LENZ Therapeutics, Inc. (LENZ) Q4 2025 Earnings Report, Transcript and Summary

Good morning, ladies and gentlemen, and welcome to the LENZ Therapeutics Year-end 2025 Financial Results Conference Call. [Operator Instructions] As a reminder, this call is being recorded. At this time, I would like to turn the call over to Dan Chevallard, Chief Financial Officer. Please go ahead.

Thank you. Good morning, and thank you for joining us today. My name is Dan Chevallard, Chief Financial Officer of LENZ Therapeutics. We are joined today by Evert Schimmelpennink, our President and Chief Executive Officer; and Shawn Olsson, our Chief Commercial Officer; as well as Dr. Marc Odrich, Chief Medical Officer, who will join us for the question-and-answer session. Before we begin, I would like to remind you that this call will contain forward-looking statements regarding LENZ's future expectations, plans, prospects, corporate strategy, regulatory and commercial plans and expectations, cash runway projections and performance. Actual results may differ materially from those indicated by these forward-looking statements as a result of various important factors and risks, including those discussed in our filings with the SEC and which can also be found on our website. In addition, any forward-looking statements represent only our views as of the date of this webcast and should not be relied upon as representing our views as of any subsequent date. We specifically disclaim any obligations to update such statements. The company encourages you to consult the risk factors contained in our SEC filings for additional detail, including in our 2025 Form 10-K, which will be filed later today. With that, I will now turn the call over to Eef.

Thank you, Dan. Good morning, everyone, and thank you for joining us. We are now about 5 months into the launch of this. I would summarize where we are today in 3 simple observations. First, the product clearly works, something I know many of you are also hearing as you do your own bucket checks. Second, what we're seeing so far suggests the promising share of patients who buy the product tend to refill. And third, we are clearly building a new treatment category. And while new categories take time to develop, the signals we are seeing reinforce our confidence that this can become the blockbuster market opportunity we have always envisioned. At this early stage of the launch, our priority is putting the right foundations in place. This category can scale and adoption can accelerate over time. Importantly, we are executing this launch from a position of significant financial strength. We closed the fourth quarter with over $292 million in cash, which gives us the resources and flexibility to continue investing in building this category. Let me take you through each of these observations, starting with the product itself. Across the field, we continue to hear consistent feedback from both doctors and patients. The clinical performance we saw in our trials is translating directly into the real world. This works quickly with many patients noticing the effect within about 30 minutes and with the benefits of near vision typically lasting throughout the workday. Importantly, we're also seeing the same broad patient profile we observed in our clinical program. That breadth matters when you consider the scale of the opportunity. Presbyopia affects approximately 128 million people in the United States, and this is the first and importantly, the only once-daily eye drop capable of addressing such a broad segment of that population, which is what ultimately creates the opportunity for a large and durable category. From launch through the end of this quarter, we believe that we are on track to have sold over 45,000 boxes of this prescribed by more than 10,000 eye care professionals, creating a strong and rapidly expanding base of physicians adopting the product. In fact, the number of prescribing doctors we have seen at this stage of the launch already significantly exceeds what we observed with several recent eye care product launches. Importantly, we are seeing strong productivity within that base. As we look deeper into prescribing behavior, we're seeing a very encouraging pattern among our highest volume prescribers. When we normalize for the same script volume of around 45,000 scripts and compare prescribing frequency across top deciles of our ECPs, the data suggests that our top 1,000 prescribers are filling over 40% more scripts per doctor than what was observed at a comparable point in the VUITY launch. And based on the same data, we estimate that the total amount of prescribing doctors that took VUITY to get to this volume is approximately 2x . What this tells us is that once physicians understand how to integrate this into their practice, they are successful with it. We view this as an important signal because it suggests that the opportunity is not only to continue to bring more physicians into the category, but also to increase productivity across the broader ECP base as we learn from these top prescribers and use those insights as a blueprint to scale across the field. Equally important, we are seeing encouraging early signals around patient persistence. What we are seeing so far suggests that patients who try the product and choose to purchase it often continue using it, which is exactly the behavior we hope to see at this stage of the launch. Our sample strategy is a key part of this. By allowing patients to try the product first, we see a natural self-selection dynamic, but patients who experience the benefit and choose to purchase are more likely to continue using it. This does mean that the early new patient numbers developed differently compared to the launch of VUITY, where patients often had to purchase the product before trying it. That approach led to a faster initial ramp, but also a rapid drop-off as many patients did not continue therapy. Our approach is designed to build a more durable patient base from the start, even if that results in a more gradual early ramp in new patients. While the refill signals we're seeing are encouraging, the pace at which new patients are coming on to therapy is therefore developing more steadily, which is consistent with what we often see when an essentially new treatment category is being established. These are the typical dynamics you see when new categories are introduced and new prescribing habits are being developed. And importantly, they are very addressable through focused execution in the field, combined with effective consumer marketing. Let me discuss that some more. From our conversations in the field, there are 2 themes that emerge with ECPs as they build prescribing habits that will get this recommended to more patients more often. First, ECPs must learn how to best work this into their patient discussion and start from a place of unfamiliarity with respect to how to counsel patients on a presbyopia eye drop. Second, many physicians primarily think of this for early emerging presbyopes, patients who are just beginning to experience near vision challenges. The reality is much simpler. This can be introduced during a routine exam with a short 10-second discussion, and it works for a much broader patient population than only emerging presbyopes. Changing that mindset and helping physicians integrate the product naturally into their exam flow is a key focus for us. Based on what we've learned over these first months of launch, we are leaning in operationally to accelerate adoption. We've sharpened our physician messaging to address the 2 themes I just discussed. Specifically, our sales force is working closely with eye care professionals on how to naturally integrate this into the patient proposition and introduce the products during a routine exam by a simple, quick discussion. At the same time, we are reinforcing the breadth of the patient population. This works across a wide range of presbyopes, including contact lens wears, patients with prior LASIK, patients and not only the early emerging presbyopes. In addition, we are expanding our field presence to a total field organization of 117 reps. This expansion will allow us to increase call frequency with existing prescribers while also expanding the number of physicians we actively cover, enabling us to react to strong inbound interest from doctors who are not currently in our target panel, but who are already prescribing this because patients are asking about it or because they learned about the product through other channels. We are making this investment because we see a clear opportunity to accelerate adoption in the field, further integrating this into everyday clinical practice. Besides physician efforts, creating a new category also requires consumer awareness, and we are continuing to build the consumer side of the category. Many of you have complemented us on our direct-to-consumer campaign, which features Sarah Jessica Parker and asked when we expect to see that translate into prescription trends. As a reminder, we launched our DTC campaign in mid-January with February representing the first full month of activity. We are encouraged by the early signals we're seeing. The campaign is resonating with consumers and clearly driving engagement. Website traffic is now running roughly 5x higher than our baseline levels. And during national activations, we've seen spikes of up to 10x normal traffic. At the same time, consumer activation in a new category takes time. Across consumer-driven categories, people typically need to see it at 5 to 7x what they act on it. In our case, the journey from awareness to prescription naturally takes longer. The consumer first sees the advertisement, learns about the product, schedules an appointment with the eye care professional, receives a sample and only then transitions to purchasing a prescription. Pharmaceutical direct-to-consumer campaigns like ours, therefore, typically take at least 2 quarters to translate into prescription trends. What we are seeing today are encouraging early indicators of that process, and we would expect a more meaningful impact on script volume as we move into the second half of the year. In other words, the consumer awareness engine is now beginning to build momentum, while in parallel, we continue to focus on helping physicians integrate this more consistently into their patient discussions. With that, let me briefly summarize where I believe we are today. We have a product that clearly works and is delivering the real-world results we expected to see. We are seeing encouraging early signals around patient persistence, and we have already built a strong and rapidly growing foundation of prescribing physicians. At the same time, we're building a new treatment category, which naturally takes time. But as I've noted, the early signals we're seeing give us confidence that we are on the right path. With the operational actions we're taking in the field, expansion of our sales force and a growing consumer awareness driven by our direct-to-consumer campaign, both the physician and consumer adoption engines are now beginning to build momentum. And as prescriber habits build and consumer awareness grows, we expect to see an acceleration in new patient starts from that foundation. The opportunity in front of us remains exactly what we've always believed it to be, a large and underpenetrated market with 128 million presbyopes in the United States and a product that can meaningfully improve how patients manage their near vision. Our focus now is straightforward, continue executing, continue expanding adoption and continue building what we believe can become a blockbuster category. With that, I will now turn the call over to Shawn to give more insights into our commercial strategy.

Thank you, Eef, and good morning, everyone. As a quick reminder, presbyopia is the largest unmet vision condition in the United States. It affects approximately 128 million people, a population nearly 4x larger than those of dry eye. In fact, presbyopia affects more Americans than dry eye, demodex, childhood myopia, macular degeneration, diabetic retinopathy and glaucoma combined. This is uniquely positioned to address this opportunity and performing exactly where it matters. The product works and early persistent signals are encouraging. Because this is a new category of creation, as Eef noted, ramp in new patients is developing gradually as physicians are starting to build the habit of introducing an eye drop option during routine visits. We're focused on accelerating uptake by sharpening our physician messaging, expanding our sales force to increase reach and frequency and building consumer pull through DTC so that more patients are offered VIZZ in the exam room and more come in asking about VIZZ. I will unpack these details and insights across our key strategic pillars. Doctors recommend us and consumers request us by name. Focusing first on our eye care professional strategy. We are encouraged by the progress of doctors who recommend this. Just 5 months into launch, aided awareness is already at 98% and unaided awareness is already at 79%. As a reminder, unaided awareness means that dye doctor brought up VIZZ in the survey as an eye drop to treat presbyopia unsolicited. So both metrics are above our targets and demonstrating that ECPs are very aware of VIZZ. In the same survey, we're also seeing accuracy of key VIZZ messages resonating with ECPs as they're prompted to write in what they know about VIZZ. We see consistent answers such as pupil selective, different MOA, not pilocarpine . The results demonstrate that ECPs understand VIZZ well. Confidence in VIZZ is also clear as reflected by more than 14,000 ECP locations enrolled in our . And most importantly, we expect to have over 10,000 prescribing ECPs by the end of Q1, which exceeds what we observed with several recent eye care product launches, including MIEBO and XDEMVY at this stage of their launch. In addition to the broad ECP prescriber base, we're also seeing ECP confidence as over 55% of these doctors have written VIZZ multiple times. As we look at the first 5 months of launch, we're also gaining important insights that continue to reinforce our confidence in the opportunity for VIZZ. First, we're seeing that access to optometrists and ophthalmologists is not a meaningful barrier for VIZZ, as evidenced by our consistent execution of our field team, which continues to deliver approximately 7 calls per day. Secondly, our sampling strategy is working. We see that most patients are able to obtain a sample. And when they do, it helps identify those who like the product, which in turn has supported encouraging refill rates. In terms of prescriber mix, it remains about 80% optometry and 20% ophthalmology with our expected top prescribers performing as anticipated. As Eef stated earlier, once these ECPs have integrated this into the practice, they're successful with it as data suggests, our top 1,000 ECPs are filling over 40% more scripts per doctor than what was observed at a comparable point with VUITY. Interestingly, we're also seeing adoption broaden across lower decile writers, which is an encouraging sign for the depth of the opportunity. Particularly notable is the growing number of eye care professionals writing VIZZ multiple times who never wrote VUITY. We view that as an important proof point. It suggests that VIZZ is not simply capturing prior prescribers in this category, but it's expanding physician engagement with the prescription presbyopia opportunity more broadly. And finally, while others enter this market, their limited success means this remains a true category build effort. We're working to build new prescribing habits and overcome legacy prescriptions from prior products. And our market research confirms there is still an opportunity to further educate ECPs that VIZZ is not just for early presbyopes and how to more routinely integrate VIZZ's discussions into the standard eye exam. Based on what we've learned in these initial months, we've already begun to implement clear steps to accelerate adoption. We're expanding -- we're excited to expand our field organization from 88 representatives to 117 representatives, as I noted earlier, which will allow the in-field organization to cover a broader set of ECPs who are already prescribing VIZZ and increase call frequency with eye care professionals. This expands the outside field team's reach to approximately 15,000 ECPs. We believe that added reach and frequency are important to supporting behavior change needed to build the category and integrate VIZZ as a routine part of the presbyopia discussion. We've already begun recruiting the expanded field and expect to be fully onboarded in Q2. At the same time, the field is focusing on the messages that matter most to bring up VIZZ more often, including the broader inclusion criteria from our clinical studies, which included moderate advanced presbyopia and strong success that we're seeing in the moderate advanced presbyopes as well as practical tools to make offering VIZZ to patients a simple and seamless addition to the office visit. Moving to our consumer strategy of driving patients to request VIZZ by name. We're encouraged by the early momentum we're seeing. Since launch and through the end of March, we expect to have sold more than 45,000 monthly packs of VIZZ. And importantly, this is proving to be a product that works for patients and is generating encouraging refill behavior. We are already seeing patients come back for refills, transition from 1-month to 3-month prescriptions and in many cases, start directly with a 3-month order, which reinforces our view on the benefit of the product that the most important near-term driver of growth is focusing on increasing NRxs. To support that, in addition to our work we just discussed with ECPs to bring VIZZ into the conversation more often, we've recently launched our direct-to-consumer campaign and have seen strong early uptake that I'll outline shortly. Our spokesperson, Sarah Jessica Parker, is resonating well with VIZZ consumers and our advertising is now running across a broad mix of high-impact media, including YouTube, Instagram, TikTok, ESPN, Paramount+, Uber, Pinterest and other platforms, helping us reach consumers where they spend their time and driving not only sustained increase in web visits, but up to a 10x increase in visits to vizz.com. We've also begun activating influencers across a diverse set of audiences from well-known reality personalities to recognizable voices in sports media and iconic actors who are now the Presbyopic age. In addition, we're seeing strong pickup across broad media platforms, including Good Morning America, New York Live, The New York Times and Late Night TV. As we look at what we are learning from our early consumer launch efforts, our consumer mix today is approximately 60% female and 40% male, with the majority of users between the ages of 45 and 65, which is consistent with the audience we target and expect it to reach. As we highlighted earlier, it typically takes a couple of quarters to see DTC take hold, and we're encouraged by the early performance indicators of our advertising, where click-through rates and cost per impressions are exceeding relevant benchmarks. For example, our early lift in brand awareness from YouTube is performing 2x above benchmark, and we're seeing similar lifts across both men and women demographics. Just as importantly, these campaigns are giving us useful insights into how our various creative assets perform across women and audiences, including which visuals, messages and executions are resonating the most strongly with consumers. Even with our early encouraging DTC metrics, we're actively optimizing our creative ads and media placement to maximize impact. We're increasing investment allocation behind the higher-performing media placements while reducing the allocation to lower-performing media, allowing us to concentrate resources where we are seeing the strongest response. We're also introducing new permutations of creators into the mix, which bring up the everyday frustration with reading glasses, which we believe is an important point of recognition as consumers consider VIZZ. Starting in April, we will pilot linear TV commercials in select markets across our top states to test patient response. Linear advertising is your traditional TV commercials on your common network stations like ABC, NBC and cable through typical providers like Comcast. Together, these actions will continue to optimize our media mix, ad messaging and build additional consumer demand for VIZZ. We're encouraged by the progress we've made. We are seeing broad physician adoption, growing commercial demand and encouraging early repeat behavior and the first signs that our consumer campaign is beginning to activate that market. We continue to believe this is a category of one. As the only approved presbyopia eye drop with up to 10 hours of duration, this offers a differentiated profile that we believe is well aligned with the need of both consumers and eye care professionals as demonstrated by the ECP adoption and encouraging patient persistence. I'd now like to hand the call over to Dan Chevallard, our CFO, to step through our financial results.

Thank you, Shawn. As both Dave and Shawn have outlined, the fourth quarter and recent period of launch has been a tremendous time for LENZ as we have proudly introduced this into the U.S. marketplace, representing a novel solution for the treatment of presbyopia with the 128 million Americans frustrated with their near vision. As has been highlighted, this is a true market build and one that we're doing from a position of financial strength. This morning, I'd like to focus my remarks into 3 sections. First, summarizing our 2025 financial results, and discuss our outlook on 2026 capital allocation, and I will conclude by highlighting the significant progress made on the global expansion of VIZZ through our international partnership strategy. First, and as has been mentioned, we continue in the launch of VIZZ from a position of financial strength, ending 2025 with approximately $292.3 million in cash, cash equivalents and marketable securities. We remain debt-free and ended 2025 with approximately 31.3 million shares of common stock outstanding. Our Q4 results were highlighted by net product revenues of approximately $1.6 million in our first quarter of product launch with over 20,000 monthly paid and filled prescriptions. As you will recall, we launched VIZZ with availability through 2 consumer channels. The first, our e-pharmacy receives prescriptions from the ECP, processes individual orders and ships product directly to the consumer's home. We recognize revenue when our product is delivered to the consumer. Our second channel, the more traditional retail pharmacy is a channel supplied by our network of wholesalers. As is typical through this channel, we recognize revenue when shipments of VIZZ are received by the wholesaler, not upon delivery to the patient. Turning now to our operating expenses. We have discussed in previous quarters our planned ramp in spend as we move into launch, specifically driven by our commercial strategy. Our total Q4 operating expenses was approximately $40 million, including $4 million of noncash stock-based compensation expense compared to $31.4 million in Q3 of 2025. Importantly, net cash burn in the fourth quarter was approximately $32 million. Cost of goods sold in the fourth quarter totaled $400,000 and was primarily driven by indirect product costs associated with nonrecurring manufacturing processes. Going forward, we anticipate this to trend to an approximately 9% direct product gross margin. Total SG&A expenses increased to $39.6 million in Q4 2025 or approximately $35.9 million net of noncash stock-based compensation compared to $9.4 million for the same period in 2024, driven almost entirely by the establishment of our sales force and launch of VIZZ, including a significant nonrecurring investment in Q4 to enable the launch of our DTC campaign in early Q1 of 2026. Sequentially, quarter-over-quarter, SG&A increased by approximately 43% from $27.6 million in the third quarter. In recent quarters, we have discussed the importance of capital allocation at LENZ and the significant weighting of our SG&A spend towards sales and marketing to support VIZZ. In Q4, approximately 80% of our SG&A was driven by sales and marketing, with the remaining representing general and administrative expenses. This is a trend that we expect to continue. Total research and development expenses decreased to 0 in Q4 2025 compared to $5.9 million in the same period last year. Sequentially, R&D expenses decreased quarter-over-quarter by 100% from $3.8 million in the third quarter. This reduction was anticipated and was primarily a result of the conclusion of our positive Phase III CLARITY study and subsequent approval of VIZZ in July. Finally, our net loss per share, both basic and diluted, was $1.16 per share in the fourth quarter of 2025 on a net loss of $35.9 million compared to a net loss per share of $0.46 in the fourth quarter of 2024 on a net loss of $12.7 million. As we look ahead to 2026, I wanted to highlight a few points to help further characterize our P&L. First, on the revenue front, and after our first quarter of sales, we noted a better-than-anticipated blended gross to net ratio of approximately 90% or $67 per monthly package of VIZZ. Additional non-gross to net costs of the respective distribution channels have consistently resulted in a net cash per unit of $60 per monthly package with the difference flowing into our SG&A line. This net cash per unit of $60 is consistent with our long-standing expectations. Our Q4 2025 cash burn was substantially in line with our go-forward quarterly expectations over 2026. The recently initiated sales force expansion was in our 2026 operating plan. We will continue to target an allocation of approximately 75% to 80% of our OpEx to sales and marketing with an aim to maintain reasonably flat G&A spend period-over-period. R&D spend now becomes a de minimis line item on the P&L. The last point I'd like to highlight is an update on our recent progress advancing the global expansion of VIZZ through our international partnership strategy. We've seen significant progress across the globe in recent months and now anticipate potential approvals in multiple geographies in early 2027. Breaking that down, as we initially announced in Q3 of last year, the NDA review in China is now well underway. In May 2025, we executed a commercialization agreement with Lotus Pharmaceutical and are happy to report that of the 8 country license in Southeast Asia, we have NDA submitted and under review in 3 countries, including South Korea, Thailand and Singapore. As announced in early March, we recently submitted our central marketing authorization application to the European Medicines Agency for approval in Europe with our submission to the Medicines and Healthcare Products Regulatory Agency or MHRA in the U.K. to follow. Théa, our commercial partner in Canada, continues to make progress towards their submission to Health Canada and significant regulatory activities are already underway with Lunatus, our commercial partner for the recently signed 9 country distribution agreement in the Middle East region. In total, 5 ex U.S. NDA or equivalent submissions have been completed, and we anticipate over 10 to be completed by the end of this year with multiple potential approvals possible in 2027. In summary, we feel confident about where we are both financially and strategically, and the team is well positioned to execute and advance VIZZ on the back of a strong balance sheet with a broad strategic network of partners making regulatory advancements globally. With that, I'll turn the call back over to Eef.

Thanks, Dan. To conclude, I'm incredibly proud of the LENZ team and the progress we are making in these early months of launch. We're seeing what we hope to see, a product that clearly works, encouraging early signals of patient persistance and a growing base of prescribing physicians. We are now focused on accelerating new patient adoption through disciplined execution in the field and continued investment behind the category. We believe we are in the early stages of building what can become a significant and durable market. As we continue to execute and prescribing habits built and consumer awareness grows, we expect to see an acceleration in new patient starts from this foundation. We look forward to updating you on our continued progress in the quarters ahead. With that, I'd like to open up the call for questions.

[Operator Instructions] your first question comes from Stacy Ku with TD Cowen.

We really appreciate all the detailed commentary on the VIZZ launch so far. We have a couple of questions. So first, maybe further discuss that sampling dynamic to NRx and the retention that you're seeing, how is refill, let's say, high level tracking to your internal expectations so far? So that's the first question. And then second, as you're trying to broaden patient demand, maybe talk a little bit more about the investments and where you think they can help with the friction points that you listed. Do you believe that select television advertising plans will also take about 2 quarters to lift prescriptions? We're asking because from what we remember, our consultants told us that VUITY ads were everywhere. Of course, the prescribers were not necessarily prepared to set expectations on VUITY's efficacy profile, which has been your focus, but just help us understand that dynamic. And maybe a reminder on the size of the VUITY sales force as you're expanding your sales force as well. And then the third question is on the prescriber additions. If you're willing to comment, what percentage are from your initial target group versus the imbalance from patient demand? And are you seeing a certain practice profile where the prescriber becomes a repeat?

Thanks, Stacy. Appreciate your questions. Let me start off with the NRx and refill dynamic and give a little bit more color, and then Shawn will talk about the DTC and ECP question. So we feel very good about where we are actively, as I've mentioned, accelerating adoption. If you look at the strong foundation that we've built with the over 10,000 prescribing ECPs and more than 45,000 boxes sold, we believe that that's a great start. And what matters most early is to see that the product works, as I've mentioned, that we see that patients who choose the purchase continue to use it, and we're seeing both. So new patient starts are developing as expected for a new category that takes a little time, like I mentioned. We're actively working to continue to accelerate that as per plan. So significantly or specifically, we're expanding our sales force, like I mentioned, we're adding 29 reps to drive both breadth and frequency. And Shawn will probably talk about that a little bit more as he answers your ECP question because that allows us to increase coverage of physicians that are already showing interest, but also increases how often we engage with those existing prescribers. And along that, as I mentioned, we'll continue to build the consumer demand through DTC, and that ties into your second part of the question, I think. So as we now pivot into the refills, we know that this is a refill-driven category and early signals are encouraging. We're seeing patients come back and reorder. If we now look at that cohort of patients that got that first order in Q4 or the first quarter of our launch, we're seeing them come back and reorder. We're seeing patients move from initially a 1-month pack now to a 3-month pack, suggesting that they are committed and they're liking the product. We're also seeing patients that are new to the product now actually starting initially on multi-month supplies. So in our mind, that tells us that they had a chance to sample the product, the sampling strategy works. They self select and they like the product enough to start off with treatment. So all of that, we feel is very consistent with the product that's delivering for patients. And it's still early. So we want to make sure that we see this dynamic develops over multiple quarters. But again, the patterns that we're seeing so far are aligned with what we would expect. So with that, let me switch over to Shawn to talk about DTC and ECP.

Thanks, Eef. Thanks for the questions. When we look at broadening the patient demand and where we're focusing our investments to help, our primary focus has always been digital advertising to hit the patients where they are. So we know what these patients look like, and we knew that prior to launch, right? We knew that they make over $100,000 a year. They're mostly between 45 and 65. They're in major city centers. And that digital marketing is working. What we look at every single day is what's our click-through rates of different ads, what's our cost per impressions of not only different ads but different media placements. So inside that digital aspect, it's really a lot of optimizing, right? Do we actually see more benefit when we're putting the assets on YouTube versus when we put them on Instagram and how that translates to visits to our website. So that's a lot of optimization. The influencer standpoint, same thing. We look at the influencers post and we say, okay, we saw the post by Heather Dubrow and she got 650,000 views. What does that look like and what does it translate? So a lot of that is optimizing. With the addition of linear, what we're also seeing is there are select markets where the patients are early adopters. And therefore, as we continue to evolve and optimize that media mix, it's a good opportunity to bring linear TV in those select markets and test that response and we continue to optimize to get that broader adoption. You are correct. When VUITY launched, they're putting a big substantial media plan out there. We're being much more focused with targeting each individual that we want to drive in versus driving a shotgun approach of telling all 125 million people about it to make sure we have an efficient campaign. You also brought the sales force size. Looking into more and more about the VUITY launch, it appears they had a sales force of roughly 300 people specifically focused on VUITY. So therefore, our expansion from 88 to 116 (sic) [ 117 ] also makes sense, but it's also a more rationally sized sales force. So jumping into that, which was the second part of your question on the target groups of ECPs and where are they sitting. So our field, the outside portion of the field was focused before on about 12,000 eye care professionals that covered decile 4 through 10 of VUITY, 10 being the highest prescribers. And we continue to see that today. Our decile 10 doctors are our highest prescribers as well. And we have the inside sales team covering the lower deciles. The growth from targeting 12,000 to 15,000 ECPs at the outside field is because we were seeing those lower decile ones prescribing repeatedly as well as a good portion that we actually called in our analysis NA. These are doctors that have never written VUITY. So we have doctors that never wrote VUITY that are now wanting to write VIZZ. And so a good way to think about it is our target initial group from outside sales was 12,000 ECPs, and we've now grown that to 15,000 ECPs because of those deciles that were not targets. Now when we do that, we're growing not only the number of targets, but when we expand this field from 88 to 117, what you're also seeing is the ECPs per rep is getting smaller. So we can get in that doctor office more often and really work with them to make sure they can get to that 10-second conversation to bring it up to every patient and understand that they can offer this to more patients, not the early presbyopes. So hopefully, that answers your question, Stacy.

Your next question comes from the line of Yigal Nochomovitz with Citigroup.

Just a few questions here. I'm wondering if you could spend a little more time talking about these top 1,000 writers in terms of their behavior and how they approach the conversation with the patient, their knowledge of the product. I know you mentioned that many of the ECPs that are familiar with VIZZ believed apparently erroneously that it was only for the early presbyopes and not for the other categories you mentioned, Shawn, like the contact lens wearers, the ones with prior LASIK and the pseudophakic. So I'm just curious how that crept into the message that some people apparently didn't understand that it was for a much, much broader set. And how are you planning to help correct that perception and then discuss the behavior of these top writers that seem to get it and have gotten it from the very beginning. So that was my first question.

Thanks, Yigal. Great question. Shawn and I will tag team on that a little bit. So just to double-click on the stats that I shared. So very encouraging for us to see those 2 things that I have shared. One is that it's only taking us about half of the amount of prescribing doctors to get to the same script volume that VUITY got to at 45,000. So I think what that tells us is that doctors are enthusiastic. They like working with a drug, and they especially like working with a drug that's efficacious. And if you in that group, like look at the top 1,000, you see that they're actually writing 40% more. So those are the doctors that wrote the most for VUITY, they're writing even more for us. And your question on what makes them different. Again, I'll hand over to Shawn shortly, is really around they figured out how to, one, bring this up consistently and easily and quickly and offer it as an alternative option to their patients, setting the right expectations around what to expect from an eye drug and then realizing that, as you've mentioned as well, this is truly something that they can offer to pretty much every eligible presbyope in the practice. So I think that's what makes them different. And we're obviously trying to follow it up and share that with all the other doctors out there already prescribing and all the new ones that we're tapping into. So with that, I'll hand it over for Shawn to give some even more color on that.

Yes, absolutely. And thanks, Yigal, for the question. So Eef hit on a lot of the key points, but jumping in a little bit deeper. So our top 1,000 prescribers, again, they're tied to those higher decile accounts. So these are doctors that are more comfortable implementing new technologies, historically are also higher prescribers. But this is something that they're more used to doing in general on a day-to-day basis. What we're seeing is they follow that standard process, which we always continue message, make sure you give the patient a sample and a script, right? Allow all the patients to try it and then give them the script as well. And as they've said, they offer up as an option to more patients. They've figured out how to do the 10-second pitch, how to offer it and set the right expectations. In terms of your questions on the understanding of the broader use, why are some still thinking only about the early presbyope, this is really an effect of the previous product on the market, which really was tested in a younger population and the efficacy really only worked in that very early emerging presbyope. Therefore, people naturally go there. It is taking work to make sure people understand that we really did show just as much success in moderate advanced presbyopia. And then we show them the graphs to actually show those that have worse presbyopia gain more lines. And that's a process to understand that this product truly does work for that full scope of presbyopes.

Okay. Awesome. And then this is really quick. Just maybe for maybe Shawn also. This is just more of an operational question. You mentioned doing the TV ads. I think that wasn't in the original blueprint. I'm sure it was one of your scenarios. But I assume this doesn't mean that your emphasis and investment in terms of targeting the regional influencers, one layer below the SJPs that, that's still in place as it was with the initial plan. And then also, are you able to track -- I know Eef mentioned the conversion to -- the uptick in the web traffic when you have various campaigns that are delivered to the market. Are you able to track the conversion rates there? And are you seeing higher conversion to Rxs as a result of these waves of coming to the website?

Great question, Yigal. So first, talking about the TV ads. So our strategy remains the same on primarily focused on digital ads and the influencers. So we never plan to do broad national linear TV campaigns. However, what we're seeing is there are key markets that are prescribing a lot more often than others. And so this is a perfect opportunity to drop linear advertising on network TV and cable in those targeted markets in a responsible, financially responsible way to see what type of response we see. So that's the opportunity that's now provided itself with linear TV. So think of these as key markets, we test the response. And in testing those response, you need exactly what you just brought up. How does that translate to then visits to the web and then does that then translate to actual scripts later on. And that's exactly what we're continuing to look at every day. So we can see when we actually run different ads in different markets, how that then responds to web traffic. I think we're early on in DTC, so we don't have a pure correlation from the web traffic to then a script later on. There isn't a connection there, but it's something that we'll continue to look at for correlation to make sure we continue to further optimize those DTC ads.

Your next question comes from the line of Marc Goodman with Leerink Partners.

This is Alyssa on for Marc. So you previously had highlighted 3 different patient categories as the foundation of the advertising strategy. Could you update us on which of those segments are driving the early adoption today? And then secondly, I might have missed this, but on the distribution, can you clarify whether prescriptions are being fulfilled entirely through the e-pharmacy channel or if retail is now kind of contributing to that? And how is the mix between those 2, if so?

Great. Thanks for the question. So if you think back to our strategy in terms of early adopters, we want to focus on those that are in contacts. We want to focus those that have had post refractive surgery and what we call the active lifestyle. So we commissioned a survey of patients that have recently received the product. And what we're seeing is those targets are right. When we actually look at the data, we're seeing about half of the patients on this have worn contacts. About 1/3 of them have had LASIK in the past and that about 1/4 of them have had BOTOX in the past 12 months. Now that quarter number is a little bit biased because we have an equal split of men and women, about 60% female, 40% male in terms of our prescriptions. And BOTOX does tend to be about 90% women, 10% men. So that would lift up that percentage overall. But we feel good about our targets that we're focused on there. And then in terms of the mix of retail as well as the pharmacy, both meaningful channels, we have not broken out or shared that mix yet.

Your next question comes from the line of Biren Amin with Piper Sandler.

For Q1, can you maybe tell us what the split is between the 1-month pack and the 3-month pack? My second question is, I think previously, you had estimated 5 refills per year. In your early adopters, do you feel that, that still would align with your annual refill projections? And then third question is, can you talk about how many of the samples in Q4 converted to scripts in Q1? I think that would be a good barometer of patient experience.

Thanks, Biren. Great questions. And obviously, we all know that ultimately, these statistics are going to be very important to track the progress of the launch. We're also remaining with what we said before that refill -- actual refill percentages is something that we really start to look at in the second half of the year and start to communicate that. But what we do see at the moment on your various questions is that, like I mentioned earlier, that 3-pack is important in the market, and we're seeing that move. Again, this is early days. So like for many of the statistics and the parameters that we've spoken about, we really want to see a couple of quarters and see how this clearly develops before we feel that it's a reasonable number that we can start to share. Same goes for refills. Like I mentioned earlier, we're encouraged by what we're seeing. We also need to remind ourselves that the cohort that we currently can follow is the one from Q4 of last year. So our first 3 months of being in the market with this, the first consumers have a chance to buy this product. And that's probably a mix between initially when we just started to bring samples out, consumers that bought the product without having sampled and later in the quarter, that now most of the people will have had a chance to sample. So on top of that, you see that somebody bought a 3-pack, for example, in December, which is clearly happening, you wouldn't expect that person to come back until maybe late Q1 or even into Q2. So that means that the numbers that we're seeing now, we're really looking at them more as a barometer than the actual number. But clearly, like we shared, what we're seeing is encouraging us, and we feel that we have a product that does live up to what we want to see, a product that people like, that once they order it, they are sticky and they continue to buy it.

Your next question comes from the line of Jason Gerberry with Bank of America.

This is Melanie on for Jason. First, can you share any more details about indicators that are most encouraging regarding the DTC program that can spur growth? And secondly, anything you can share about key thresholds you're looking to see in NRx and refills in the second quarter?

Thanks, Melanie. I appreciate it. So in terms of the DTC program, when we think of our DTC, what we're really looking to see is are we driving consumer activation, right? And so in terms of this stage of a DTC program, where we're still fairly early on, the easiest items to look at that we're looking for, for indicators are, are we driving awareness? And are we driving increases in web traffic? And are we doing it at a responsible financial spend. So the indicators we continue to look at are, are we increasing people that are going to website? Not only are we seeing a sustained increase in website visitors, we're seeing up to a 10x increase in web visitors depending on what we're running. That's very good. When I look across the metrics of our DTC, I'm looking at what are we paying per 1,000 impressions, what are we paying per click. Again, what we're seeing right now with our ads, we're testing well. We're actually doing better than benchmarks for click-through rates as well as spend per impression. So that's looking positive. And then what we're continuing to look at is as we talk to the patients, serving them, did they see an ad, did that drive come in? And so those are all the metrics that we're continuing to look at.

The second question was around key thresholds that we're looking for as we enter into the second quarter. But I think just looking back to what I shared earlier, there's 2 elements that we're focusing on and that Shawn just highlighted as well, activating the doctors to bring it up to more patients more often. Obviously, that's something that's ongoing. And then really starting to see that DTC play out. Those things all take a little bit of time, which is why we've said that the DTC, this is not only for us, but in general, any Nielsen report that you pick up will show you that it takes at least 2 quarters to really see that translate into DTC. I think early indicators that Shawn talked about that we're seeing are very positive. And similarly, with the expansion of the sales force happening in Q2, we would expect that to take a little bit of time for that to take effect. But we really are expecting more of a step change in acceleration of new patients as both of these mechanisms fully take a hold closer to the second half of the year.

Your next question comes from the line of Lachlan Hanbury-Brown with William Blair.

I guess the first, I'd be curious what you're finding in terms of how often or how many samples doctors giving out. Are you finding the reps when they go back the fridge is empty or they still have some? Do they have to go back earlier? Just I've spoken to a few docs that tend not to give the samples, they prefer to write a script. So kind of curious to see what you're seeing on the sampling and the volume front there. And then maybe a second one on the prescribers. Curious what you're seeing in terms of the time it takes for them to go from a single prescription to become a repeat prescriber? Is it -- there's a cohort of doctors that basically immediately prescribe it to multiple people and then others that prescribe one and takes much longer? Or is there a trend you're seeing there?

Thanks, Lachlan. Good questions. Let me start off with the sampling and then double-click a little bit more on the sampling strategy and the conversion and how we think about that. So sampling in our case is really designed to bring the right patients into the therapy. So it's a central part of our strategy as we've highlighted early on because the product has such an immediate and observable effect. So we want to get samples out there, and that's how what we focused on to get as many samples as needed to as many offices as possible to make sure that those patients can really experience the product first and then self-select into the therapy. And we're seeing that, that's working. We believe that currently, probably more than 90% of people that start with this or new patients have had a sample first. So again, that strategy is working. What's also important is to understand how the sampling works. So the samples are dispensed, as you've mentioned, directly by physicians. So once our reps leave the samples with the doctor, there's no way for us to track individual samples and how they're being handed out to patients and how many are being handed out. But what we do see is that most of the doctors now are handing them out. But you are right that there's a group of doctors that just prefers to write a script directly. We'll continue to work with them to actually start to change that habit as well. So we actually don't really look at conversion as a key metric at this point. Samples for us are very cost effective and it's really a way to get as many people as we can to try the product, make sure they like it and then they self-select in. Like I said earlier, that this will lead to indeed a much more sticky patient population. I think your second question was around prescribing dynamics. What we see is that, as you would expect at this stage, there's a mix like Shawn highlighted, there's a great amount of doctors that are already doing what we would like them to do, provide a sample together with a script. There's also a group of doctors that wants to sample first and have the patient call back. If they like it, they write a script, the doctors that, to your point, write a script immediately put out a sample. So all the different flavors that you can think of are currently out there. And that's the focus of us now to take that blueprint of doctors that we know are very successful with the product, that high percentages of the patients converting and start to apply that or keep that to the rest of the doctor cohorts.

Your next question comes from the line of Matthew Caufield with H.C. Wainwright.

Can you speak more to the nuances you're seeing in terms of that initial refill patients? Like, for instance, have the refills been predominantly those early presbyopes so far?

Yes, great question. So when we look at the consumer, just given a little bit more detail. So when we dig into it and look at those people that are adopting the fastest, and we're seeing the refills come through. Again, what we're seeing when we break it down, it's 60% women, 40% men. Predominantly that 55- to 64-year-old, there are certain states that we see perform better than others. And when we dig into them, they are our target patients that are doing it. It is, as I stated earlier, half of those patients have worn contacts in the past. About 1/3 of them have had LASIK. And I said 1/4 of them have had BOTOX. But again, that's a bit biased by the mix of male, female. So we are right on that core target. We're hitting the right patients that want to use it. I think the most important thing is they get the sample and try it because that self-selection is so important. And that's what really drives that repeat behavior is getting them to self-select in, try the product, know it's for them and then continue to use it. So I think that's the important nuance to focus on.

That concludes our question-and-answer session. As I'm showing no further questions, thank you for your participation, and we will now conclude today's conference call. You may now disconnect.