Alcon Inc.
Q4 2020 Earnings Call Transcript

Published: 24 Feb 2021

[Operator:]

Good day, and welcome to Alcon's Fourth Quarter and Full-Year 2020 Earnings Conference Call. All participants will be in a listen-only mode. . After today’s presentation, there will be an opportunity to ask questions. Please note, this event is being recorded. I would now like to turn the conference over to Karen King. Please go ahead.

[Karen King:]

[David Endicott:]

Good morning, everyone, and welcome to Alcon's fourth quarter and full-year 2020 earnings call. Despite operating in the extraordinary circumstance of a global healthcare crisis in 2020, we did make significant progress on our strategic initiatives and delivered innovative products that enabled us to grow our market shares. Let me begin by recapping highlights from 2020 and recent months, including market dynamics and our strategic priorities. After my comments, Tim will discuss the fourth quarter and full-year performance. He’ll provide some color on 2021. Then I'll wrap it up with some closing remarks and we'll open the call for Q&A.

[Tim Stonesifer:]

Thanks, David. We're pleased to report fourth quarter sales of $1.9 billion, up 1% versus prior year. Net sales in both franchises returned to growth, led by strong results in North America, partially offset by softness in international. The rapid recovery in the back half of the year from the second quarter low point enabled us to finish the year with sales of $6.8 billion, down 8%. Surgical sales were up 1% in the quarter, driven by growth in implantables and equipment other. For the full-year, Surgical sales were down 11%. Implantable sales of $350 million increased by 4% in the fourth quarter, primarily due to the continued strong demand for PanOptix. As David mentioned earlier, PanOptix continued to gain share and performed well as it lapped its launches in the U.S. and Japan. We're also starting to see incremental sales contribution from Vivity, which we previewed with select accounts in the U.S. and launched in most major European markets in the fourth quarter. The strong performance in the AT-IOL category offset lower sales from monofocals, which were impacted by COVID in certain markets. For the full-year, implantable sales were down 6%.

[David Endicott:]

Thanks, Jim. In summary, 2020 was a challenging year, but we've come up the other side a stronger, more robust company. I want to thank our 23,000 plus associates for their hard work, their support and commitment during these clearly trying times. We've demonstrated our agility, resilience and ability to execute in the face of significant headwinds. Our products continue to win in the marketplace and we'll feel this momentum with an exciting pipeline in 2021. We expect the eyecare market to benefit from an increased demand for health and wellness and to continue to be underpinned by strong long-term fundamentals. We'll share our perspectives on long-term growth at our upcoming virtual capital markets day on March 24, where we will discuss our strategy and innovation agenda, and how we'll create shareholder value and improve outcomes for our customers and their patients. Please visit our website for more details. Now, let's open up the line for Q&A.

[Operator:]

We will now begin the question-and-answer session. . The first question today comes from Veronika Dubajova with Goldman Sachs. Please go ahead.

[Veronika Dubajova:]

Good morning, and thank you, guys, for taking my questions. I hope you're keeping well. I just want to kind of follow-up a little bit on the outlook for 2021. I think, Tim, in the past, you've sort of said you thought the shape of the P&L in 2021 should be pretty similar to 2019. I would love to get your updated thoughts on how you're thinking about that, in particular, given some of the step-up in the OpEx run rate in the fourth quarter. And maybe just comment on what proportion of the SG&A spend and R&D spend was phasing versus a new run rate of costs where you've expanded your sales presence, et cetera? And then, a quick one for David on Vivity. David, what are you seeing in terms of the proportion of new patients that this is attracting in the European market? I know it's early on, but just ballpark if you can share some anecdotes with us? That would be great. Thanks, guys.

[Tim Stonesifer:]

Yes. Sure. Thanks for the question, Veronika. Listen, I think that when you think about 2021, our assumption right now is that markets return to historical levels at the back half of the year. So, if that is to happen, I think, it's very reasonable to think that we're going to grow faster than the market, right? If you think about the investments we've made in PanOptix, we've made in Vivity, we've made in PRECISION1, so you can decide. I would look - take a look at our shares. And as these markets return, I think it would be very reasonable to think that we're going to grow faster than the market. So, that's really the underpinning assumption. And then as you work your way down the P&L, from a gross margin perspective, obviously, we're not going to have the absorption challenges we had this year. We may have a little bit depending on how long the COVID situation drags out in the first-half of the year. But at this stage, not expecting a material pressure point there. On the R&D front, we would be spending more. I think in 2019, we spent roughly 8%. We've always said we're going to spend that 7% to 9%. My guess is we'll be sort of at the higher end of that range as we continue to fuel our innovation pipeline. To your question around SG&A and the ramp, I think it would be a similar profile. In fact, I think we'd probably be a little bit more productive because we're starting to see some of the benefits of some of the transformation work we're doing. We'll also have a little bit more leverage. So, a similar profile with maybe a little bit lower from a percentage basis. So, that's how I think about the P&L if you were to compare 2021 with 2019.

[David Endicott:]

Yes, Veronica, on Vivity and PC-IOLs, in general, I would just say that, our experience right now has been that Vivity seems to be adding share to the overall picture. I think we've had a nice share growth. We continue to get good steady share growth around the world. Europe has certainly been adding to that as we get Vivity out. And it does seem to be adding it on top of the PanOptix share that we have there. I think the going-forward part for us is really just trying to get an assessment of what we think the penetration may change over time. We are pleased to see some of the penetration improvement in HCI. Well, it's a little hard to tell right now whether or not that's a function of a mix of accounts. So, the fastest, more assertive accounts are probably coming out first and monofocals are probably trailing a little bit. But we are seeing global AT-IOL penetration up almost 140 basis points from prior year. And typically, what we've seen is that kind of 50 to 100 and it kind of always settles back. So, we'll see whether that's a sustainable idea. We kind of hope that Vivity is bringing new patients in, but we'll see how that takes shape over time. And as we see the monofocal market return, we'll have a better picture of that.

[Veronika Dubajova:]

That’s really helpful. And Tim, can I just quickly ask or confirm I'm understanding you correctly. Your expectation is the market is the same in the second-half of 2021 as it was in the second-half of 2019. You don't expect any growth versus those second-half 2019 levels. That seems pretty conservative to me. I just want to make sure I got your point on that.

[David Endicott:]

Well, let me comment on the markets kind of separately. I think right now, the United States is doing quite well. And I think we – from about the – we were almost back to 2019 in the fourth quarter. So, take that for what it's worth. International was a good bit behind that, though, and I would say it was kind of 5% to 10% off of its peak on the Surgical side. On Vision Care, the U.S. had kind of a remarkable fourth quarter that I think – looks like it was up in the high single digits. International, however, was again behind that number. So, I think we're cautious about wanting to see the recovery complete and see that kind of international growth, in particular. If you look – if you've seen around the world, there's some kind of recovery plans that are out there that extend into June right now. So, we're watching those carefully. I think we feel good about where we are. We also feel good about our share positions in those markets. So, candidly, as I've said before, I'm not 100% sure when they come back exactly, but they are going to come back and they are going to grow beyond that. And underlying fundamentals for us mean, if we've gained share through this stretch, we are disproportionately going to benefit as they do come back. So, Veronica, I'm not 100% sure whether it's back half or second quarter or where we really turn the corner on this, but we feel pretty good about our position.

[Operator:]

The next question is from Bob Hopkins with Bank of America. Please go ahead.

[Robert Hopkins:]

Oh, great. I have just two quick questions. Thanks for taking them. First, just wondering if – given your - I would love to get your preliminary thoughts on any divergences you see in the outlook for the recovery between the Vision business and the Surgical business over the course of 2021? That would be the first question. And I'll just go ahead and state the second one upfront. I was just wondering, I'm sure we'll get specifics at the Capital Markets Day. But directionally, from where you sit today, do you think that disruption from COVID will have an impact on the original 2023 targets that you talked about? Or is there enough spacing between where we are today in 2023 versus those old margin targets are still quite valid? Thank you.

[David Endicott:]

Yes. Let me take the first one, Bob. And I think the Vision Care business right now looks like the U.S. business has done pretty well bouncing back. The international business, again, I think, is in a different place. I will say, though, that the – when you look at the numbers on the ground, there is a slight divergence between what we're seeing in the consumption data and what we're hearing from practices. So, if you - some of the research we've been doing over the last quarter would say that we still have a significant number of U.S. providers who say exams are below normal, lower than last year, significant portion of practices are reporting revenue that was below last. Now, the weird part of that is, even though we see total fits down, almost 20%, in the fourth quarter. We saw a 9% consumption growth in the U.S., those are U.S. numbers, just so you know what they are. And that's odd. But I think that there is some belief that this is a normalizing market on our perspective, that there's some reasonable growth that has come back for people who probably were wearing their glasses through most of COVID and decided they were going to – get them fogged up and started to buy back some of that. There's some general market growth as we kind of stabilize prescriptions. And there's a willingness, I think in optometry to a certain degree, instead of fitting the lens to renew a prescription for it, without necessarily seeing the patient right now, it's a small percentage, but it's big enough that we can compensate a little bit for what we see in short visits. So, I don't know precisely where that sits going forward. But I think it's a good sign that the consumption value total was up in the fourth quarter for the United States. International continues to be a little bit slower. And we believe that'll continue on for a little while until we see a little bit more foot traffic into what's largely a chain dominated Europe. And the same thing in Japan, which are the two large international parts of our businesses. On the original targets, just maybe one point to make here, I think when we set out to spin this company out, we said, two-thirds of that was going to come from revenue leverage and our operating improvement would come from just growth in revenue. So, the thesis has always been about revenue growth. We, obviously, were going to get some gross margin from mix and other efficiencies. But we have been on a tear, really, I think, on the revenue side, feel good about our share position, but the market is falling away. So, clearly, there's some impact. But I think from our perspective, we gave a low to mid 20s operating income range, and we still feel like the low end of that range is in play. So, I think the view that we have continues to be that, depending on the revenue and depending on how the markets move, our thesis should still be intact. But I think going forward, we want to update that with you and we'll give a better update, I think, with more specificity in the March timeframe. So I guess just next month.

[Tim Stonesifer:]

The only other thing that I would say is sort of the underpinning assumptions and work that needed to be done to drive those financials that David just talked to, those are all on track. So, a big piece of that was the Vision Care line installations. And despite COVID, we've continued to execute upon that. Even though we took out $200 million of costs in Q2 versus the original target when we started seeing the COVID pressure last year, we kept our R&D projects all on track, we continue to invest in that because, again, that's going to be critical to driving some of that long-term growth that David alluded to. So, I think the underpinning operational levers are all on track to drive that.

[Operator:]

The next question is from Larry Biegelsen with Wells Fargo.

[Lawrence Biegelsen:]

I just wanted to ask one quick clarification on Bob's question, the response to Bob's question, David. The low end is in play. And I think Bob was referring to 2023. So, can I just confirm that the low end is still in play for 2023? Or has COVID kind of pushed that out by a year?

[David Endicott:]

Larry, we've been saying for, I think, a while that our thesis was still intact. I think it's a matter of where the revenue hits. And we still believe that the revenue lines, assuming that we get the markets back, as we've indicated, we think they're coming back, in the back half of this year where COVID will be behind us, we think we've got time to get there. And so, I don't think we've changed in any of our perspective on where it is. I think it probably is to the low end of what we described at the time. But again, we'll give you a little more color on that in 2025 when we get to the end of March.

[Lawrence Biegelsen:]

David, the 5% contacts – so, one on contact lenses. The 5% growth in Q4 was quite good. Do you feel like you've turned the corner and now can grow above market in 2021? And is there any reason Q1 2021 would slow significantly from Q4? And I'll just quickly ask my second one. David, if I look at consumables as a proxy for procedures, Tim mentioned 2020 was down 15% year-over-year, it typically grows mid-single-digits, how are you thinking about the catch-up of loss procedures over the course of 2021 and 2022? Thanks for taking the question.

[David Endicott:]

On the contact lens piece, we have, I think, gotten ourselves back to what I'd say is kind of growth at market. I don't think we're beating the market yet. We are in some kind of smaller spaces. For example, in the places we really desire to be, so silicon hydro gel, we're doing very well. We've grown market share in the fourth quarter in that category. And that is the fastest growing part of the contact lens market. So, we feel good about that. Because that's, of course, where DT1 plays. That's what PRECISION1 plays for entering toric and multifocal. So, a lot of our energy that's going at the fastest growth part of this segment, is paying off well. But we obviously have a big underlying reusable business we have to pay attention to, and we also have some older dailies business. The exciting part for us is, as we see the fourth quarter took shape, what we saw was our total dailies, and that's really DT1 plus P1, plus DACP, that's really what we're trying to think about. Because we're losing a little DACP share. We're cannibalizing a little bit. We're losing it to some other people, that's normal. That's what we would have expected because it's an older HEMA lens. And I think as you kind of go forward, and see this shift to SiHy continue, we're disproportionately capturing share in the SiHy. So we're watching the total daily share very carefully. And in terms of new fits and switch fits, we had a very good fourth quarter. So, I would say we were up a good bit in share of new and switch fits for the dailies segment, in sphere in particular. And so, I feel good about what we've said there, and I feel good about where we're going. But I will tell you that, again, we've got more work to do. I do think that a growing above market is our expectation for 2021. And it's, I think, well within our reach, given the near term trajectory we saw with P1 and the continued strength of dailies TOTAL1. On the other piece of it, the surgical procedures, I think it's right to wonder where we are with consumables. The market overall in recess for the year was off almost 25%. We were off, I think, in consumables, what was it, about 13% or something in that neighborhood. Maybe 15%, I can't remember. 15% on that one, then 3% in the quarter. So, let me just suggest that we think we're gaining share in the consumables business right now and that the market has been, obviously, slow internationally, in particular. The US market looks like it was nearly back to the 2019 levels. It wasn't quite there, but I think it was off 1% or something. So, really close to what we would have expected as we started this journey some months ago. But I think our share looks pretty good. And our international share, in particular, has picked up with both Centurion and Legion performing very well internationally. We're expanding our footprint and I think we outperformed the market really a bit on consumables relative to the actual procedures that were in the market. So, I think that the market picks up internationally, but we'll have to see when. And again, I would say, we feel comfortable saying back half of the year, but we'll see how the COVID thing plays out.

[Tim Stonesifer:]

We did this before. Let me give a little more color because I'm sure we'll get more questions on 2023 and margin expansion, what have you. So, the other couple points I'd make is, one way to think about it is if you take our Q4 2020 rate, margin rate, it was 14.9%. Now in there, you have some pressure from absorption. So, we spiked up the $30 million, so you guys can quantify that. And then, we also have some R&D timing in there, right, because we're playing a little bit of catch up from Q3. So, if you normalize it, if you will, that kind of gets you to 17%. And then, what you need to believe over the next two or three years is you going to get, call it, a point and a half, two points of additional gross margin. Again, we've spent a lot of time walking people through the Vision Care installations. And we've always said that the benefit of that margin expansion will probably come in the latter part of the plan. So, think about it in 2022. You're going to get that mix lift that we talked about. PanOptix is a perfect example. So you've got to believe you get a point and a half or two points from there. And then you get to two, three points of SG&A leverage. Again, when we gave the original guidance in 2018, there were a lot of things that we weren't quite sure about. PanOptix was just launched in the new markets. Vivity was in clinical trials. PRECISION1 was in development. So, we feel like we're in a much better space now than we were in 2018 just because some of those variables are sort of taken out of play. So, you've got to believe that operating leverage on the revenue side. And if you take it from kind of the Q4 exit rate, normalize it. That kind of gets you there.

[Operator:]

Next question comes from Matt Miksic, Credit Suisse.

[Matthew Miksic:]

Maybe on that topic, just following up on the margins, for David, the share of switchings, sort of new switches is encouraging on P1. I'm wondering how important as you start to sort of look for these 1.5% to 2% improvement in gross margins that you mentioned and sort of volume on the P1 side that these fits start improving just because it seems like you take share where there's a jump ball, where there's an opportunity, not necessarily where there's just a lift in consumption. And then I have one follow-up.

[David Endicott:]

I don't think that's the big picture. The P1 is important, for sure. But it's a small part of what we're doing right now and will be for a while. DT1 continues to be a big product for us. P1 will grow nicely, I'm sure, and it will take share for us. But getting ourselves really in a leading share position in daily SiHy is kind of the big picture. I think toric lens will help us, the sphere is doing well, our DT1 multi-focal is doing a great job of picking up patients there in a fast growing sector as well. So, we feel good about that part of it. The gross margins, really, right now, you should expect it to come largely from the Surgical business for the next kind of 24 months-ish because we're getting really good mix shift to ATIOLs. And that's giving us, I think, a good bit of lift. And that will continue and that will help us, I think, as we go forward more than anything else. The real thing on margin is we lost $600 million in revenue top line between the last year and this year – from 2019 to 2020, right? So, that's a delevering, not a leverageable top line. So, that's really the impact that we're struggling with as we go forward. We've got to get the top line back. We have every confidence we'll do that. But when you start talking about the long term plan, it really hinges on our belief that we can get revenue growth and market share movement. And we're seeing all of those things take shape. So, I think Tim said it nicely. We believe we've derisked a lot of the top line assumptions that we had when we went out. We feel good about that, feel good about the share performance. And we've got a lot of our separation behind us. So, for us, it looks like a lot of blue ocean, but we feel good about where we're going. You had another question, I think, just as a follow up there.

[Matthew Miksic:]

Yes, I did. When you think about this coming meeting and the plan over there for a couple of years in the context of your sort of original plan, Vivity is a pretty significant, I guess, recent catalyst and seems to be having some success in the market. Has it changed or enhancing the sort of growth or opportunity that you have in the next 12, 18 months from what you're seeing so far?

[David Endicott:]

Well, we had a lot of these in our minds. I don't know that we had Vivity, particularly. We didn't really talk about Vivity much. We also didn't talk about Pataday. We didn't talk about a few others that are like multi-dose preservative free tears. We've got some other things, I think, that we're excited about. Again, we just don't know 100% about technical yet. But I do think what you should believe is that we're investing for product flow that will impact our revenue top line going forward. And Vivity is going to do well. We'll see how much we can get, in addition to what PanOptix does. PanOptix has clearly done very well for us. We think it will continue to do well, as we said earlier, for the next several years. But I think Vivity has the potential to add, particularly in places like Europe. And Vivity's kind of interesting proposition right now is that it's a really great upgrade to our toric, right? So, if you're an ATIOL user, using a toric, Vivity provides you all the toricity you would have gotten from the AcrySof Toric, which is again the market leading toric lens in IOLs. But it also gives you intermediate vision and it also gives half those patients near vision. And really, that's pretty exciting for the surgeon who was not super comfortable with the visual disturbances of traditional ATIOLs. So, we have a real unique product here. We'll see how much that takes on in terms of new patients, new docs, but that's clearly exciting for us. But I wouldn't limit it to that. I do think that our pipeline looks good. And that's really what CMD is going to be about for us. Again, I think we should kind of make sure we understand what we're – we're trying to kind of give you an R&D day, if you will, of what we think the near-term drivers are for products and what we think the long-term investments are for platforms that can mature and really change the market. So, we'll give you a good look at all of that stuff. And hopefully, you'll walk away feeling good about our belief in the revenue line.

[Operator:]

The next question is from David Lewis with Morgan Stanley.

[David Lewis:]

I just had two quick ones for me here. And maybe start with Tim. Tim, just looking at the first quarter guide, which we appreciate, it was actually a pretty strong number by our view. But there's a lot going on in that first quarter. There's your normal quarterly cycling, there's got to be some resurgence recovery and weather dynamics as well as you're anniversarying a big quarter for PanOptix in the year-ago period. Can you also flush out that guidance relative to some of those factors that I mentioned here in the first quarter?

[Tim Stonesifer:]

Again, there are a lot of moving parts. I think at a high level, I think I would expect to see revenue in line with Q4. We're going to continue to monitor the COVID situation in EMEA, Japan We obviously had a bad stint of weather here, particularly in Texas last week, but we've taken that into consideration. So, we'd expect to be somewhat in line. From a cost perspective, wouldn't expect to see quite as much manufacturing absorption pressure, as we saw in Q4. There may be a little bit depending on, as I said earlier, how long COVID lingers, but I wouldn't expect it to be at that $30 million level by any stretch. R&D will probably be a little bit lighter. Again, we had about $174 million of R&D spend in Q4. We had a lighter Q3 than what we had wanted. So, we had a little bit of catch up there. So, that'll kind of toggle back to a more normalized level, if you will. And then, we're going to continue to invest behind the revenue growth. So, assuming that that revenue line is intact, we're going to continue to put money behind advertising promotions to drive that. So, that's how I think about Q1 as compared to Q4.

[David Lewis:]

David, just in 2020, just one of the surprises was just equipment and that was another very good number within Surgical in the fourth quarter. Were you surprised this year just how that equipment number kind of manifest itself in the back half of the year? There's some concerns about sort of equipment pull forwards or push outs. How do you think the equipment business sort of wrapped up on the year? And then how do you think about the outlook for that business in 2021? Thanks so much.

[David Endicott:]

Candidly, we were a bit surprised by the strength of the capital equipment market. And I think if you go back to a couple of calls ago, I was probably negative about the potential for capital. And I don't know that we were way off except for the fact that we did pretty well with some of our newer stuff, which has gone pretty well for us. We had a 10% quarter on equipment and that was both US and international. So, we had good strength in our cataract equipment, particularly strong with Centurion and our new entry Legion in the international markets, which is a lower priced, but advanced fluidics kind of phaco machine. Performed very well there. Vitrec was also double-digit growth for both US, international and we've got a small bump in the US, of course, for procedural eyedrops where we had a bit of an outage. But I would probably just say that the overall effort I think internationally is up on equipment. And in some markets, I think we may have underestimated the desire and drive for new equipment, read China and some of the emerging markets.

[Operator:]

The next question comes from Anthony Petrone of Jefferies.

[Anthony Petrone:]

Got a couple. One on contact lens, one on surgical. Strong contact lenses, Dave. How should we think about restocking and destocking trends as COVID continues to play out? I know that that had some pushes and pulls in 2020. Just wondering how that plays out in 2021. And in terms of the PanOptix, Vivity sort of dynamic, do you think there's a little bit of cannibalization of PanOptix from Vivity or are these two completely separate lines? And then, I'll have a quick follow-up for Tim.

[David Endicott:]

Anthony, I think on the contact lens business, we think that most of the movement inventory is pretty normalized right now. I don't think we saw – we saw a little bit of movement. We always see just a little bit here and there. But nothing in the fourth quarter that looked unusual. It was an unusually strong quarter in the United States. So, we're closely looking at that. But it looks like the inventories were appropriate for what we saw. And I don't really see a whole bunch of change in that dynamic going forward. So, I think we kind of think it's pretty normal right now. On the Vivity and PanOptix piece, we really haven't – I'm sure there's some cannibalization. There must be because we've got fairly high share combined. But what we're really looking at is whether or not we're getting additional penetration or additional share growth all-in. So, there are some markets like Europe where we don't enjoy the same share we have in the United States and some of the other markets in which we've got out first with PanOptix. So, we think there is opportunity to grow share, for example, in Europe, and I do think we see that, and it is additive. So, I think at this point, we aren't seeing a lot of cannibalization, but I wouldn't say there's none. I just think that in aggregate we're doing quite well. I think on the quarter, very nice share progression for us all over the world really between the two products combined.

[Anthony Petrone:]

Tim, just quick on the second-half 2019 to second-half 2021 comparison, just want to get that treated. Are you suggesting that we model off second-half 2019 combined revenues thinking about second-half 2021? Just want to see if that's the comment there. And how you're thinking about the second-half of 2021, again, just kind of lapping 2020?

[Tim Stonesifer:]

I don't mean to be coy, Anthony, but I'm not going to get into modeling second-half versus second-half. Again, I think our assumption is that the markets return to sort of those historical levels at the second-half of this year. And then again, assuming – I think you just need to take into account our product launches, our shares. And when those markets return, we should get a disproportionate amount of that return, given our share position. So, I think that's the main assumption that I would use to model out your revenue line, and then you can work the rest of the P&L as I laid out to the earlier question.

[Operator:]

The next question is from Julien Dormois of Exane.

[Julien Dormois:]

I have two and they both relate to Ocular Health. The first one – and sorry for being a bit blunt here. But I'm just – can you help me reconcile what I see as conflicting trends between the strong performance you have highlighted in reusable lenses, but at the same time a decline in sales for contact lens care. So, just seems a bit counterintuitive to me. So, is that Ocular Health is meant to improve in the course of 2021, are more patients got fitted with reusable lenses, or what am I missing here? And second questions relates to the reopening in the spring. No one of us has a crystal ball, but it appears that maybe the reopening and the lifting of restrictions could happen earlier in the spring than they did last year. So, could this prove a nice surprise for Ocular Health, especially in the context of eyedrops and the launch of Pataday in the room to benefit from easy comps, especially in Q2?

[David Endicott:]

Let me start by saying, the reusable lenses was a bit of a surprise to us as well. Again, I don't know that I have a really good explanation, but I think it was up 3% on the quarter. And the kind of lens care business, again, has been pretty consistent, kind of in that mid-single digit decline area for a while. Sometimes it does a little better than that. But that's kind of where we assumed it would be. So, the only surprise for us was that the resurgence of the reusable lenses in the quarter. And to be honest, I'm not reading a lot into it. It could be that people just kind of decided they were tired of wearing their glasses, they're tired of the way they looked on the little the Zoom screen that they've got, or whatever. I think we're going to have to see another quarter of data before we really make much out of the reusable side of that. So, I would just assume that these two things are a little bit disconnected, as you say, for the moment. And we'll see if that continues. If it continues, there's obviously something we're missing here. But at the moment, we think it's just kind of a data aberration that looks a little weird. On the spring reopening, again, I don't know how to think about the effect spring versus back half. It's a bit like Tim just answered. What we're modeling right now is that the full market return is – they're kind of in the back half of this year. Now, the United States looks like it got mostly back to normal by the end of last year, but the rest of the world has not. And so, it's really important to understand that what we're saying here is not what our revenue is going to do, what the markets are going to do, is the markets for international are going to continue to move back towards normal, probably hitting normal sometime the middle part of the year. I think that's a pretty safe bet. I don't know – if it helped a little sooner, would it be upside? Maybe. But again, the main thing for you to think about is where our share position is against where the markets are and try and work your way back to what you think our revenue is going to do. That's how we're thinking about it. And again, that's partly why we're still careful about trying to guide here. It's really a little bit early for us because we can still see significant down markets in places around the world, Asia-Pac in particular, Latin America in particular, both still double digit below market, where they should be. So, again, we'll have to see where they show up. Again, I'm optimistic that we'll get good reads on that by probably the middle of the year and that's why we're kind of calling it the way we are.

[Operator:]

Our last question today comes from Jeff Johnson with Baird.

[Jeffrey Johnson:]

David, I wanted to go back. You made a comment – and we've heard the same thing that some docs were maybe a little more lax on filling prescriptions that expired at the end of 2020. And kind of correlate that with the 9% consumption growth you're talking about in the fourth quarter. I'd be interested to hear if some of that strength in the US contact lens market especially has continued into January and February, or if there was kind of that rush these patients who hadn't filled a prescription all year and had some benefits that were maybe expiring at the end of 2019 – or at the end of 2020, I'm sorry, if there was maybe a little aberration there in December especially that doesn't continue in January, February? Just what have you seen so far in the first couple months of this year on the contact lens US market?

[David Endicott:]

Jeff, let me stay away from commenting on the intra-quarter stuff. But let me say this way. I don't think that 9% is a sustainable number on a routine basis. We've had for a long time a belief that the contact lens market grew on a value basis somewhere in that 5%, 6% a quarter range. That's probably where the normal rate ought to be. It's kind of a historical rate. So, I think probably what we believe is, over the long haul, I don't know when exactly, but when the markets get back to where they should be, we should be kind of growing on that same kind of curve we were for probably five or six years with that kind of change from reusables to dailies driving a value upgrade off of relatively stable contact lens volume. So, slight to up in new patients, but similar kind of numbers where you're kind of growing flat to up 1% in use, but really getting a nice value trade up. It looks a little bit more like 5%, plus or minus little bit on 5%. So, that mid-single-digits is where I think the natural steady state is. I really don't know where we are right now in the in the early part of this year.

[Jeffrey Johnson:]

Just on the IOL side, I think I heard you, I just want to make sure I understand, you think even off the 75% PC-IOL market share in the US and Japan, there's still room for that to move a bit higher over the next couple, few years or over the next year or two anyway? And then, where do you think share for you guys goes on the toric IOL side? Does that hold steady? Obviously, that's been a good growth driver over the last couple of years as well. You've got some competitive entrants there? Does the toric IOL share hold steady or where does that go over the next year or two as well? Thanks.

[David Endicott:]

I think we expect to hold share in torics to a large degree. There's a lot of competition in and out. Around the world, we have pockets of opportunity. In Europe in particular, but also, I would say, Asia, we have opportunities to grow share in the PC-IOL space. So, we have a 75% share, as we said, or better than that in the United States right now. And even Japan is not even that high. But the rest of the world, I think, is considerably lower than that. So, I would say that, in our minds, both PanOptix and Vivity represent share growth opportunities for Asia, for China, for Latin America, for Eastern Europe. And I think those are things we pay very close attention to. So, I think given the pace of where we are on a wrap-around basis, plus the new markets, kind of plus the potential for penetration change, we feel really good about our position on the IOLs right now.

[Operator:]

This concludes our question-and-answer session. The conference has now also concluded. Thank you for attending today's presentation. You may now disconnect.