RxSight Guidance Update Earnings Call Transcript

Quartr
Provided by Quartr
July 8, 2025

Key Takeaways

  • Negative Sentiment: Preliminary Q2 revenue was $33.6 M, down 4% year-over-year, driven by a 49% drop in LDD sales and softer LAL procedures, prompting a full-year guidance cut to $120–130 M.
  • Positive Sentiment: Management is implementing a commercial pivot focused on enhanced clinical support, education, data-driven analytics and peer-to-peer programs to boost LAL utilization and practice commitment.
  • Positive Sentiment: Full-year gross margin guidance rose to 72–74% from 71–73%, reflecting a shift toward higher-margin LAL sales in the revenue mix.
  • Neutral Sentiment: The company ended Q2 with a robust cash position of approximately $227.5 M in cash, cash equivalents and short-term investments.
  • Neutral Sentiment: RxSight secured new regulatory approvals and partnerships in international markets including Singapore, Korea, the EU and UK to support global LAL adoption.
AI Generated. May Contain Errors.
Earnings Conference Call
RxSight Guidance Update
00:00 / 00:00

There are 13 speakers on the call.

Operator

Thank you for standing by. My name is Eric, and I will be your conference operator today. At this time, I would like to welcome everyone to the RxSight Q2 Preannounced Earnings Call. All lines have been placed on mute to prevent any background noise. After the speakers' remarks, there will be a question and answer session.

Operator

I would now like to turn the call over to Oliver Muravchowicz, Vice President of Investor Relations. Please go ahead.

Speaker 1

Thank you, operator. Presenting today are RX Site President and Chief Executive Officer, Doctor. Ron Kurtz and Chief Financial Officer, Shelly Tunin. Earlier today, RX Site released select preliminary financial results for the three months ending 06/30/2025 and revise full year guidance. A copy of the press release is available on the company's website.

Speaker 1

Before we begin, I would like to inform you that comments and responses questions during today's call reflect management views as of today, 07/08/2025, and will include forward looking and opinion statements, including predictions, estimates, plans, expectations and other information. Actual results may differ materially from those expressed or implied as a result of certain risks and uncertainties. These risks and uncertainties are more fully described in our press release issued today and in our filings with the Securities and Exchange Commission or SEC. Our SEC filings can be found on our website or the SEC's website. Investors are cautioned not to place undue reliance on forward looking statements, and we disclaim any obligation to update or revise these forward looking statements, except as may be required by law.

Speaker 1

During today's call, we will also discuss certain non GAAP financial measures. I would like also to remind you that the preliminary results discussed on today's call are estimates and that our complete unaudited financial results for the second quarter of twenty twenty five, which are subject to the review of our independent auditor, are expected to be announced on Thursday, 08/07/2025. Please note that this conference call will be available for audio replay on our Investor Relations website. With that, I will turn the call over to our President and Chief Executive Officer, Doctor. Ron Kurtz.

Speaker 2

Good afternoon, and thank you for joining underperformance resulted from a sharp decline in LDD sales and continued softer than expected LAL procedures. Press Although longer capital equipment acquisition cycles may have contributed to the observed drop in LDD sales, which typically occur late in the quarter, we believe the underlying cause for both results is the slower ramp in LAL utilization that was first noted in 2024 following a period of rapid growth in our installed base and which is the focus of our ongoing response. Since committed users are key both to making strong recommendations to patients as well as to convincing new practices to adopt the LAL, we are executing a commercial pivot to reverse the observed utilization trends by ensuring that every new and existing LAL practice is not only well trained, but fully prepared and supported for lasting success. To accomplish this realignment, we are intensifying our focus on clinical support, education and value added engagement efforts, leveraging our unique analytics to drive sustainable same store sales and new customer commitment. While we navigate these near term headwinds, we remain steadfast in our own commitment to our clinical partners as they deliver the high quality customized visual benefits of adjustability that ultimately drive further LAL adoption.

Speaker 2

Before I discuss more about our shift in commercial strategy, I'll ask Shelly to provide additional details on our Q2 underperformance and revisions to 2025 guidance.

Speaker 3

Thank you, Ron. I will review our preliminary second quarter revenue results and updated guidance for the remainder of 2025 that were included in our preannouncement press release. Our preliminary second quarter twenty twenty five revenue was $33,600,000 down 4% compared to the year ago period and down sequentially 11% from our first quarter twenty twenty five revenue. As Ron already outlined, the sharp revenue decline in the second quarter was primarily driven by a significant drop in LDD sales coupled with softer LAL sales performance. During the second quarter, we sold 40 LDDs, down 49% from the year ago period and down 45% from the first quarter of twenty twenty five.

Speaker 3

We ended the second quarter with an installed base of ten eighty four units, up 34% compared to the second quarter of twenty twenty four and up 4% compared to the end of the first quarter of twenty twenty five. We sold 27,380 in the period, up 13% from the second quarter of twenty twenty four and down sequentially 1% compared to the first quarter of twenty twenty five. While we will provide a full financial report on August 7, based on the preliminary revenue results and the commercial pivot outlined by Ron, we are revising our full year 2025 guidance as follows: We are reducing revenue guidance from $160,000,000 to $175,000,000 to $120,000,000 to $130,000,000 now an expected decrease of 14% to 7% compared to 2024. While the majority of the revenue reduction reflects significantly lower expectations for LDD sales, we also anticipate the LAL trends to continue into the second half of twenty twenty five as the commercial shifts to drive procedure volume and our second in our installed base builds momentum. Our revised gross margin guidance range is now between 7274%, an increase compared to the previous guidance range of 71% to 73% and representing an applied year over year increase of 130 basis points to three thirty basis points.

Speaker 3

The increase in gross margin guidance is primarily due to the shift in revenue mix as the higher margin LAL sales will increase as a percentage of revenue with a reduction in LDV sales. We anticipate operating expenses to be down slightly from our previous guidance in April and now in the range of $145,000,000 to $155,000,000 representing an implied year over year increase of 7% to 14% compared to 2024. While we are mindful of managing operating expenses, we also want to ensure we make the required investments to grow LAL adoption. Included in our costs, primarily in operating expense, is noncash stock based compensation expense in the range of $27,000,000 to $30,000,000 We ended the second quarter of twenty twenty five with cash, cash equivalents and short term investments of approximately $227,500,000 compared to $229,300,000 on 03/31/2025. And with that, I'll turn the call back to Rob.

Speaker 2

Thank you, Shelly. We believe our return to growth depends on empowering our clinical partners to deliver the optimized visual outcomes enabled by our groundbreaking technology. By recentering our strategic focus, field support and commercial execution around customer success, we plan to reinvigorate the core value drivers that establish the LAL as the growth engine for the overall premium IOL market. As part of this shift, we will be implementing a more proactive data driven customer support model by analyzing utilization trends, adoption tiers, support requests and clinical outcomes data on a daily, weekly and monthly basis, we can deliver more targeted interventions through our clinical and commercial teams. This includes rapid escalations when needed and timely LDD level insights to maximize engagement during our field teams visits to customer practices.

Speaker 2

These initiatives are designed to close adoption gaps, enhance customer satisfaction and to support sustained utilization growth across our global base. We will also leverage the insights gained by our experienced clinical partners by expanding our peer to peer programs to support practices at every stage of the LAL adoption journey. Such exchanges not only raise the level of expertise and efficiency across our user base, but also serve as a powerful catalyst for deeper, more sustained engagement between doctors and RxSight. Taken together, along with our continued investments in key R and D programs, we believe this integrated approach will help more practices maximize their investment in the LAL and reignite the word-of-mouth momentum that has propelled adoption thus far. As we establish this customer success driven adoption model in North America, we plan to leverage a similar approach in our developing efforts in international markets.

Speaker 2

We believe that the expanding group of active surgeons in Korea, our latest regulatory approval in Singapore and new clinical partners in The EU and UK are important milestones that underscore the growing global recognition of the LAL as a transformative technology and personalized vision. We also recognize that translating the promise of adjustability into reaccelerated sustained growth will take continued focus over multiple quarters. However, with our deep reservoir of clinical and technical capabilities, a best in class field organization and a strong balance sheet, we are confident in RxSight's ability to execute on these strategic priorities to unlock the full potential of our platform and to deliver enduring value to patients, doctors and shareholders alike. And with that, I'll ask our operator to open the call for questions.

Operator

Your first question comes from the line of Ryan Zimmerman with BTIG. Please go ahead.

Speaker 4

Thanks. Can you hear me okay, Ron and Sally?

Speaker 3

Yes. Thank you.

Speaker 4

Okay, great. Ron, I can appreciate your comments about new customers taking longer to come up the curve. But that doesn't explain why the LED sales were soft as they were in the quarter. And I'm wondering if you can elaborate on what you think is driving that. I mean, I have my suspicions about competition from launching some new equipment.

Speaker 4

But maybe you can give us a little more color as to what drove the weakness, particularly in LDDs, given how big of a miss that was?

Speaker 2

Well, I would say that we generally believe that LDD sales are driven by the previous generation of successful LAL adopters. So it is critical for us going forward to reverse those utilization trends so that we can point to customers who continue to have success and excellent ROI with the LAL. And so I do think that the two are linked and that the adoption challenges that we've had over the last few quarters have been a primary underlying reason for the LDD stall. There are, as I mentioned, some potential quarterly specific things related to longer capital equipment acquisition times, and we tend to be very back end loaded. But again, if we focus on the areas that we can accelerate and impact LDD in the long run, we believe that is by accelerating LAL utilization.

Speaker 4

Okay. And just let's talk about guidance for a moment here. Why was guidance coming out of the last quarter, which was weak, kind of the right levels in your mind, Shelly? And now given another quarterly miss, why is the new guidance sufficiently derisked now? And obviously, it implies a massive decel in the back half of the year.

Speaker 4

But with the changes to your sales strategy, why should investors think that this is fully derisked?

Speaker 3

No, I understand your question. Thank you for that, Ryan. If we look at the low end of the guidance at $120,000,000 high end at 130,000,000 That puts the second half of the year somewhere between, at a low end, dollars 48,000,000 and a bit over $50,000,000 about $55,000,000 And so I think that what is embedded in that guidance is the reality that Ron talked about, that our newer customers are getting up to speed less quickly. Our older customers are flat and in the more recent cohorts down a bit. And that really does reduce LDD sales.

Speaker 3

So if we look at LDD sales, we don't expect them to be on a quarterly basis much higher than what we had in the second quarter. I think we'll get a few more international revenue units as we just got these approvals. But the substantial part of it is going to be The U. S, but certainly in The U. S, less than half of what we were expecting previously.

Speaker 3

And I think that as we looked at our funnel in the second quarter, it looked great all quarter up until the end when we didn't close. And as you know, most of what happens in the quarter happens right at the end. So that was a new phenomenon for us. So we're trying to, one, build that in and expect LDD sales to be relatively flat as compared to the second quarter, but certainly not back at the level of the first quarter. And then we expect pretty much the same trend in AL sales that the momentum that we need to create with our existing customers is going to take time and and time to reverse and get going with our newer customers.

Speaker 3

We do have the resources to do that. All of our clinical people are are very good. All of our trainers are very good. We'll continue with new marketing initiatives and new customer initiatives as we talked about, but we're not expecting a lot of increase on that LAL. So at this point in time, I think that we have moved our guidance to quite conservative, and I think that's the right thing for us to do at this point as we, make this shift to commercial strategy.

Speaker 3

Would you add anything to that, Ron?

Speaker 2

No, I would agree. It's better to be to take a conservative approach given the current situation and obviously we're going to try to outperform that.

Operator

Thank you. Your next question comes from the line of Larry Biegelsen with Wells Fargo. Please go ahead.

Speaker 5

Good afternoon. Thanks for taking the question. Ron or Shelly, so LAL utilization was down about 21% year over year in Q2. The guidance implies utilization is down significantly in the second half. Can you please explain what you think is driving the decline in utilization?

Speaker 5

In other words, what's wrong? Just kind of tell us what you think is going on here. And can you be more specific about how you will improve utilization? I obviously heard your comments earlier, Ram, but it sounded like, you know, sorry to say this, but more of what you I would have thought you were doing already. So just maybe just simplify it for us, what is driving such a significant decline in utilization and what you're doing to improve it?

Speaker 5

And I have one follow-up.

Speaker 2

Yes. I think, Larry, thank you for the question, that we have what we've noted and what we've commented on is that our newer customers are adopting more slowly than our previous customers. And that the realization that those customers require more support to get started and to move up the adoption curve is what has changed over the last few quarters. And so those efforts that I talked about are more extensive than what we needed to do or felt we needed to do previously. And so we're moving into a cohort that is we believe is going to be highly successful with the technology.

Speaker 2

They generally like the technology, but is for a number of reasons requires more time and support. And that's what we're focused on delivering to them.

Speaker 5

And how do you do that by reducing OpEx guidance this year? Like what changes are you making operationally? And the guidance came down a little bit on OpEx, operating expenses. So how are you augmenting those things that you mentioned and reducing expenses at the same time?

Speaker 3

That's a good question, Larry. And while we're mindful of that, we do have You know, we have about 200 people in our commercial organization already. We can certainly deploy those as well. And we just looked across the entire company and said what things have the most value add. We've had a number of initiatives in, you know, sales and marketing for a while to make things more automated, and that allows us to do a little bit more with less.

Speaker 3

But we're also making sure that we're clear that we want to manage our expenses very carefully with the rest of the organization. So they're down a bit, but not substantially so.

Speaker 5

Just one more for me. Yes, please, Rob.

Speaker 2

Yes, I would just add that with the significant drop in new LDDs, the resources required to onboard those can be redirected to the current and other new customers. So we have significant resources that we can call upon through this refocus.

Speaker 5

It's just one more for me. I don't I'm not sure we can expect an answer today, but the guidance implies almost a 30% year over year decline in sales. You've talked about it taking time to fix the business. How do we think about your ability to grow the business beyond 2025? Obviously, I mean, can you grow in 2026?

Speaker 5

How are you thinking about growth beyond 2025? Obviously, it's important to investors, you know that. I don't expect specific guidance, but any color would be helpful. Thank you.

Speaker 3

Yes, I think that's a good question. And obviously, the first component of that is working this year to increase the guidance that we have for LAL sales and boost those for not only newer customers as well as, you know, customers who have been in place longer that we don't think have reached their full potential in terms of the amount of procedures they can do. That in turn helps us with LDD sales in that the more successful people see their peers be, the more likely they are to invest. You know, I'm not going to blame it on, you know, external factors, but, you know, there is a bit of turmoil right now, and I think people are standing still until that gets resolved as well. But I think most of it is us.

Speaker 3

And while it will be a small part of our business, even through 2026, we have international opportunity as well. And I think some of the new markets that we just got approval for are really good markets for us, Korea, UK and EU in particular.

Speaker 2

Right. Yes,

Speaker 5

Larry, I would just

Speaker 2

reiterate the long term benefits of our technology for the cataract surgeon. We provide the best clinical outcomes, outcomes that can be customized to individuals. They have a strong financial incentive to adopt our technology. We have obviously moved into a group that is going to take a little bit more effort on our part here in The U. S, but that's not unexpected.

Speaker 2

And we've already started to develop and role model the programs that we think address the new requirements as we move forward in the adoption curve.

Speaker 5

All right. Thank you.

Operator

Your next question comes from the line of Steve Lichtman with Oppenheimer and Co. Please go ahead.

Speaker 6

Thank you. Hi guys. Obviously as discussed the LDD mix is the primary focus, but wondering if you can comment relative to utilization on some of the things you discussed last quarter including trialing from competitor products as well as sort of the macro environment impact on utilization. What's sort of the latest update on those factors?

Speaker 2

Yes. I think that our utilization was down, but our overall LAL numbers were flat. And that again largely reflects that newer customers are not have not gone up in their adoption curve as quickly as they have historically. So while those external factors are could still very well be in play, we're going to have to wait and see for some of the other manufacturers in the area in the field to announce their results to really know what the overall market is doing.

Speaker 6

Okay. And then just a follow-up clarification on the LDD commentary. I guess one, Shelly, you mentioned the funnel look good through the quarter, it didn't materialize. Obviously, you're not assuming based on the guidance that those fall into 3Q and beyond. But can you talk a little bit more about what happened sort of at the end there in terms of that funnel?

Speaker 6

And then also your comment about sequentially the number being on absolute basis largely in line, maybe slightly up versus 2Q, but then you also said less than half of what you were expecting before, which I think for the full year it was a little over 300,000,000 So can you just square exactly what you're assuming in terms of LDD placement? Thanks.

Speaker 3

Yes, that's a good question. I didn't mean less than half of what we had in 2024, but certainly, you know, less than half of what we internally expected in the second half of this year. Right? So

Speaker 6

Okay.

Speaker 3

You know, 40, you know, in the quarter was, you know, not less than half, but certainly quite a bit lower than our internal expectations for the second quarter and going forward. So that's good clarification. Thank you very much. And I think that what we saw in the quarter is generally, you know, we have about a six month, you know, robust funnel. We tend to look at the quarter.

Speaker 3

We look at the quarter, you know, at what we think is going to close in the quarter, you know, highly probable to maybe, you know, a Hail Mary. But the funnel itself in absolute numbers looked very similar to the way it normally does at the beginning of the quarter and remained that way. Usually the funnel does not go down. It might go up a little bit during the quarter, but it doesn't go down. And we really sell a lot in the last half of the third month.

Speaker 3

And that's possible for us because our installs only take about four hours and people buy when they're ready. And what happened is that we just did not get those sales that we expected at the end of the quarter and we're not expecting that they'll just come roaring back in the third quarter. We think the dynamics that are in place that delayed those sales will continue through the end of the year, hopefully get a little better, but definitely continue until we can get our existing customers, particularly the newer customers back on a really good growth trajectory in terms of the number of LALs they're using, an absolute number and number of LALs per LDD because that's what potential customers look to is how are my peers doing, how quickly do I think I can pay back the LDD. And they're aware of the incremental revenue of about $2,000 per eye that they get with the LAL, primarily because 40% to forty five percent of patients come to people who would not otherwise have gotten a premium IOL. But nonetheless, they feel like they need to, you know, clear that hurdle of number of LALs.

Speaker 3

And I think that LDD sales in The U. S. Will not reignite until we can get our existing customers proving to new customers that they're going to grow as quickly as previous cohorts had. Would you add

Speaker 6

anything Okay, thank you. Thanks. I'll jump back in queue.

Operator

Your next question comes from the line of David Saxon with Needham. Please go ahead.

Speaker 7

Great. Yes. Thanks, Ron and Charlie. Thanks for taking my question. So I wanted to start on just some comments, Ron, you made about newer accounts adopting slower and needing more support.

Speaker 7

So how much of that slower ramp is due to the profile of these more recent accounts versus any dynamics from like macro or competition? And then does that dynamic change how you think about where we are in terms of penetration in The U. S? And then I just have one follow-up.

Speaker 2

Again, I think that each individual practice is different and so it's hard to make generalizations. But will I generally, I think the practices that we're going into now do require a little bit more support and that can come in different forms. And so we have it might be marketing support, it might be clinical support, it might be other types organizational support. So we need to take it practice by practice and develop a toolkit for this next group of adopters. I think that there's plenty of we're still at an early stage of penetration, but we're seeing that in this environment, we need to do a little bit more than we have in the past in order to move people up the adoption curve.

Speaker 2

And I think we will do that.

Speaker 7

Okay, great. And then just one on utilization. Of there's been some focus on newer account utilization, but wanted to talk about the mature accounts. Like what are you seeing across those cohorts in terms of utilization? Is it holding steady?

Speaker 7

Or are you seeing those accounts kind of decline in terms of utilization? Thanks so much.

Speaker 3

Yes. I think that, you know, they have declined as well, you know, and a lot of those, you know, in the first quarter attributed to, you know, things you were getting at, macroeconomics, uncertainty and trialing. But they have continued to go down. Now the thing that's interesting is the older the cohort, the flatter it is. So our oldest cohort is pretty flat, you know, going back four quarters.

Speaker 3

And then each of the cohorts by year go down just ever so slightly more than the one before. But I think the real distinction because, you know, all of those cohorts have been, you know, pretty tight in terms of the number of LALs per LDD between each cohort. It's really the 24 cohort as we talked about last quarter, it has been much lower than the previous cohort of 23 in terms of how quickly they get up the adoption curve. And I think that that's the most telling of the trends as well. And so that's kind of how the cohorts have come out first and second quarter of this year.

Speaker 7

Great. Thank you.

Operator

The next question comes from the line of Adam Mader with Piper Sandler. Please go ahead.

Speaker 8

Ali, thank you for taking the questions. Two for me, and I'll ask them upfront. First, I guess, wanted to better understand the message on competition and trialing as it relates to your Q2 results. Do you think you saw much of an impact last quarter from J and J Odyssey, the B and L relaunch, PanOptix II or not so much? And as we think about the guidance, the revised guidance, the 120 to $130,000,000 maybe just to the extent you can help us understand kind of what's contemplated for competitive impact in the back half as well as kind of what's assumed from a macroeconomic standpoint?

Speaker 8

Thank you.

Speaker 2

Yes. So I think that what we said in the past is that when it's sort of traditional with multifocal lenses that when a new one comes out, there's a lot of incentives associated with launching that product. And over the last year, we had multiple products launched sequentially, which was highly unusual. And that the last phase of that really was last quarter with the launch of PanOptix Pro by Alkyne. Although we would anticipate and things what others have said is that typically they've been more restrained in terms of incentivization and rollout tends to be more gradual.

Speaker 2

But all of those players are now have competitive products in the multifocal space. They're very active. And they are clearly marketing against the LAL, which has been the fastest growing premium IOL for the last four years. So we're discounting the impact of competition, but we feel that we have a differentiated product. Most of that competition is going to be directed against each other, the other multifocal IOLs.

Speaker 2

And I think that's what you've seen in the market share moves. But it does we get about a third of our patients from the multifocal lens group. And so it does have some impact on us.

Speaker 3

Yes. And certainly, as we talk about the factors that Ron just outlined, in our guidance, we assume that and we have assumed that some of the competitive trialing, particularly those things around pricing, should come to an end, you know, sometime in the third quarter and end in the fourth quarter. And that, as Ron said, has some effect on us, but certainly not the largest effect on us. They're really competing against each other. And then in terms of the macro environment, since about mid last year, us and the largest competitors were talking about the fact that the overall cataract market in The U.

Speaker 3

S. Was flat. And premium IOLs, other than us, actually remained flat and decreased over the last couple of years. We've been all the growth in the marketplace. I'm so sorry.

Speaker 3

And so I think that the trends that made that happen, you know, will play out both ourselves and the largest players did say, you know, during the, you know, first quarter that we would expect that those things would lift in the second half. And perhaps they still will, but we're still, you know, focused on the fact that our revenue will be less than we originally projected primarily because of LDD sales, but that we would not get the lift that we initially expected in the second half on LAL sales since the flatness has continued in the second quarter and the first quarter.

Speaker 8

Thank you for the fulsome response. Appreciate it.

Operator

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

Speaker 9

Thanks. I think I just had one question at this point. And it's kind of just on, if you're hearing anything from physicians on why kind of the demand just isn't there, right? I understand that you're really maybe you're too focused on adding on newer accounts, but have you been getting kind of any feedback from physicians? Is there any kind of shortcoming or kind of detail on LALs or LDDs that you need to really push that is kind of currently leading physicians not to adopt LALs even after they've purchased the LDD?

Speaker 9

Do they have any concerns of the system?

Speaker 2

Yes. I think that our existing customers, especially the ones who've adopted the technology and used it extensively are remain highly favorable. And even doctors who have adopted the technology to a lesser extent are generally extremely favorable about the clinical results. There are a number of reasons why a practice or why a doctor may not adopt it as the majority or at a high level in their practice. And that is really the focus of our renewed commercial effort to systematically identify those reasons.

Speaker 2

Is it how the LAL is being presented to patients? Is it the way that it's the marketing materials or lack of marketing materials? Are there workflow issues in clinic? There are just a number of factors that we can address with our teams, our field teams. And we believe that we can impact those.

Speaker 2

And that's based on the fact that we have impacted those in a number of sites where we've had trial programs, especially over the last quarter or two. And so our focus over the next couple of quarters for sure is going to be on expanding those and driving LAL adoption in those practices.

Operator

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

Speaker 10

Hey, good afternoon guys. So I wanted to ask a question and it's really a follow-up on some of the other questions that have been asked. But if you look at your LALs sold for the first two quarters, they were in that $27,000 range, a little bit higher. And then I think the implied guide would have it down on an actual number, LAL sold basis, pretty substantially. So it seems like there's a little bit more of a something else beyond a utilization dilution from some of the newer accounts that you're placing.

Speaker 10

I appreciate some of that's probably the market. But I guess I'm just trying to understand the expectation. It seems like some existing accounts are going to be doing a lot less or selling a lot less LALs than they were previously. So I'm just trying to reconcile some of the comments and maybe parse out the LAL sold the actual LAL sold versus the utilization comments?

Speaker 3

Yes. No, I think that it's a good question. And I think at this point in time, we look at the entire business and our guidance, we think it's more prudent to be conservative and particularly as we go into the third quarter not knowing what seasonality is going to look like. So I think that that's really generating our commentary and our guidance LALs as well as LDDs.

Speaker 10

Got it. And then one follow-up, Ron, on some of the accounts where you've enacted these new programs. I mean any sense for have you seen incremental increases in utilization in those accounts that you've started some of these new programs in?

Speaker 2

Yes, we have. And that's what gives us confidence that moving forward, we can move the needle at a larger number of accounts with more focus on these efforts.

Speaker 10

Okay. Thanks for taking the questions.

Operator

Your next question comes from the line of Danielle Antalffy with UBS. Please go ahead.

Speaker 11

Thanks so much for taking the question. Really, a lot of the questions have been asked, but just wanted to follow-up on the penetration point that was made. And I guess, Ron, now this is the second quarter in a row of weaker than expected sales. Do you guys feel differently about how you've been thinking about peak penetration? And I'll ask my follow-up now because it's kind of tied to that.

Speaker 11

I mean, has the profile like have the characteristics of the physicians that are adopting now that are ramping more slowly, has their patient profile changed? Has their profile changed in a meaningful way that maybe these just aren't stocks that would be high adopters of a premium priced technology? So those stories go together, but one peels the onion back a little bit more. I'll leave it at that.

Speaker 2

Yes. I don't think that there's a substantial difference in the patient population or the potential for premium in the practices that we're now going into. But there are they have different requirements and we have to adapt and this is something that we've done multiple times. We have to adapt our approach to that next group of adopting practices and surgeons. And we're in the process of doing that.

Speaker 2

It also is coupled with advancements in the technology, which also appeal to that next group. So I don't see this as being reflective of a ceiling. It's more of a transition to that next group, which is something that we would expect as we continue to move up the adoption cycle.

Speaker 3

Thank you.

Operator

Your next question comes from the line of Tom Steffen with Stifel. Please go ahead.

Speaker 12

Hey guys, thanks for taking the questions. Ron, I wanted to ask about just outcomes you're seeing in the field with LAL, at least in our checks over the last handful of months, really the last three to four months, we've been hearing a bit more about unsatisfied patients and maybe that doctor sentiment seemingly is shifting a bit negative. So can you just discuss a bit outcomes in the field, what you're seeing patient satisfaction, etcetera?

Speaker 2

Yes, happy to Tom. So we have been collecting Phase four clinical data since we launched the product. And we primarily collect that from new accounts and new customers as they come on. And we don't see any change. The results are extremely excellent outcomes.

Speaker 2

They mirror almost identically our FDA, most recent FDA outcomes. So I don't see a significant change in overall outcomes. Of course, we're doing a lot more procedures. And so even a small percentage of unhappy patients is going to be a larger number than it was when we were doing a fewer number of procedures. And that's something that we look at as a learning opportunity, and it's a learning opportunity for our customers as we invest as we look into those cases, and we typically find a reason or an opportunity for improvement with those customers.

Speaker 2

So that's one of the things that we'll be focusing on. It's not a major point, but it is it's something that by expanding our clinical support programs, we can go into more detail with customers when they need it.

Speaker 12

Got it, really helpful. And then second question just on LDDs. Ron, you've talked about kind of adapting the selling approach with sort of the next group of potential surgeons. As we think about LDDs and system placements, are there any kind of refined thoughts on the selling approach for placing systems in The U. S?

Speaker 12

Thanks.

Speaker 2

At this time, I think it's still the basic premise that by adopting the LAL, practices can offer a differentiated high quality vision product for their patients. And they can use it on a large variety of patients. That is the core benefit of the technology. And because they are converting generally more patients, about forty percent to forty five percent of patients from patients who would otherwise have gotten a monofocal IOL without an additional payment to the practice, they are realizing a higher return on their investment. Now what we've run into is that as the adoption pace within those practices has taken longer, that ROI has also taken longer.

Speaker 2

So hence our focus on accelerating that so that we can continue to point to the successes that we've had with that immediately preceding group.

Speaker 12

Great. Thanks again.

Operator

I'll now turn the call over to Ron Kurtz for closing remarks. Please go ahead.

Speaker 2

Well, you, operator, and thank you all again for your interest in RX Sight. We look forward to providing further updates on our regularly scheduled second quarter twenty twenty five conference call in early August. Thank

Speaker 1

you again and good night.

Operator

Ladies and gentlemen, this concludes today's call. Thank you all for joining and you may now disconnect.

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