David Bruce
Analyst · Stifel. Your line is now open
Thanks, Jim. Prior to the onset of COVID-19, we saw a very encouraging momentum in the first couple of months of 2020 as the U.S. rollout of our revised MP3 probe expanded the interest of glaucoma physicians and our non-incisional MicroPulse laser therapy. As we noted in our Q4 earnings call in early March, interest at the American Glaucoma Society meeting doubled versus last year's meeting. Previously, dormant customers were reengaging with us attracted to the improvements embodied in the revised probe and we had surpassed the 50% conversion of sites in the U.S. and we're well on our way to reaching our goal of completion by mid-year. It's important to keep in mind that glaucoma is a progressive disease without a cure whose treatment paradigm requires a sequence of increasingly invasive approaches to slow the rate of disease progression. Therefore, the glaucoma procedures deferred because of COVID-driven restrictions still need to be performed and within an acceptable timeframe before incremental permanent damage could occur to patients' vision. The interest in our non-incisional glaucoma therapy that effectively lowers IOP and extends the runway before patients need more complex incision-based surgeries remains intact despite the limits on current procedure volume and patient visit. Given this dynamic, we are confident in our intermediate and longer-term growth potential remaining very promising. Late in Q1, measures began to be implemented to stop the spread of COVID-19 such as mandated shelter-in-place orders, recommendations for non-COVID patients to avoid hospitals, recommendations by the medical societies and governments to defer all non-urgent procedures and most ophthalmology offices closing and staffing furloughed or reduced to minimal activity for only urgent patient visits and procedures. This resulted in our physician customers experiencing significant short-term limitations to conducting procedures and they also made decisions to defer capital equipment purchases in the second half of March that persisted through April. In fact in our outreach to existing G6 accounts during this period, approximately 25% were closed and the remainder were solely treating emergency cases. IRIDEX has also taken steps to mitigate the impact of COVID-19 to our business operations and limit risk for our customer's, employees. We made adjustments to our business methods to remain in close contact with our customers employing more digital and virtual meetings and selectively visiting customers who were accessible and needed in order to continue to drive forward the momentum we achieved in the beginning of this year. We are located in the San Francisco Bay Area and as such followed the recommendations from county government and health care agencies, in mid-March IRIDEX quickly transitioned almost all employees to a remote work environment. A small number of our team continues to support essential operations at our facilities after we instituted social distancing and other recommended measures to ensure their safety. We'll continue to follow local and national guidelines to determine the appropriate time to resume in-office functions. Our sales organization has largely shifted to virtual sales activity and encouragingly has been able to continue strong engagement with customers. While not a replacement for global industry conferences, face-to-face meetings and on-site clinical training, we have effectively shifted to a broad virtual program, hosting a number of widely attended sales events and maintained continuity with key accounts as closely as possible. One opportunity of the clinic and surgicenter closures is that physicians and staff are more available to engage with us. We've conducted over a dozen grand rounds in clinical training with eight to 15 physicians engaging in these virtual sessions, many more than we could typically engage at one-time when their clinical and surgical schedules were full. As we speak today near the midpoint of the second quarter, we see two phases of activity within the quarter. In the first half there was widespread shutdown; and in the second half, we expect to see staged reopening. In the shutdown environment, only urgent procedures were performed in our transscleral laser therapy was a desirable choice for patients with high intraocular pressure that urgently needed treatment. Early in April, we conducted a webinar discussing treatment choices and the role of IRIDEX procedures as a tool for that environment. We attracted over 300 registrants, 150 attendees and hundreds of follow-on viewings that demonstrated to us position interest in exploring the solution. Customers are telling us they were selecting our therapy for those urgent procedures, because the short procedure time and non-incisional effective IOP reduction was a solution that minimized exposure risk and especially important required only minimum patient follow-up. The reopening phase is starting now. Surveys show 30% to 50% of surgery centers plan to reopen in May and many of the rest plan to reopen in June. And in a recent survey of ophthalmologists nearly half indicated they anticipated rescheduling patient cases before the end of second quarter. But our customers are also telling us to expect initially to be operating under reduced capacity to allow extended time for safe patient management and equipment cleaning. Some are estimating capacity at 50% initially and grown to 75% over a couple of months. In this environment, we're encouraged to hear our customers saying the simplicity of our procedure and minimal patient follow-up are highly valued. So, while we've been promoting these value elements all along to drive adoption of extended non-incisional runway for progressing glaucoma patients, the importance and attractiveness has increased in this COVID environment. We are engaged and ready to support our customers in the new environment by conducting remote proctoring for cases, web-based physician certification and educational seminars supporting customers and prospective customers. For example, in the U.S. we've conducted more than 60 virtual physician trainings often with multi-doctor participation, including large groups at several major top-tier teaching institutions. We are encouraged by the engagement with our customers and progress that's achievable through these methods. Our international sales in glaucoma are primarily through premier distributors around the world. Our plans were to roll out the revised version of our MP3 probe internationally, but had to be adjusted in the restricted COVID world. In April, we conducted a worldwide virtual training for distributors with over 240 attendees, which was a record online meeting for us. We followed that up with direct virtual detailed training with individual country distributors, staff and key opinion leaders in that country. Again, we're encouraged with the engagement and focus indicating the intermediate and longer-term potential remains very strong. In the U.S., we're getting updates from our field team and are monitoring the news and market reports to determine the actual return of elective surgeries state-by-state and are encouraged by our strong presence in many states that are easing restrictions or plan to use such restrictions in the near term. In regions outside the U.S., procedure recovery is progressing at various rates with Asia Pacific leading; the European Union showing limited recovery is starting, but still uncertain capacity or pace of opening; and Latin America and other regions are still evolving. Therefore, at this stage, there are simply too many variables to quantitatively predict procedure volumes, which type of procedures will be prioritized and in which markets. Summarizing glaucoma, for all the reasons I've discussed, we believe IRIDEX is well positioned to recover and grow our volume as various regions of the U.S. and worldwide begin to expand patient visits and procedure volumes. Our team is eager to move forward where it's safe and appropriate to do so, to support our customers and continue expanding the role for effective, durable, non-incisional glaucoma procedures. Turning to our retina business. Our comprehensive medical and surgical platform continues to hold a leadership position in the treatment of a broad range of retinal diseases, however, that market remains competitive and price-sensitive. Customers are also experiencing significant economic impacts from the deferral of procedure revenue, so we expect but can't yet quantify their shift in appetite for capital purchases. Some deferrals are clear, because of the shutdown periods at offices and surgery centers, and we experienced that at the end of the first quarter. How laser system purchase volume recovers and to what degree short-term and longer-term is still uncertain. However, it's important to note that a significant portion of sales in a mature segment, like our retina and surgical laser systems, is replacement of old or failing equipment and tends to be more resilient. We expect that business to reflect the overall economic recovery of the practices. An additional important segment of our retina business is disposable surgical EndoProbes. That is likely to follow a similar recovery for ophthalmic surgeries as we've discussed for our glaucoma probes. In 2019, the combination of retina EndoProbes and glaucoma probes made up about half our overall revenue, and we're well positioned in both procedures for volume recovery to drive sales recovery. However, so much variability in how recovery progresses makes forecasting difficult. What we control is our efforts to support and promote the benefits we deliver to which our team is fully committed. With regards to our product development projects, we reported to you in March that our development and manufacturing partner for new laser systems in Wuhan, China, had experienced shutdowns and project delays as the Chinese government acted to restrict transmission of COVID-19. They came back online in mid-March about the time IRIDEX became subject to shelter-in-place orders and began to work remotely. However, we are effectively working closely and making good progress toward a goal to achieve product launches later this year. As we reported in March, we remain confident that we have a stable supply chain to meet projected demand and the operational efficiencies and capital resources to support our business during this period. We believe normalcy will eventually return as the world works through the COVID-19 outbreak and we will accelerate our initiatives to drive demand for our glaucoma therapy. We are optimistic we have newfound recognition in the glaucoma community for the enhanced role of our non-incisional effective and durable lowering of intraocular pressure that requires minimal patient follow-up. We continue to see the opportunity for significantly increasing our share of the treatment for the millions of moderate to severe glaucoma patients worldwide. With that, I'd like to turn the call over to the operator for questions. Operator?