopefully start securing some some.
Average wins, which I would think in the 2025 timeframe. Although you can cover that what we would expect to see maybe with success yeah sure. So.
Happy to talk a little bit about where we see the trends going here, obviously, we arent prepared today to give any specific guidance for 2024 or 2025 associated with where we see the dry eye portion of the business going.
We would be.
Fairly cautious in expanding our commercial resources until we start seeing some market access wins, so for us the priority in terms of our.
Resources right now is to really go about securing appropriate and fair market access for tier care and as we get wins on that front, we would expect those to be accelerants to our revenue growth already you see on our dry ice side of the business because its growing from a small base. It is.
Growing quicker than our corporate average revenue growth rate and we would expect just given.
Still a small base in the business that that could continue now I think it will just depend on the timing of these market access agreements and how quickly we.
We can ramp those up but we see this as a very large market opportunity for us. We think we have great clinical results that we can share with the payers on why this is appropriate for coverage, but we need to go execute on that before we will start talking about specific.
Specific guidance and where we can take this opportunity.
Okay.
Great very helpful. Thank you for taking the questions.
Okay.
Thank you please standby.
Our next question comes from Tom <unk> from Stifel. Please proceed with your question.
Great Hi, everyone. Thanks for the questions I'll start with tier care.
Cerro more specifically.
In regards to kind of the payer discussions.
And ultimately trying to secure reimbursement could you maybe put a little bit of a finer point around roughly I guess, where you believe base case reimbursement.
We're a single procedure might be.
For it to be viable I guess your ASP.
On the Smart led is a good starting point, but maybe if you can just help us with how to think about.
When the reimbursement decisions come in what's a good outcome, that's a great outcome.
What you are targeting et cetera.
Yep.
Yes, Tom what I would say is at this point, it's really too early we are just now starting to think about engaging payers on that front and we need to have those conversations and do the appropriate health economics and outcome assessments to be able to that fair and reasonable reimbursement.
I would say that even with our current business. We believe that this is a viable business on the self pay.
Market that we've already been accessing in the controlled launch and we think that establishing fair reimbursement will only accelerate that patient access.
But we arent going to give specific ASP target today, because it's just too early for us to comment on that and provide anything.
Realistic.
Yes.
I'll just add one comment to that Tom.
Yeah.
The design of Sahara was deliberate we randomized against the market, leading dry eye prescription Rx, which is sold billions of dollars over the years.
<unk>.
And discussions with payers they naturally want to understand what they're paying for today, how it's working for the patients is it addressing.
Their patient signs and symptoms is it addressing the underlying cause of disease. We know that <unk> does all of these things exceptionally well and that prescription Rx can sometimes be prescribed to patients who.
Really are in need of an interventional procedure addressing the underlying disease, My Bill and me and Glenn So Theres a lot of economics at stake right now the design of Sahara to randomize against costly prescription Rx was deliberate and those prescriptions can cost.
<unk> of dollars per year to the system and to patients. So just you can rest assured on one thing that theres plenty of plenty of value here in terms of what the results look like for tier care the.
Nicole value the health economics value. So we're confident that.
Should we be successful in our payer coverage discussions.
There are.
There is a very attractive business model for all stakeholders good value for all stakeholders.
Got it that's helpful.
I compared it to.
The glaucoma side of the business, maybe a two parter first.
Quickly just on the Iris Iris registry data.
Can we expect to see the next tranche or I believe there were multiple analyses that were being explored.
Part one and then part two to this is just on competition in the U S.
Paul Ali or Tom.
Just your latest thoughts and observations more specifically are you seeing internet a little bit more in the fields.
And then maybe how would you compare this year's competitive landscape in 2023 to last year, where I think there were some challenges with new products.
Yes, Tom I'll take a couple of those first starting off with IRS. We're very excited about this data while we partnered with Veronica It's got a license to this iris real world evidence database Thats, a American Academy of <unk>.
The <unk> real world.
Outcomes database thousands of cases of of Migs real World. We did we did our.
Daters have presented this year at various conferences, one year outcomes, which are very exciting that show omnis very consistently effective.
And primary open angle glaucoma.
And.
We're really looking forward to the two year outcomes and getting those published.
Very very good results in terms of both IOP reduction as well as.
Medication reduction.
He is.
The data showed omni was numerically greater than all of them and reached statistical significance.
Across several of those arms. So we will be very very important data I think for the field of migs to see it will be submitted.
Fully very soon within hopefully within a month or so will be submitted to a very top journal and we would hope to see publication.
By the end of the year.
Yes.
Matt.
<unk> study just to be more specific it included.
<unk> cases, hundreds of omni cases.
Many many hydrous cases, many <unk> cases, and cataract alone cases in all of the Migs interventions omni hydrous and ice that were performed in combination with cataract surgery.
So that's that's IRS hopefully if all goes to plan, we could see a publication in a top tier journal by the end of the year or early 2024, Thats two year outcomes on both IOP reduction in medication reduction and it's very favorable to omni.
In terms of competition what are we seeing out there we are seeing some some.
Use of Standalone stance, frankly, we we welcome it standalone standalone market opportunity.
We've said many times it's.
It's a huge market opportunity there are many many patients who need earlier effective surgical interventions this market needs to be transformed away from <unk> and lasers, and then invasive surgery, just like the combo cataract Migs market has developed over the past decade.
The standalone early intervention market needs to develop it to heavy lift we've been doing a lot of that heavy lift on our own for the past several years, we welcome others, who can who can help in that lift as far as our position, we've been taking share and growing our business and the established migs market based on efficacy.
We have very high confidence that's why our surgeons and our customers are using omni in the standalone market based on that differentiated efficacy profile. So because we feel so confident that our surgeons love the clinical outcomes and rely on the clinical outcomes that they see with omni and a touch of sticky business. It's in our interest.
To have competition come in to the market and help develop the market and teach everybody. It's a very significant teaching exercised an education exercise.
To move from.
Standards of care of Medicine lasers.
While patients are progressing to earlier surgical interventions.
And then lastly in terms of the competition 2022 versus 2023, I think 2022 was was frankly noisier. There were a number of different products that were released that were new in terms of what.
What they did and it's harder to assess.
That market is those newer things we're being introduced I think this year 2023, while there's.
Introduction of Standalone Stenting, as an example, thats something thats a little more familiar it's been around for a long time, and it's something we understand and welcome.
Got it and then if maybe I can ask one follow up to that.
I wanted to ask about Dr trainings.
Facilities ordering.
On the mix side I don't think we've received those figures for maybe a couple of quarters now so Paul if you can just talk to.
With a doctor trainings.
And I guess sign as well looked like over the past couple of quarters, maybe has competition or have the LCD noise.
<unk> slowed that a bit.
Yeah, I'll take that one.
Yes, we haven't disclosed the specific numbers on surgeon training Q2 was also strong saw great growth on a year over year basis, and we're pleased with that and Thats, obviously, a portion of what's driving our growth in overall surgical glaucoma up 35% year over year.
But we think the more important metric is active ordering accounts and that is the number we do disclose that was up over.
Over 1100 versus $8 75 in the second quarter last year last year, so up 30% year over year.
In terms of impact associated with that.
Posed ltvs, we did have some sales rep time impact in June associated with the proposed LCD ease our staff spent time covering those changes.
And that did have a small impact on <unk>.
Surgeons trained and ordering accounts in the period.
But not a material one obviously, we still exceeded expectations for the quarter and we're happy with the overall growth rate in surgical glaucoma.
Perfect. Thanks, everyone.
Thanks.
Yeah.
Thank you.
I am showing no further questions at this time, so I would like to turn the conference back over to Paul for closing remarks.
Thank you all for your time and attention and interest in <unk> Sciences. We appreciate it. Thank you and have a great day.
Okay.
This.
Today's conference call. Thank you for participating you may now disconnect.
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