LENSAR Q4 2025 Earnings Call - Merger Terminated, ALLY Validated, Company Reboots as Standalone
Summary
LENSAR closed 2025 with clear scars and a usable blueprint. The planned Alcon acquisition was terminated after FTC resistance, but management frames the process as a market validation for the ALLY robotic cataract laser. Despite transaction drag, LENSAR grew procedures, expanded installed base, and kept recurring revenue momentum, while taking back a $10 million deposit and negotiating material concessions and deferrals on acquisition-related bills.
The next phase is pragmatic and incremental. Management expects a multi-quarter restart, driven by distributor reengagement outside the U.S., accelerated system placements, and higher utilization on an installed base of roughly 200 ALLY systems. Cost discipline remains a headline priority, with guidance of no more than a 10% rise in cash-based operating expenses for 2026, and a forecasted gross margin band of 46% to 49% for fiscal 2026 as tariffs and inflationary pressure ease.
Key Takeaways
- Acquisition with Alcon was terminated after the FTC signaled it would seek to enjoin the merger, the decision described as mutual and pragmatic.
- Management argues the Alcon process validated the ALLY Robotic Cataract Laser System as superior to first-generation femto lasers, reinforcing product value.
- LENSAR received the $10 million transaction deposit from escrow, and reported cash at December 31 of $18 million which will be cleared of the $10 million deposit liability in Q1 2026.
- Total revenue in Q4 2025 was $16.0 million, a 4% decline year-over-year, driven primarily by weaker system sales outside the U.S.
- Full year 2025 revenue rose approximately 9% versus 2024, with recurring revenue up 15% to $46.3 million at year-end, and Q4 recurring revenue of $12.7 million, annualizing to over $50 million.
- Procedure volume remained a growth engine, up about 20% in Q4 and 22% for the full year, surpassing 206,000 procedures globally in 2025.
- Installed base: ~200 ALLY systems at year-end (up ~48% year-over-year) and ~435 combined Ally and LLS systems (up ~13% year-over-year); backlog stood at 13 systems awaiting installation.
- ALLY system performance metrics: US procedure market share rose from 14% to 23.4% since launch, LENSAR systems perform on average 27% more procedures annually than the national laser average, and management cites ~600 procedures per ALLY unit per year in the U.S. on average.
- Q4 placed 15 ALLY systems, but non-U.S. placements collapsed to 1 in Q4 2025 versus 10 in Q4 2024, reflecting distributor pause during the acquisition period.
- Acquisition-related costs totaled $17.1 million in 2025, with $14 million unpaid at year-end; advisors conceded ~$4.3 million of unpaid balances and $5.0 million of remaining liability deferred until May 2027.
- Gross margin: Q4 2025 gross margin was 43% versus 42% in Q4 2024; full year gross margin fell to 46% from 48% in 2024 due to inflation and tariffs which LENSAR did not pass through to customers; management expects 46% to 49% for fiscal 2026.
- Adjusted EBITDA was positive for 2025, with Q4 adjusted EBITDA of $595,000, indicating operating cash flow positive operations excluding working capital impacts.
- SG&A in Q4 rose 51% year-over-year to $10.3 million, driven by roughly $3.5 million of merger-related costs; total operating expenses rose 41% to $11.9 million in Q4.
- Management guidance and priorities: accelerate revenue via system placements and utilization, maintain strict cost discipline, and enhance cash flow, with a stated plan for cash-based operating expenses to increase no more than 10% in 2026 (excluding merger items) and most incremental spend directed to commercial activities.
- Distributor outlook: recent distributor conversations were constructive but conservative, management expects multi-quarter reengagement internationally with material recovery likely into 2027, and potential expansion into additional markets such as Australia, New Zealand, parts of Europe, Southeast Asia, and Latin America.
- Competitive positioning: LENSAR emphasizes ALLY features including dual modality laser, machine learning-driven treatment planning, improved ergonomics and throughput, and strong astigmatism management as the reasons for replacement wins and growth in femto-naive adoption (about 50% of Q4 system placements).
Full Transcript
Josh, Operator/Moderator, Conference Call Operator: As a reminder, this conference call will be recorded. I would now like to turn the call over to Lee Roth, President of Burns McClellan, investor relations advisor to LENSAR. Mr. Roth, please go ahead.
Lee Roth, President, Burns McClellan (Investor Relations Advisor to LENSAR): Thanks, Josh. Once again, good morning, everyone, and welcome to the LENSAR fourth quarter and full year 2025 financial results and strategic update conference call. Earlier this morning, the company issued a press release providing an overview of its financial results for the fourth quarter of 2025. This release is available on the investor relations section of the company’s website at www.lensar.com. Joining me on the call today is Nick Curtis, Chief Executive Officer, and Tom Staub, Chief Financial Officer of LENSAR, who will provide an overview of recent developments, our go-forward strategy, and our Q4 financial results. Following these prepared remarks, we’ll turn the call back over to the operator to answer your questions.
Before we begin, I’d like to remind you all that today’s conference call will contain forward-looking statements, including statements regarding our future results, unaudited and forward-looking financial information, as well as information on the company’s future performance and/or achievements. These statements are subject to known and unknown risks or uncertainties, which may cause our actual results, performance, or achievements to be materially different from any future results or performance expressed or implied on this call. We caution you not to place any undue reliance on these forward-looking statements. For additional information, including a detailed discussion of the risk factors, please refer to our documents filed with the Securities and Exchange Commission, which can be accessed on the website. In addition, this call contains time-sensitive information accurate only as of the date of this live broadcast, March 31st, 2026.
LENSAR undertakes no obligation to revise or update any forward-looking statements to reflect events or circumstances after the date of this live call. With that said, it’s now my pleasure to turn the call over to Nick Curtis, Chief Executive Officer of LENSAR. Nick?
Nick Curtis, Chief Executive Officer, LENSAR: Thank you, Lee. Good morning, everyone. I appreciate you joining us today. It is no doubt an understatement to say 2025 was a unique and unprecedented year for LENSAR. We take great satisfaction knowing that the leading eye care company in the world, Alcon, publicly recognized the value of ALLY and LENSAR, given the joint acquisition announcement made in March of 2025. This validates our statement that ALLY is the best next-generation technology, delivering significant and relevant performance improvements in each of the critical elements of laser-assisted cataract surgery, including advanced ergonomics, efficiencies, imaging, and automated treatment planning with a dual modality laser. ALLY is the only system that employs machine learning and compute power during treatment planning and optimized treatment to deliver outcomes that are better than any first-generation competitor.
The termination of the acquisition agreement was a mutual pragmatic decision made after a year of focused effort and considerable expense from both sides. While this acquisition was approved overwhelmingly by our stockholders, ultimately, we made the decision to terminate because the Federal Trade Commission would seek to enjoin the merger. While both parties worked towards offering acceptable accommodation to allow it to close, it became clear the FTC was not open to changing their position. We were disappointed in the outcome. However, the upside of this process is the validation of the ALLY Robotic Cataract Laser System superiority compared to all other first-generation lasers available today, as well as the value attributed to LENSAR based on the success the product has achieved since its launch and its future potential.
Therefore, with new resolve and new purpose, we’re excited to emerge and reengage as an independent company, picking up where we left off 12 months ago. We’ve spent the last 2 weeks working on initiatives and jump-starting relationships with key stakeholders. I’ll briefly discuss the last 2 weeks and share our high-level go-forward strategy today. Relationships are important, and before I present our strategy, I would like to take a minute to thank our partner vendors, agents, and suppliers who not only provided excellent support and counsel, ultimately shared that disappointment and financial burden with us through granting reductions in fees as well as extended payment terms. These partnerships are beneficial to LENSAR in returning to our prior operating cadence, allocating more of our financial resources and attention to operations.
We can immediately start getting back to our business as usual and smooth return to focusing on growth and expanding our presence with increased installed base and procedures. We appreciate their collaboration and contribution to our future success. Additionally, in association with the termination of the acquisition, we received the $10 million transaction deposit that had been in escrow. In the last three quarters of 2025, we operated with an increasing degree of uncertainty among our partner customers, potential partner customers, and distributors regarding our future and the timing of the close of the acquisition. Despite the uncertainty that delayed U.S. customer decision-making on ALLY and LENSAR and halted OUS distributor activities and purchasing systems, we expanded the ALLY installed base by nearly 50% compared to year-end 2024, while achieving 20%+ year-over-year growth in procedure volume for both the fourth quarter and full year 2025.
There’s no question the last nine months of 2025 were negatively impacted by the acquisition process and extended timeline, and not just by the increased SG&A expenses associated with supporting the transaction. While our 2025 results include a 9% revenue growth, I need to be transparent and clear. We expect through the next several quarters of 2026, a gradual return to our historical operating performance. When you consider our longer-term growth metrics, the trajectory has been impressive. Our full year 2025 procedure volumes are up 50% compared to 2023, the first full year of Ally commercial availability. By reflecting on a longer-term vantage point, you get a much better picture of what we see as the future opportunity for LENSAR and Ally.
Since the launch in August of 2022, we grew our installed base to approximately 200 ALLY systems and grew our procedure volume, gaining market share from 14% procedure share in the U.S. to 23.4% as of the end of 2025. I wanna say we gained almost 9.5% of market share points in 3.5 years. These market share gains come from three specific areas. First, it comes from competitive accounts, replacing first-generation lasers with our ALLY Robotic Cataract Laser System accounts for the largest gain in share. Second, the gain in share is demonstrated by what happens after we replace a competitive system. LENSAR, on average, performs 27% more procedures annually than the national average per laser, providing evidence that we are growing the overall market for robotic laser cataract procedures.
Third, nearly 50% of our systems in Q4 2025 were from femto-naive surgeons, further expanding the market for laser-assisted cataract surgery. The data provides evidence LENSAR is addressing the shortcomings of the first generation laser-assisted cataract surgical lasers by delivering the most technologically advanced next generation robotic laser for cataract surgery in multiple ways, significantly improving efficiencies and patient throughput, allowing for more procedures with faster treatments and fewer staff interactions, leading to the potential for fewer mistakes, less anxiety, and a better overall patient experience. Second, customizing precise, specific, reproducible treatments optimized by utilizing features such as machine learning and surface anatomy recognition, imaging, and optimizing data for treatments by communicating with preoperative devices in the surgeon offices, leading to better outcomes in refractive cataract surgery using astigmatism management.
To put in perspective, our competitors have the ability to bundle more products using cataract procedures, more feet on the street, and much deeper financial human and operational resources. Despite this, we’ve been incredibly successful in increasingly growing ALLY’s market share. Why? LENSAR is a small, nimble, and resilient organization. We’re known for innovation that aligns with surgeons’ practices and patients’ objectives. LENSAR is and always will be a surgeon and practice-centric organization. We have extensive clinical evidence that is giving surgeons the confidence to make the decision to implement ALLY in their practice. Over the last three years, ALLY’s performance, placements, and procedure volume speaks for itself. All I can say as we start the second quarter of 2026, we expect to compete as we have in the past. Listen here, we’re back. I’d like to spend a few moments talking about our business outside the United States.
As a reminder, while LENSAR started commercializing ALLY in the U.S. in August of 2022, it wasn’t until two years later that we received the European certification and began to sell ALLY internationally. Looking at the timeline, ALLY had been on the market outside the United States for roughly seven months when the transaction was announced. The uncertainty over the post-acquisition ALLY distribution landscape had a greater impact on our outside United States distributors than our U.S. customers, and that uncertainty caused a meaningful slowdown in our international business expansion over the last year. With our distributors, the ALLY launch got off to a very successful start, quickly gaining acceptance with new sites and meaningful momentum, which came to a hard stop. After meeting with the distributors post-acquisition termination announcement, I believe we’ll begin to return to significant system growth in these international markets over time.
Most, if not all, the distributors were both happy and relieved with the termination of the merger. Although they have all indicated their enthusiasm and are ready to support the business going forward, their conservative immediate forecasts indicate this will take some time. We will work together on the transition timing to regain the lost momentum and begin to contribute to an increase in worldwide system and procedure market share. I’m confident in our ability to drive long-term success and create value for our surgeon partners in the United States, our distribution partners overseas, our global customers, the patients they serve, and our shareholders. We also continue to rely on our long-term existing physician partners and private equity groups as they are our partners in success. These partners recognize we are working hard to deliver and provide the most responsive service, support, and best product in the market.
Going forward, we’ll be focusing on a few key areas. Continuing to grow our procedure volumes and recurring revenue will be critical to our success. This will come through a combination of additional system placements and increased utilization on the 200 ALLY systems currently in the field. Our procedure revenue is recurring in nature. It is stable, it has a predictable trajectory following an install, and importantly, carries a significantly higher margin than system revenue. The acceleration of system growth discussed in my remarks will contribute to significant long-term growth in procedure volumes, which will further strengthen our recurring revenue base. An important statistic to consider here is system utilization rates, another area where we are well-positioned for success in driving overall market growth. Once again, LENSAR systems in the U.S. perform an average of 27% more procedures than the national annual average of lasers currently installed.
There is not another robotic femtosecond laser available in the marketplace. We’re excited to speak with you, answer your questions, and we appreciate the confidence and support you put into the LENSAR team. Now let me turn the call over to Tom, and he’ll cover our financial highlights for the quarter. Tom?
Tom Staub, Chief Financial Officer, LENSAR: Thank you, Nick. I’d like to discuss our fourth quarter and fiscal 2025 results. However, my remarks will be succinct and poignant for two reasons. One, our fourth quarter and 2025 results were impacted by conducting our operations under the previously contemplated acquisition by Alcon. Two, we start the second quarter as a standalone company tomorrow. I’ll highlight the relevant aspects of Q4 and our 2025 results as they relate to our future results and operations. In association with the termination of the merger, there are some significant adjustments to our future financial statements that I’d like to highlight. First, the $10 million merger deposit that was being held in our bank account becomes ours.
Thus, the cash that we report at December 31 of $18 million is ours with full title, and the $10 million deposit liability will be eliminated in our first quarter 2026 results. Second, we recorded $17.1 million in total acquisition costs in 2025, with $14 million of those expenses unpaid as of December 31. With the termination of the merger, approximately $4.3 million of the unpaid balance will be eliminated or written off by concession of our acquisition advisors, and then $5 million of the remaining liability will be payable starting in May 2027, a significant payment deferral.
Lastly, and importantly, as Nick has mentioned, we have re-engaged with our key stakeholders, including our distributors, and we start today with the help of these key stakeholders to reestablish our standalone operations at an operating cadence more similar to prior to the announcement of our acquisition. Our performance in the fourth quarter was solid, with a total revenue of $16 million, representing a 4% decline year-over-year, primarily as a result of lower system sales. As you look at regional sales, U.S. Ally sales were 12 systems, increasing 1 system from Q4 2024. However, there was only 1 Ally sale outside the United States in the fourth quarter of 2025, compared to 10 Ally systems sold outside the United States in the fourth quarter of 2024.
We attribute the fluctuation in ALLY unit sales year-over-year largely due to our distributors’ uncertainty as to when their collaboration with ALLY and LENSAR would end. You can understand our excitement as initial conversations with distributors demonstrated their willingness and enthusiasm to reengage. This will be an important growth driver to top-line revenue, recurring revenue, as well as enhanced cash flow. The quicker our distributors reach out to potential ALLY customers and reengage in ALLY’s promotion, the faster our operations outside the United States begin to meaningfully contribute to our total system sales and enhance our cash flow. Another important aspect of our business is recurring revenue. While total 2025 revenue increased a respectable 9% over 2024, 2025 recurring revenue increased 15% over 2024, offsetting the decrease in system sales for the year.
The decrease in system sales for 2025 was entirely due to sales outside the United States, decreasing to 20 systems in 2025 from 23 systems in 2024. This is especially noteworthy as 8 systems, 40% of our fiscal 2025 system sales, occurred in the first quarter of 2025 prior to the acquisition announcement. The comparable 2024 period, as Nick mentioned, was only five months of activity as we did not receive regulatory approval and launch in Europe and Taiwan until August 2024. Recurring revenue grew 17% in the fourth quarter 2025 to $12.7 million, annualizing to over $50 million, and we exited the full year 2025 at $46.3 million, up 15% compared to the $40.1 million in 2024.
This performance reflects the continued expansion of our installed base as well as increased system utilization with procedure volume remaining a key driver. Fourth quarter procedure volume increased approximately 20% year-over-year, and full year procedures grew 22%, surpassing 206,000 globally. We placed 15 Ally systems in the fourth quarter, bringing the installed base to just over 200 Ally systems, up 48% year-over-year, while our total combined installed base of Ally and LLS systems grew to approximately 435, an increase of 13%. We exited 2025 with a backlog of 13 systems pending installation. Gross margin for the quarter was $6.9 million and represented a gross margin percentage of 43% compared to a 42% gross margin in the fourth quarter of 2024.
Our gross margin for the full year was 46% versus 48% for fiscal 2024. The decline in margin percentage represents the impact of inflationary cost increases to our raw materials and production process, accompanied by tariffs assessed in 2025. We did not pass on tariff costs to our customers. We are forecasting an increase in our gross margin percentage and expect it to be in the 46%-49% range for fiscal 2026. The more successful we are with system sales, the lower we will be in this gross margin range. However, increased system sales will have a more beneficial impact on our recurring revenue as gross margin percentage and recurring revenue factors are inversely correlated when it comes to ALLY sales.
Other than the recurring revenue, another important aspect of our 2025 results is that we maintained a positive adjusted EBITDA for the year with a fourth quarter adjusted EBITDA of $595,000, thereby indicating operating cash flow positive operations excluding any working capital impact. We are proud of our positive adjusted EBITDA operations for the year, considering we operated 9+ months under the pending acquisition, and during that period, we were missing top-line revenue and cash flow from our typical system sales outside the United States. From an expense perspective, our fourth quarter results were impacted by approximately $3.5 million in merger-related costs, which drove a 51% increase in SG&A year over year to $10.3 million, and a 41% increase in total operating expenses to $11.9 million in the fourth quarter.
Going forward, we expect that the underlying expense profile of the business will become more stable with our cash-based operating expenses being a reasonable guide for 2026, with us expecting no more than a 10% increase in cash-based operating expenses and the majority of this increase devoted to commercial activities. As we look ahead, our focus is on transitioning from this 12-month period of disruption to one of execution and growth with three clear priorities. First, accelerating revenue growth. We expect continued expansion of our installed base and increasing system utilization, thereby increasing recurring revenue. Second, maintaining our cost discipline. This priority continues and has been a focus since launching ALLY. Third, enhancing cash flow, especially as it relates to increasing system sales, particularly outside the United States.
We believe that the combination of cash on hand as well as the discounted and extended payment terms of acquisition costs provide us with the necessary flexibility and financial resources to effectively restart our operations and return to our previous growth run rate and operating success. We will now like to turn the call over to Josh for Q&A. We’re happy to answer your questions.
Josh, Operator/Moderator, Conference Call Operator: Thank you. As a reminder, to ask a question, please press star one one on your telephone and wait for your name to be announced. To withdraw your question, please press star one one again. One moment for questions. Our first question comes from Frank Takkinen with Lake Street Capital Markets. You may proceed.
Frank Takkinen, Analyst, Lake Street Capital Markets: Great. Thank you for taking the questions. A lot to cover. Maybe I’ll start with the distributor commentary. Nick, it sounds like the conversations you’ve had over the last few weeks have been really positive, but I did hear the comment of exercising a little conservatism as you re-engage with those folks and think about kind of how that’s gonna actually translate to OUS system revenues. What more can you tell us there, and how should we be thinking about reading into that commentary and applying it to our models as we think about growth re-accelerating throughout 2026 or 2027?
Nick Curtis, Chief Executive Officer, LENSAR: Sure. Hey, Frank. Good to hear from you. It’s been a while since we’ve done these calls. The business outside U.S., you know, is different in a lot of cases, particularly in a few of the countries where you don’t have as many private practice and let’s say, ambulatory surgery center owners where they can make the decision or a private equity group that makes the decision. For example, in Germany, where we have a large private equity group, and we are, you know, one of the primary suppliers there. In some of the, particularly Southeast Asia, some of these go on tenders. Given the uncertainty, they were hesitant to engage in a tender because they’re over an extended period of time.
For example, they’ll start re-engaging in these tenders, and those tenders take time. Quite frankly, we may have lost a few renewals in the short term, you know, from some of these deals, not our deals where they had our systems, but where we had an opportunity to, let’s say, quickly replace a competitive system. I just expect that it’s gonna take us, you know, several quarters to really reinvigorate, get out and assess where some of those tenders are, where we have opportunities, and begin to do that, as well as participating in some of the various conferences like we do here.
Tom Staub, Chief Financial Officer, LENSAR: I just caution to say that we had this massive quick start when we got the ALLY approved two years later. Now essentially there’s been zero activity for the last nine months. There’ll be some restart up, and it’s not like there’s a backlog sitting there because essentially these distributors were planning for life without LENSAR that they didn’t expect to be distributing on a going-forward basis. They’re really enthused, and I just say it’s gonna take us a little time to get back to that sort of momentum that we had in the last quarter of 2024.
Frank Takkinen, Analyst, Lake Street Capital Markets: Yep, very helpful. To me, it seems like there’s two phenomena going on. OUS likely more capital placement oriented, and then in the U.S. with each incremental placement gets incrementally harder. Maybe there’s less upfront payment and more kind of lease-based placements. How should we think about that throughout the year and a mix of maybe kind of more lease-based or usage-based placements versus actual capital sales throughout the year?
Nick Curtis, Chief Executive Officer, LENSAR: Great question. As you know, and as Tom had indicated, when we sell a system outside the U.S., when it leaves our dock, we essentially recognize revenue on the system sale itself, and it’s a very quick recognition. In the U.S., the revenue recognition is different. You have to get the system installed, you have to begin training, and the system is accepted by the customer, the end user, before you begin to recognize revenue.
On procedure deals or when we do placements and really even when we sell a system in the U.S., usually you’re looking at in the neighborhood of close to 60 days before, you know, before you really start getting into the revenue phase that, you know, to get to some normal procedure volume because you’re training people and you’re, you know, you’re getting the systems put in place and procedures and whatnot. Traditionally, we’ve been in the neighborhood of somewhere north of 50% sold systems in the U.S. and let’s say, you know, 50/50 or perhaps even a little bit more on the sold versus the placed. I would expect that that’s probably gonna drop a little bit.
What we’ve seen is that the competition, you know, they lack the system. They go out with procedures and they try to drive, you know, a price competitive versus, you know, what we do with a value proposition, which a much more efficient, faster, better treatment overall. I think that over the next couple quarters, you’ll see us go from that sort of 50-55% sales sold systems versus placed systems in the U.S. to a lower percentage, particularly as OUS takes a little time to sort of ramp up there. Does that help you in terms of the percentage?
Frank Takkinen, Analyst, Lake Street Capital Markets: Yeah. No, that’s very helpful. Appreciate that. Maybe just the last one, for Tom. I heard the comment, 10% increase in cash OpEx. I just wanna make sure I understand that. Essentially, if we look at 2025 OpEx and back out the $17.1 million of M&A-related expense, and then grow that 10%, is that what you’re inferring? You would be in the neighborhood of kind of $38 million-$39 million of operating expense for 2026.
Tom Staub, Chief Financial Officer, LENSAR: That, that’s exactly right, Frank. The only thing that I’ll say is the way we look at things is cash-based operating expenses. We throw out, you know, sort of amortization as well as stock-based comp, and then it’s the 10% off that base. Yes, you’re correct.
Frank Takkinen, Analyst, Lake Street Capital Markets: Okay. Perfect. Thank you, guys.
Josh, Operator/Moderator, Conference Call Operator: Thank you. Our next question comes from Ryan Zimmerman with BTIG. You may proceed.
Ryan Zimmerman, Analyst, BTIG: Hey, guys. Thanks for taking the questions. Maybe just to start, I don’t think I heard the procedure growth was still really good, you know, worldwide. I’m wondering if you could comment, Nick, on U.S. procedure growth, ’cause I think you also face a tougher comp there. We saw a bit of a slowdown in cataract volumes, you know, through much of 2025. Maybe just comment on kinda, you know, where that stands. You know, as you think about the business going forward, I appreciate that the system dynamics will be choppy as, you know, you kinda get the train out of the station.
Talk to us about the recurring revenue side of things, particularly around procedures and how you think that will, you know, kind of function as we look ahead to 2026.
Nick Curtis, Chief Executive Officer, LENSAR: Yeah, thanks. Good to hear from you, Ryan. Appreciate your questions. As Tom had mentioned, we exited the year with $46 million, approximately $46 million in recurring revenue, and that was ramping closer to $50 million when you look at the fourth quarter and on a rolling forward basis. Well, really, our business is becoming very healthy on the recurring revenue side. It was 79% of our revenue in the fourth quarter. As we go forward, we expect that those 200 installed systems will continue to produce. We’re doing approximately 600 procedures a year or so on average on the ALLY units in the U.S. on a going-forward basis on average.
That’s quite a bit higher than what the average installed base is. We expect that’s actually going to continue. Because of what we do with astigmatism management, we started to see more femtosecond laser naive, we refer to as femto-naive, which represented 50% of our new business in the fourth quarter. We expect that to continue and to continue to grow as well. Now those accounts, a caution, take a little bit longer to ramp because they’ve never done lasers before, and they’re, you know, putting in a new system, and they’re getting trained, and they have to train staff and educate patients and whatnot.
You know, that will take us a quarter, two quarters to get those folks sort of up to speed as more new customers come on. Representing a pretty large segment in a lot of particularly when you look at cataract surgery reimbursements and the need to deliver better outcomes, our astigmatism management, you know, over 65% of procedures that we do involve some form of astigmatism management. I think you’ll see the mix of customers that heretofore are replacing older competitive devices. On average, you know, we do 27% more procedures than the national average of systems. We take about a 60-day ramp, and you see those procedures coming up to where our averages are, or more.
You’ll see a mix of newer customers and maybe some of the office-based surgery centers, which is trending, moving into office-based suites, where those are lower volume accounts, take a little more time. You may see the average number of procedures drop slightly, but you’ll see more systems doing those and whereas the current install base will continue to grow.
Ryan Zimmerman, Analyst, BTIG: Okay. Very helpful. You know, just to circle back, Tom, on expenses. I appreciate the math and commentary that you gave. It’s very helpful. But I guess my question is, you know, in this transitory period, I imagine, you know, expenses came down artificially. You know, now you do also need to, you know, kind of, again, get the train out the station, if you will. So, you know, when you think about kind of the cadence of expenses and appreciating kind of where it’s going, you know, shouldn’t we see some type of kind of acceleration, you know, foot on the gas pedal, if you will, to, you know, get things, you know, get kind of operation humming again?
I’m just wondering, you know, if the 10% is the right number, as I think about, you know, kind of into 2027 and beyond, I guess. You know, I know it’s a little premature, but, it just seems like there’s, you know, kind of multiple vectors here, you know, cross-currents around operating expenses, for 2026.
Tom Staub, Chief Financial Officer, LENSAR: Very astute question and a very good observation, Ryan. I mean, yes, you know, our expenses did go down over the last 13 months just because of being under the acquisition process. Even though our advisors discounted and extended the payment terms, you know, that’s still a big nut for us to cover as a small company. We’re being very judicious in our expenses, and the increases are all gonna be commercial for the most part in 2026. As our distributors come online and we see a larger contribution of sales outside the United States and more cash flow coming in, I fully envision ramping up our commercial activities in 2027 well beyond 10%.
We’re kind of, you know, in this moderation phase until we’re certain on how quickly our distributors can come back after this 13-month lag where they effectively put their pencils down.
Ryan Zimmerman, Analyst, BTIG: Right. No, understood. When you think about kind of what’s entailed, and this is more directed at Nick, I guess, like, you know, yes, you’ve had conversations with the distributors outside the U.S. You know, they understand, you know, where you guys are at as a company now, you know, not going through with the merger. Does your thinking around, you know, your OUS efforts, you know, change? Does it? You know, do you see bigger opportunities than maybe you thought about before? You know, is there room to go beyond kind of the markets that you were in, you know, kind of pre-merger? You know, some of those approvals were really good. We saw a really good uptake in Europe.
Now the question is, you know, as a standalone, you know, does your aperture change, I guess, you know, particularly outside the U.S.?
Nick Curtis, Chief Executive Officer, LENSAR: Yeah. A really great question. You’re starting to delve a little bit into some strategy here. I’ve seen it. It’s really interesting because in terms of especially replacing some of the older systems from competition that are out there. I’ve seen some interest in a few other countries that we have not gone into. I’m gonna be looking at a few opportunities such as Australia and New Zealand in particular, where there’s actually quite a bit of interest in replacement of older systems there. That would be one market that we haven’t been into that we may look into. I think that we’ll see in Southeast Asia our activity come back there.
Like I said, there’s more of a tender business there, and so it’s gonna take us a little more time. Where I see there’ll be some systems there this year, but I think that really as we get into 2027 into, you know, first, second quarter of 2027, we’ll see quite a bit more growth in that Southeast Asia market. I think there’s a lot more expansion growth in Europe into countries where heretofore we haven’t been in. Because again, not to underemphasize or overemphasize, you know, ALLY addresses a lot of the shortcomings as to the reasons why people abandon, you know, femtosecond laser-assisted cataract surgery before.
Because we have this good install base in the U.S. and our business is growing, it’s almost been an advantage getting the approvals later outside the U.S. because it’s helpful for the distributors where they see that there’s uptake here in the replacement of competitive devices. There’s a lot of systems outside the U.S. where they’re sitting in accounts that are just not very productive, and I feel like, you know, competitive systems. We’ll have some opportunity there. I don’t see the opportunity coming back in South Korea anytime soon. As you know, they’ve got big issues around reimbursement and insurance company reimbursement there, but that’s been away from us for quite a while, so it doesn’t impact our business negatively or positively, if you will.
I think we probably need to look at some other markets in South America, Latin America, where heretofore we haven’t been either. I think now.
Ryan Zimmerman, Analyst, BTIG: Yeah.
Nick Curtis, Chief Executive Officer, LENSAR: You know, we can address some of these things. Those are longer term, you know. I think we’ll see Europe come back, and we’ll have some opportunity outside of Germany that we hadn’t really gone after before. I think our distributors are interested in doing that, and we’ve made some additional relationships there. I think we’ll see Southeast Asia, in various countries there we do business come back strong, and then we’ll look at a few of these other markets.
Ryan Zimmerman, Analyst, BTIG: Okay. I appreciate it. I know this, you know, again, this call was a maybe change in plan from what everyone expected, but it’s good to hear from you guys and, you know, we’ll get the dust off and move forward.
Nick Curtis, Chief Executive Officer, LENSAR: Hey, Ryan, you know what? That’s life, and the reality is it’s what you do to adjust and how you pivot and how you decide.
Ryan Zimmerman, Analyst, BTIG: Right.
Nick Curtis, Chief Executive Officer, LENSAR: To move from there. You’ve got two choices. You can quit, or you can come out fighting. I’ve never quit and I have to come out fighting, so.
Ryan Zimmerman, Analyst, BTIG: Very nice. Thank you, guys.
Josh, Operator/Moderator, Conference Call Operator: Thank you. I would now like to turn the call back over to Nicholas Curtis for any closing remarks.
Nick Curtis, Chief Executive Officer, LENSAR: I really appreciate everyone joining us today. It’s been invigorating to do a call after not having a call for about a year now. While the termination of the merger was not the outcome that we anticipated, I think it really positions us to the positive there as it positions us to move forward with a much greater focus and control as an independent company. As a standalone company, we certainly know we have the best product available. I think it came out loud and clear through the process here, and we’re ready to capitalize on the significant market opportunities that lie ahead. Rebuilding momentum is gonna take several quarters, but our priorities are very clear, and I believe our team is aligned to deliver.
We’re confident that on the path, it really is enabling us to unlock even greater long-term value for our surgeons, patients, and shareholders. We look forward to sharing our progress with you all as we move forward. In closing, I just wanna say once again, LENSAR is back. Thank you.
Josh, Operator/Moderator, Conference Call Operator: Thank you. This concludes the conference. Thank you for your participation. You may now disconnect.