LENZ

LLM Evaluations

Transcript Summary

LENZ Therapeutics reported its Q1 2026 financial results, focusing on the ongoing commercial launch of VIZZ for presbyopia. The company achieved $1.9 million in total revenue and 25,000 filled prescriptions in the quarter. Management highlighted a prescriber base of 10,000 unique physicians, noting that VIZZ is seeing higher productivity per doctor compared to previous category entrants. Despite a slower-than-expected start for new patient prescriptions, the company is implementing several strategic pivots. These include a direct-to-office sales model for physicians, a sharpened marketing campaign targeting "reading glass fatigue," and a clinical focus on contact lens wearers to prevent practice dropout. Dr. Marc Odrich addressed the safety profile, emphasizing that VIZZ's unique mechanism of action as a pupil-selective miotic has resulted in a lower-than-background rate of retinal events, distinguishing it from competitors. Financially, LENZ is well-capitalized with $258.4 million in cash and a lean operating structure that has eliminated R&D spending to prioritize commercial efforts. The company expects these tactical adjustments and an expanded sales force to accelerate adoption and script growth in the coming quarters.

5-year share-count history (top 10 holders by peak, incl. exited) + price

Revenue Segments

Filing Risk Scores

LENZ Therapeutics: Rapid Cash Burn and High Customer Concentration Post-FDA Approval

Full Earnings Call Transcript — Q1 • 2026-05-11

Operator: Good afternoon, ladies and gentlemen, and welcome to the LENZ Therapeutics' First Quarter 2026 Financial Results Conference Call. [Operator Instructions] Following prepared remarks from management, we will conduct a question-and-answer session. And instructions will follow at that time. 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.
Daniel Chevallard: Thank you. Good afternoon, and thank you for joining us today. My name is Dan Chevallard, Chief Financial Officer of LENZ Therapeutics. We are joined today by Eef Schimmelpennink, our President and Chief Executive Officer; Shawn Olsson, our Chief Commercial Officer; and Dr. Marc Odrich, our Chief Medical Officer. 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, 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 first quarter 2026 Form 10-Q which is being filed today. With that, I will now turn the call over to Eef.
Evert Schimmelpennink: Thank you Dan. Good afternoon everyone. In Q1, our performance was consistent with the expectations we outlined on our last call. We delivered approximately 25,000 paid and filled prescriptions, bringing total monthly units sold since launch to roughly 46,000 and generated $1.9 million in net revenue, including $1.7 million in product sales. New patient adoption has continued to grow, but not yet at the pace we are aiming for. And I want to address that directly. We've done the work to understand the dynamics. We've identified what needs to change, and we're executing on those changes now. What continuously gives us confidence are the strong fundamentals underlying that top-line number, and the strength in the category we are building around VIZZ. Our product clearly works in the real world, which is reinforced by consistent feedback from both doctors and patients, underscoring that real-world efficacy is living up to expectations. We have built a growing base of prescribing physicians, with over 10,000 unique prescribers through the first quarter, and new prescribers writing for the first time every day. And we are seeing a very clear productivity signal emerge within our prescriber base. At this same approximate stage of launch, for our 46,000 filled scripts, VIZZ is generating roughly 30% more scripts per prescriber than VUITY, a pattern that holds true across all our prescribing deciles. In other words, we're reaching the same level of total volume with fewer prescribers because physicians who adopt VIZZ are prescribing it more consistently. This is an example of the encouraging dynamics that we're experiencing as we build a truly new category. Early adoption builds more gradually, but as prescribing habits are developed, they drive consistent uptake. In addition, we continue to see promising patient adoption and persistence. Once patients move from a sample to purchasing the product, many stay on therapy, which we have seen reflected in early refill behavior and, importantly, in purchasing patterns. Over 2/3 of our e-pharmacy volume is now coming from 3-month prescriptions, a meaningful increase in our e-pharmacy consumer purchasing behavior from Q4 to Q1. This highlights the point we want to make from a sampling launch: our patients try the product first, convert after experiencing the benefit, and then continue use. Taken together, this gives us confidence that we're building the category on a durable foundation, and we view these metrics as important early indicators which will scale over time. At the same time, and as we've noted during our last call, building a new category will take time, particularly as prescribing habits and patient behavior continue to evolve. Through Q1, the pace of new patient starts and routine ECP prescribing was more gradual than we expected it to be. We have a laser focus on improving that over the coming months and will hold ourselves accountable to demonstrating these upcoming quarters. As we are now several months into our launch, we believe we have identified the key barriers to adoption. Over recent months, we focused on these areas in depth, including through extensive work with advisory boards and direct engagement with both physicians and patients, to better understand how to improve both the prescribing process and the patient experience. There are 2 primary areas where we see clear opportunities to drive adoption. First, on the physician side, VIZZ is well understood. Brand awareness is extremely high among ECPs and VIZZ is recognized as best in class. However, it is not yet being brought up proactively enough in the patient conversation. This requires an important behavioral shift, as physicians learn to incorporate a new type of treatment into a routine exam flow. It does not historically include the integration of a novel pharmaceutical option for treatment of presbyopia. Second, on the consumer side, the path from awareness to prescription and ultimately to purchase is naturally a multi-step one. Surveys and direct feedback have highlighted where the patient journey can be further improved to support conversion. Based on these insights, we are sharpening execution and have already taken targeted actions to accelerate adoption. Again, on the physician side, we're refining how VIZZ is introduced in the exam room to make it simpler and more natural to bring into the conversation. One example is a renewed focus on contact lens patients, where VIZZ provides a clear and immediate value to that practice by helping patients stay in their lenses longer. This serves as a practical entry point that corresponds to a significant part of their patient and revenue base. We're highlighting ECP success stories from peers to illustrate how VIZZ has been integrated into practice, specifically for these patients as examples of real world wins. This helps physicians better understand and use VIZZ more consistently to drive real value, and from there expand usage more broadly across the presbyopia population. Importantly, as I've mentioned, these refinements are informed by direct work with advisory boards and testing panels of physicians, where we have incorporated real-world feedback on what works and how to improve both the ECP conversation and patient experience. On the patient side, we're evolving how patients get started on therapy. We've introduced tools, including a simple QR-based getting started with VIZZ experience video, that clearly explains how to use the product and what to expect, helping patients complete the initial trial and transition more confidently to ongoing use. Additional materials to support this effort are finalized and will be rolled out shortly. In addition, and we've omitted, we're enabling physicians to sell VIZZ directly to patients in their practices. This can simplify access and reduce friction in the conversion progress. Early feedback on this approach has been encouraging, while we remain mindful that this is not available in all markets. Taken together, these actions are designed to increase both how often VIZZ is introduced in the exam room and the conversion from trial to ongoing use. Shortly, Shawn will go into more detail on how we're executing against these priorities. In parallel, as we scale the product, we're also continuing to improve the overall user experience. We are transitioning to an FDA-approved, large scale manufacturing process that will further improve our direct product cost of goods. This also allows for a tighter formulation specification and enhanced vial format, which we expect will further improve both ease of use and comfort upon instillation. These are natural advancements as we move from initial launch to broader scale, and are part of our ongoing focus on optimizing the patient experience. Our attention now is on execution against the key drivers that I highlighted today. We expect that these actions will drive meaningful and measurable progress in ECP and consumer adoption as we advance through the year. We have a product that clearly works in a large and under-benefited market, and we continue to see strong validation from both patients and physicians on the value it brings. At the same time, we're building a new category, where both prescribing habits and patient behavior will need to evolve. Importantly, we have solid and actionable understanding on how we can influence that evolution to accelerate adoption. We've already begun to act on these insights and initiatives. And these actions continue to roll out across the field and the patient journey. We're focused on demonstrating meaningful and sustained script growth over the coming months and quarters. Lastly, in parallel we're seeing strong momentum outside the U.S. There are recent European and U.K. submissions, as well as meaningful inbound partnering interest from key markets including Europe and Latin America. Combined with our existing partnerships across China, Southeast Asia, Canada, and the Middle East, we believe we're building a strong foundation for global expansion. With that, I'll hand it over to Shawn, who will go into more detail on how we're executing against these priorities. Shawn?
Shawn Olsson: Thank you Eef. Good afternoon everyone. As Eef outlined, we are in the early stages of building a new category. And our focus is on translating strong product performance and early adoption signals into consistent and scalable growth. From a commercial perspective, we're encouraged by what we are seeing in the field. Eye care professionals prescribing VIZZ are seeing it work in their practices. And that confidence is translating into repeat prescribing behavior. We are seeing a growing number of physicians not only prescribe VIZZ, but write it multiple times. In fact, approximately 60% of prescribing ECPs have now written VIZZ multiple times. Which we view as a strong signal of confidence and early habit formation. ECP awareness and interest is high. Understanding of the product is strong. And consumer interest and awareness is growing. What we're focused on now is how we translate that interest into consistent prescribing behavior and consumer adoption. And importantly, doing so in a way that shows tangible progress in new script growth in this early phase of launch. Focusing on our eye care professional strategy. We continue to see strong engagement and adoption among physicians. Just a few months into launch, aided awareness is in the high 90s and unaided awareness is over 80%. Which tells us VIZZ is already well known in the eye care community for the treatment of presbyopia. We are also seeing that physicians clearly understand the product. They consistently describe VIZZ as differentiated, pupil selective, and ciliary sparing. While delivering a 10 hour duration. That level of clarity is important because it helps address the major barrier of being compared to previous products in this category. Where our focus is now is translating that understanding into consistent behavior. This is about helping physicians bring VIZZ into the patient conversation more naturally and more frequently. And integrating it into their standard eye exam flow. We are also seeing this translate into prescribing behavior. As Eef mentioned, at a comparable stage of launch, VIZZ is generating significantly higher scripts per prescriber than what was observed with VUITY. And importantly, we see that pattern consistently across the prescriber base. What that looks like in practice is that once physicians begin to prescribe VIZZ and integrate it into their workflows -- into their workflow, they tend to prescribe it more frequently compared to what we saw with VUITY at a similar stage. This is not limited to a small group of high volume writers, but something we are seeing more broadly across the prescriber base. This ties directly to how we have designed the launch. With sampling, patients experience the product first, and physicians utilize these experiences to build an understanding and confidence in VIZZ. That creates a more natural fit in the practice, where prescriptions are written with greater confidence and consistency. And we see this as an early indicator of how adoption can continue to build over time. As we've been working through this in the field, this also helped clarify where we should focus to further accelerate adoption. One of the areas we're seeing the strongest early traction is in contact lens patients. This is a well-known challenge for eye care professionals. The contact lens population peaks in the 30 to 39 year old age range. And as this group ages, up to 71% of patients drop out of contact lenses after the age of 50. Often reluctantly, with presbyopia being a key driver. This is not just a clinical issue but a core contributor to practice revenue, where contact lenses and related services play a significant role. What we're hearing from physicians is that VIZZ provides a very practical solution to that problem. As one physician put it, this is a way to keep my patients in contact lenses and improve their experience at the same time. This is a clear example of where ECPs can benefit for their patients and in their practice, through the regular adoption and prescription of VIZZ, as a patient satisfaction and retention strategy. That ability to both improve patient outcomes and support the practice makes this a highly relevant and actionable use case. Importantly, this is not just anecdotal. Our most recent consumer survey showed that approximately 50% of VIZZ users reported they used contact lenses as their primary form of distance vision correction, reinforcing that this is both a meaningful and scalable opportunity to drive adoption. Turning toward consumer strategy, we are encouraged by the early momentum we are seeing. But most importantly, this is where we see a key opportunity to improve conversion and scale adoption. Patients are interested in the product, and we are seeing strong engagement across our channels. What we are focused on now is improving how patients move from awareness to prescription and ultimately to purchase. The journey in a new category for a prescription drug is naturally more complex. A patient sees an ad, learns about the product, schedules an appointment, receives the sample and then decides whether to move forward with the prescription. Each step creates an opportunity to either progress or drop off. And our focus is on making that process simpler, clearer, and more intuitive. We are already seeing encouraging signals. Our direct consumer campaign is driving strong engagement with significant increases in website traffic and early indications that patients are entering the funnel. We are also seeing that when patients convert, they're engaging in a more committed way. In our e-pharmacy channel, which represents more than half of our prescriptions, over 2/3 of the volume is now coming through 3-month prescriptions, which is a strong signal of intense and early persistence. At the same time, we're actively refining our approach to improve conversion. On the messaging side, we have shifted to a direct problem solution consumer value proposition centered around tired of reading glasses, which directly connects with the everyday experience of presbyopia and positions VIZZ as a simple alternative. We are also improving how patients get started on therapy. This includes stronger expectation setting around how the product works, clear dosing instructions and what to expect in the first few days. We have also prepared simple onboarding tools such as QR-based resources that guide patients through the initial experience and help them transition from trial to ongoing usage. In addition, we are continuing to expand and refine our media approach. This includes testing additional channels such as linear television in select markets while actively optimizing our creative and media mix based on real-time performance data to ensure we're driving the most effective engagement. We're also seeing increased interest from physicians in directly selling VIZZ to patients from their practices where permitted. This approach is currently being implemented in select markets and structured in a way that maintains our expected economics while giving patients the additional flexibility -- sorry, while giving practices the additional flexibility to serve their patients. We believe this could also offer a significant benefit of convenience for the patient where they can leave the ECP visit with product in hand, reducing the hurdle of pharmacy abandonment. Finally, these efforts are supported by the expansion of our field organization, which will be fully deployed by the end of this quarter. This increases the reach of our field sales team to approximately 15,000 targeted eye care professionals, allowing us to respond to inbound demand from physicians outside our initial target group and to build higher frequency territories. The combination of increased reach and frequency is critical to reinforcing both physician behavior and patient conversion. Taken together, these actions are focused on increasing the number of patients who move from initial interest to trial and from trial to ongoing usage. Overall, we're encouraged by what we are seeing in the early stages of the launch. We have strong physician engagement, bigger patient interest and a growing set of levers to drive adoption. At the same time, our focus now is on translating these actions into meaningful and sustained NRx script growth over the coming months and quarters. We believe we have the right elements in place and our priority is executing against them with discipline to build momentum from here. With that, I'll turn the call over to Dan to walk you through our financial results.
Daniel Chevallard: Thank you, Shawn. As both Eef and Shawn have stated, we are encouraged by the performance of VIZZ in the hands of patients and ECPs as we build the presbyopia market. The early signs of broad ECP uptake are there, as evidenced by the over 10,000 prescribers in the first 2 quarters of launch. A figure higher than any recent launch in ophthalmology at this stage. Additionally, consumers are emerging with positive real-world experiences every day as product awareness deepens and our early launch efforts begin to take hold. Our first quarter results were highlighted by the approximately 25,000 paid and filled prescriptions of VIZZ, which was a 19% increase compared to Q4. Resulting in approximately $1.7 million in net product revenues. Our units continue to be driven by both a combination of new patient prescriptions and increasingly by monthly refill units, including both single monthly packs and 3-month orders, which are available through our e-pharmacy. While it is early at this stage of launch to be declarative about projecting annual refill rates, we are encouraged by what we are seeing in the initial trends. In Q1, and consistent with last quarter, we noted blended gross to net discounts across our distribution channels of less than 10%, resulting in approximately $67 in net revenue per monthly pack of VIZZ. Additional blended costs of the respective distribution channels of approximately $7 per unit were incurred that flow into operating expenses within SG&A, resulting in a net cash per unit of $60 per pack. That is unchanged from last quarter, and in line with our long-standing expectations. Additionally, we recognized license revenue in Q1 of $250,000 from the distribution agreement signed in January with Lunatus, our ex-U.S. distribution partner in the Middle East region. As I discussed on our Q4 call, there is significant effort underway with our existing ex-U.S. commercial partnerships as we advance towards multiple additional regulatory approvals for VIZZ, and we remain focused on the continued expansion of our global network of commercial alliances. We look forward to reporting additional progress in the months and quarters ahead. Turning now to operating expenses. Our cost of sales in the first quarter totaled $1.1 million and was comprised primarily of 2 nonrecurring events, resulting in charges to cost of sales in the period that were unrelated to product sales. The first was a period cost stemming from an out of specification temperature excursion of inventory while in transit from our manufacturer. We expect recovery from this product loss from our insurance provider in the second quarter. In addition, we incurred a onetime charge for packaging supplies associated with the previously mentioned FDA-approved manufacturing process improvement and transition. Direct product cost of sales related to our Q1 product sales were immaterial, and we anticipate VIZZ to trend to an approximately 90% direct product gross margin over time. Total SG&A expenses increased to $45 million in Q1 2026, or approximately $40.7 million net of noncash stock-based compensation. This was a 13% quarter-over-quarter increase from Q4 and was driven by our planned DTC launch investment. As is consistent with last quarter, approximately 80% of our SG&A was driven by sales and marketing, with the remaining representing general and administrative expenses. Of note, we anticipate that our Q1 2026 OPEX SG&A and the resulting cash burn is higher than our go forward quarterly run rate over the balance of 2026. Total research and development expenses were 0 in Q1, which is consistent with last quarter. Finally, our net loss per share, both basic and diluted, was $1.32 per share in the first quarter of 2026 on a net loss of $41.5 million. We ended Q1 2026 with approximately $258.4 million in cash, cash equivalents and marketable securities, and our Q1 2026 net cash burn of approximately $34 million was consistent with Q4 and in line with our budget. As we discussed on our recent year-end call, our current sales force expansion is in our 2026 operating plan and we will continue to target an allocation of approximately 80% of our SG&A to sales and marketing. In summary, we entered the second quarter of 2026 at an important point in the launch, with a clear operational plan, a strong cash position, and conviction that the actions underway will translate into meaningful growth. With that, I'll turn the call back over to Eef.
Evert Schimmelpennink: Thanks Dan. To conclude, I'm incredibly proud of the LENZ team and the progress we have made over the first 2 quarters of our launch. We're seeing what we hope to see, a product that clearly works, encouraging early signs of patient persistence, and a growing base of prescribing physicians. At the same time, we're under no illusions about where we need to go. While building a completely new category takes time, and enacting changes in both prescribing habits and patient behavior is crucial. And we have progressed from diagnosing the early adoption dynamics to actively addressing them. We're committed to demonstrating clear and measurable progress over the coming quarters, and we look forward to reporting back on that. Our focus now is 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. And as we continue to execute our priorities, translating VIZZ into meaningful and sustained script growth. We look forward to updating you on that progress as we move through the year. And with that, I'd like to open up the call for questions.
Operator: [Operator Instructions] And our first question comes from the line of Stacy Ku with TD Cowen.
Stacy Ku: And we appreciate the details of VIZZ launch discussion. So we have a few follow ups. First, it's still early days with linear TV and of course the first steps of the sales force expansion. Just help us understand, are you able to go into additional detail on encouraging signs beyond the current prescription trajectory. Are you able to identify a specific type of practice that is prescribing VIZZ multiple times. So that's the first question. And then on the second question, we do appreciate that 3-month metric from the e-pharmacy, it's very interesting. We wanted to confirm, for the next earnings call, will we be getting specifics on refill dynamics. So that's the second question. Now the third, we're just trying to understand how we should be thinking about sampling and competitive dynamics. Tenpoint, Yuvezzi, they've now launched. Just help us understand what type of counter detailing we might be seeing in real time. Should we also expect samplings from both Yuvezzi and Qlosi. And then last, on VIZZ safety. This may be contextualized, what we're seeing in the FAERS database for the launch. Now that VIZZ has been on the market for over 6 months, what are your views on VIZZ's safety profile? And maybe Shawn, maybe you could share perspectives from the patients and prescribers.
Evert Schimmelpennink: Thanks Stacy. Great set of questions there. Shawn will actually start giving you out and give some insights in the signs that we are seeing on our DTC and linear TV impacts. I'll actually now see if -- let me address the refill one first before we then go to the samples and that DTC impact. Clearly, that's a key that we've been very clear on from the beginning, we will start to share in the second half of this year. And just to repeat what we said earlier, the reason that we've always focused on the second half of the year is that we really want to see those cohorts of patients that we can look at that refill step refill step mature a little bit over time. And if you think about our Q4, so first order of launch patients, obviously order that first script in Q4 and refill in Q4. We're also seeing is that, as we've mentioned, it's time to move over to the 3 pack and logically for our 3 pack you're going be back for a reorder in at least 3 months. So we feel important to see that patient behavior a little bit more, which is why we've always indicated that we'll start sharing those refill data in the second half of this year. So I'll hand over to Shawn to talk about the DTC impact and samples and what we're seeing competition do. And then Marc will address your safety question.
Shawn Olsson: So safety things for -- or for your question about the DTC. So what I can say so far, the early indicators are strong. So the engagement with the ads are high. We look at the click-through rates. We look at the cost per thousand impressions, and we're seeing the numbers that we want to see there. And our website traffic is up significantly. We see peak of up to 10x what we used to see on our website traffic. The consumer awareness itself is building. We are hearing that Sarah Jessica Parker is resonating very well, and we have a broad digital reach ongoing. That being said, awareness is still early overall. So we still have more to do on driving greater consumer awareness, but we've seen an encouraging response from that low base and more patients entering that funnel. So what we're seeing is we're having great success on platforms like YouTube, where we're seeing ad recall and ad awareness lifts better than benchmark, and we're seeing a similar ad recall lift on Pinterest as well. So this category is naturally slower to convert because of all the steps required to get to the prescription. But we continue to monitor this and actively optimize our campaign to ensure we have the best media that's out there and refine the creative testing is needed. As I said in the earlier opening remarks, we leaned in more to the problem solution marketing of tired of readers, here's a solution, which is VIZZ. So our focus right now is that strong conversion improvement, and we expect to see a stronger impact over time because DTC typically takes a few quarters to mature. So the next question there is around the competitive so -- environment. So we continue to see VIZZ as a category of one product differentiated by its unique MOA. That being said, the market can definitely support multiple entrants. There's a large unmet need and other people out there speaking on the benefits of eye drops and presbyopia is an overall benefit to the category. This is a product where trial is very easy. So our sampling strategy wants the patient to try the product. We know in head-to-head, if you were to try the different products, our product stands alone in terms of 10 hours of efficacy and that broad patient population. So efficacy ultimately determines winner, and we feel very strong about our efficacy. We know that the prior products didn't really satisfy the market, and this is clearly differentiated with our long duration, broader efficacy, different MOA and only people selective myotic. So that real-world experience is reinforcing that iteration and competition helps build that awareness, but our focus remains execution-driven on driving this.
Evert Schimmelpennink: Before we go to Marc, just 2 quick additions to that. So your question on if the competition is Qlosi and Yuvezzi are they sampling? Yes, maybe not as broadly as we are, with the VIZZ samples but they are putting in the market. And then maybe the underlying part of your question is, for sure, if we were to stop sampling, which we're not intending to do, you would see NRx go up. I think you'd also start to see the behavior that you saw with VUITY. So from the beginning, sampling has been a core part of our strategy. We will continue to do that. And as I mentioned earlier, we're actually seeing the behavior that we want to see being driven by sampling. You sample, they like it, they convert to buying the product, and getting more sticky than if your order is just basically a sample. So with that, let me hand it over to Marc to talk a little bit more about the safety profile and what we've learned to date.
Marc Odrich: Thank you, Stacy, for your question. And it's one we're happy to get into because our data is genuinely one of the strongest parts of the VIZZ story so far. 6 months in, we've shipped approximately 46,000 boxes, which is roughly 1.2 million doses, in addition to widespread sampling on top of that. We've created some very broad use of VIZZ. What we're seeing in the real world is fully consistent with the label. The non-serious AEs being reported are mostly transient and in line with what we saw in the clinical program. On the retinal side, it is important to start with the natural background rate. In the total population, this is about 27 per 100,000, with risk increasing with age and level of myopia. So considering the background incident rate and the significant use of VIZZ thus far, 0 retinal detachments and only 2 retinal tears is much lower than what you would expect. Importantly, both retinal tears occurred in patients with pre-existing retinal risk factors, meaning they carried elevated risk independent of any treatment. Our retina experts have reviewed both cases and assessed them as likely non-causal. Honestly, again, given the number of patients now on VIZZ and the background rate of around 27 per 100,000, you would expect to see more events than this. We believe that 2 cases at this level of exposure isn't a signal, but really just non-causal background incidence. I know everyone is looking at what VUITY saw, so let's talk about VUITY for a moment. At what we believe is a comparable exposure to where we are today, VUITY had about 34 retinal events on the books, 22 of them were detachments. We believe that this shows what we have said all along: aceclidine is a different molecule than the other 2 other miotics on the market, with a different mechanism of action, and we're seeing a really different safety story play out in the real world. VIZZ is the only pupil-selective miotic. It doesn't significantly engage the ciliary body, and ciliary body engagement is the pathway most associated with retinal traction risk in this class. Across thousands of medical discussions we've had with eye care professionals, the ECP community clearly understands that mechanistic difference, and they consistently associate VIZZ with a lower perceived retinal risk profile than other miotics for presbyopia. As exposure continues to grow, what matters is that the retina-related AE rate stays below background and that we don't see a mechanistic signal. To date, that's exactly what we're seeing. The product is safe, the data supports it, and we'll continue to be transparent as the real-world experience builds.
Shawn Olsson: And to just -- to add on to a little bit to the last part of that question that you had, Stacy, on what the perspective is from the ECPs and the patients. Well, I can tell you from out in the field what I see, the doctors clearly understand that aceclidine is pupil-selective. They completely understand that because of one, the MOA that's in the PI that directly states it. And two, when people use this product, we continue to hear about that benefit of distance vision, which is avoiding that ciliary muscle, and that's why they're getting that benefit in distance vision as well. So the doctor and ECP community completely understands and aligns with the unique nature that is only available through aceclidine. And from the consumer standpoint, their focus really isn't on that, but when I think of consumers, it's making sure we set that right expectation regarding to the stinging upon instillation or redness that's on instillation is transient over time. And that's where we've been putting a lot of work into the getting started videos and QR codes, as well as training the doctors to set that right expectation for the patients.
Operator: Your next question comes from the line of Yigal Nochomovitz with Citi.
Yigal Nochomovitz: Thanks for all the detail. Appreciate all the color as you move through the first few quarters of the launch. You mentioned that the prescribers are not proactively talking enough about VIZZ in their initial patient convos. I'm wondering if you could just sort of expand a little bit more on that. I know you mentioned Eef and Shawn that contact lens wearers was an area of focus. I'm just wondering if there are other categories or other aspects of a patient's profile that would be good natural hooks in order to introduce the VIZZ concept in the course of an initial patient conversation. And then I know earlier before the launch, you talked about average utilization somewhere in the 5 months of the year range which varies depending upon heavy users versus light users. I'm just wondering if you believe that that's still a valid assumption or if you think that needs to be adjusted.
Shawn Olsson: Thanks, Yigal. So starting with the prescribers focused on how often they bring up VIZZ. So we need them bringing up VIZZ more often in their standard exam. Their standard exam is pretty quick, right? They'll go through an eye exam in 20 minutes, and they have a regimen that they follow. And once you get it into almost like a muscle memory, you consistently do the same thing unless the patient proactively brings up VIZZ. So we need to help them change how they run through that standard process. And so what we did and what we're doing to do that is we actually worked a lot on our message sharpening, so we're making it easier for the doctor to bring it up quickly. And part of that is this video and QR code. Now they don't have to spend the time, as much time walking the patient through expectation setting as well as how to use the drop, how to put in an eye drop, we've moved that over to a digital video format. That way, the doctor can bring it up easier and quickly in their natural eye exam. So this product still has broad adoption, but in our research, what we've seen so far of consumers is 50% almost of our patients that are on VIZZ use contact lenses as their primary vision correction. And that's a natural benefit for both the patient and the practice. So that's why we're focusing and leaning heavier into the contact lens strategy right now to create that muscle memory for the doctor. It's clear physician value, and it's a clearly identifiable patient. And by doing that, we can help create that cycle of I can always bring up VIZZ, and I can do it quickly. So that's really where we're focused in terms of making sure the prescribers bring it up more often.
Evert Schimmelpennink: Two other parts of that question beyond contact lenses, like Shawn mentioned, it's an important group. It's 10 plus million people, a very valuable one. We're seeing the groups that we've mentioned before. So without too much detail, it's the people that have had LASIK before, the people that are striving for an active lifestyle. We're also seeing great success in emmetropes, so people that have never been to a optometrist, they come in because they're now becoming presbyopic. So all those categories play. The contact lens one is one that we can very easily help the doctor understand what the value is for a patient and for them. And then on the refill rate, yes, we've always spoken about the 5 refills a year, and you can see our commentary on conference in light of what we said before.
Operator: Your next question comes from the line of Iren Amin with Piper Sandler.
Biren Amin: Maybe to start, you talked about going to physician offices directly to sell VIZZ in select markets. Can you maybe just talk about how this might impact your margin? Because there would be an economic incentive to physicians. So I was just wondering how the math will work for both the company and for physicians. And I guess, what target markets are you expecting to reach out to, and how many of these are in your top 1,000 ECP prescribers?
Shawn Olsson: Thank you. This is Shawn, and I'll cover a key aspect to the selling direct model and explain how that functions and operates. So for optometrists, generally, in about half of the markets in the U.S., half of the states, optometrists are able to sell prescription drugs out of their practice. So where it's allowed we offer the opportunity for doctors to buy the product directly from LENZ. That product ships to the doctor's office. From that point on, they're able to prescribe it and sell it to the patient. From an economic standpoint, you should think of this as the same economics to LENZ as a product that flows through our e-pharmacy or a product that flows through a retail channel. And our target markets are those ones, and specifically, where this is an optional avenue, which goes back to about 25 of the 50 states.
Daniel Chevallard: I think, Biren the only thing I would add to that is the revenue transaction is when we talk about gross to nets and net kind of the net price per to the company of $60 net cash per monthly unit, you can roughly estimate that from a modeling standpoint. So I wouldn't differentiate it from a channel perspective. It's just different kind of methods of selling direct and avoiding some of those costs of the wholesaler or the other distribution costs. Otherwise, very high-quality revenue transaction because it's a direct transaction between us and the doc. So in short, no meaningful difference in net economics to the company.
Biren Amin: And then maybe if I could have one more question. I think at the end of March, the company stated that emerging presbyopes were identified kind of as early adopters, and you wanted to expand beyond this group. Can you maybe talk about those efforts in terms of expanding beyond the emerging presbyopes to a broader group over the last 6 weeks or so?
Evert Schimmelpennink: Thanks, Iren. As said, maybe you referred to it that in the last call, indeed, we said that not so much from a consumer point of view, but from a ECP point of view, their initial focus on who had this product, patient type, for whom this product would work well was we saw somewhat limited to early presbyopes. That was a carryover, frankly, what we believe and what we hear from VUITYs launch, because they have that limited efficacy. They really focused on this group early, emerging emmetropic patients of presbyope. We clearly work in a much broader population. That's part of what that sharpening and messaging is to continue for our sales force to remind the doctors that while that is a appropriate category, it's just a fraction of the patient population that you can use this product in. So again, that's part of where the messaging has changed.
Shawn Olsson: And so tactically, what that has means actually move that knowledge to the doctors. We actually developed an additional piece for the field that they're out there using, specifically focused on that broad inclusion of our study trial, where it showed that we worked just as well in both moderate and advanced presbyopia as well. Tactically, also, what it means is we've updated some e-mail campaigns and posts that are targeted at ECPs that bring in peer-to-peer statements of other doctors sharing those successes that they've had with VIZZ in nonearly presbyopes to help bring that across from a peer-to-peer view as well as an advertising view.
Operator: Your next question comes from the line of Marc Goodman with Leerink Partners.
Alyssa Larios: This is Alyssa on for Marc. Thank you for all the detail on the update. Just a few questions from us. Could you give a little bit more color on the ECP direct sales initiative? I know you said they could order directly from LENZ, but would that be timed shipments, or would it be at-will ordering as they deplete their inventory? And also could you discuss the network TV direct to consumer advertising and what markets exactly you're launching that in the pilot period? Thank you very much.
Shawn Olsson: Great. Thanks for the question, Alyssa. This is Shawn again. Just a little bit more color on the ECP direct sales initiative. So these are an engagement that we enter into with the doctor. We have a contract between us and them that outlines the rules and the model itself. It is at-will ordering, so they have to order a case of product at a time, and then we ship it to them directly. At that time, they're charged and we collect payment ahead of us shipping the products out to them. So it really is a very simple model. We enter a contract with the doctor, we send the doctor an invoice for at least one case at a time, they pay the invoice for the case, we ship it directly to that doctor, and from there, they can then prescribe and sell the product to the patient in their market. So it's at-will under a contract. And then in terms of our network TV, so we've just started to do network TV in select key markets. There are a few different markets across the U.S. that we're doing this in, and we're doing it to make sure we can see what the signal is in those markets. We're running linear TV. We're still only a few weeks into it's too early to provide any details on that list.
Operator: Your next question comes from the line of Lachlan Hanbury-Brown with William Blair.
Lachlan Hanbury-Brown: Maybe on the direct to ECP sales approach, should we read from that you are maybe seeing some abandonment obviously between writing the script and patients actually filling it and that this is obviously going to sort of hopefully reduce that issue? Or is this maybe also obviously to get the physicians incentivized and make it top of mind for them, if they're seeing it in their office every day? And then maybe a second one, Shawn. I know you mentioned the change in the, certainly the name of the DTC campaign. Wondering how much more of the sort of actual content of that has changed with this new sort of problem/solution approach that you're taking?
Shawn Olsson: Thanks a lot. I appreciate the questions. So the Direct to ECP Program, that initiative was came out of just pure ECP demand as well as consumer convenience, as we want to make sure that process is easy as possible. It didn't come out of an abandonment issue. It truly was something that the doctors have been requesting for a while, and we now have the infrastructure in place to support. In terms of the content of the DTC. The tired of reading glasses and then the solution of VIZZ was a change to bring a direct alignment between those that are in readers and frustrated as a solution to that. It doesn't result in an overall change of any core creative. The creative itself still stands strong. SJV continues to test well. It's more about creating that direct connection right off the bat when people see the ad. So that's the only reason for that change. When you think of that lean into these contact lens patients, those are the people in reading glasses. When you think of those LASIK patients, those are the ones in reading glasses, so it's just bringing a tighter connection on the value proposition of VIZZ.
Lachlan Hanbury-Brown: So maybe one other just on the direct to ECP. Do you have clauses in those contracts to ensure that they charge a certain price? Or is there a sort of ceiling or floor to what they can charge in there?
Shawn Olsson: Yes. So the way that it's structured to make sure that we're setting up the right way, so we have the price that we sell it to the doctor and then the doctor can set their own final price to the patient. However, with the guardrails we have in place, so it is very clear in our materials that for $79, you can buy it from the e-pharmacy. We've got our Rx card at $79. We have a retail structure in the background. So those now are on the actual pricing pressures. We'll hone in that price for the ECP.
Operator: Our final question comes from the line of Matthew Caufield with H.C. Wainwright.
Matthew Caufield: Regarding the refills, any further observations on switching from the 1-month to the 3-month dynamics? And is that something that could have greater clarity during second half 2026? And then just additionally, with the R&D dropping to 0 for the quarter, is that drop anticipated to remain for the foreseeable future, keeping the R&D at 0 and the OpEx essentially just concentrating on the SG&A for the launch moving forward?
Evert Schimmelpennink: So on the refills, yes, we definitely see patients move. Classic example is somebody ordered a 1-pack first, and then because they like it, they move to 3-pack and they continue to do that. So that dynamic is an important one and one that we highlighted. If you look at the e-pharmacy site, which is obviously the only place where you can get a 3-pack, but that channel represents, more or less, well, the majority of our volume. You see that 3-pack now drives about 2/3 of the volume that we sell through e-pharmacy. So definitely an important factor of what we're selling. And going back to what we said earlier, we do anticipate as we move into the second half of the year, we'll be able to little bit -- to give a little bit more color on some actual statistics around that refill behavior. And then on the R&D, Dan?
Daniel Chevallard: Yes. I will take that question on the R&D spend. So I think the short answer is yes, you should expect R&D to be substantially 0. We kind of signaled over the course of 2025 a shift in the capital allocation of the company with the completion of the CLARITY studies in early last year and movement towards commercial. So you would've seen R&D be effectively 0 in Q4 and again in Q1, and that should be the expectation for the foreseeable future.
Matthew Caufield: Got it. Congrats on the progress.
Operator: And that concludes our Q&A session as I'm showing no further questions in queue. Thank you for your participation, and we will now conclude today's conference call. You may now disconnect.