Hello, and welcome to Alcon's Second Quarter 2021 Earnings Call and Webcast. At this time, all participants are in a listen-only mode. [Operator Instructions]. A question-and-answer session will follow the formal presentation. We ask you to please ask one question and one follow-up, then return to the queue. As a reminder, this conference is being recorded. It's now my pleasure to turn the call over to Karen King, Senior Vice President, Investor Relations and Corporate Affairs. Karen, please go ahead.

Welcome to Alcon's second quarter 2021 earnings conference call. Yesterday, we issued a press release and interim financial report and posted a supplemental slide presentation on our website to enhance today's call. You can find all of these documents in the Investor Relations section of our website at investor.alcon.com. Joining me on today's call are David Endicott, our Chief Executive Officer; and Tim Stonesifer, our Chief Financial Officer. Our press release, presentation and discussion will include forward-looking statements. We expressly disclaim any obligation to update forward-looking statements as a result of new information on future developments, except as required by law. Our actual results may vary materially from those expressed or implied in our forward-looking statements. Accordingly, you should not place undue reliance on any forward-looking statements. Important factors that could cause our actual results to differ materially from those in our forward-looking statements are included in Alcon's Form 20-F and our earnings press release and interim financial report on file with the Securities and Exchange Commission and available on the SEC's website at sec.gov. Non-IFRS financial measures used by the company may be calculated differently from and, therefore, may not be comparable to similarly titled measures used in other companies. These non-IFRS financial measures should be considered along with, but not as alternatives to, the operating performance measures as prescribed per IFRS. Please see the reconciliation between our non-IFRS measures with directly comparable measures presented in accordance with IFRS in our second quarter earnings presentation, which can be found on our Investor Relations website. For discussion purposes, we are providing comparisons of 2021 versus 2019, unless otherwise noted. While you need to take into account a 2-year period, we believe the comparison versus 2019 is more operationally meaningful since our results were significantly impacted in the second quarter of 2020 by the pandemic. You will find a summary of results comparing 2021, 2020 and 2019 in our slide presentation and a comparison of 2021 versus 2020 in our press release and interim financials. As usual, our comments on growth are expressed in constant currency. With that, I will now turn the call over to David.

Thanks, Karen, and good afternoon, everyone. Welcome to our second quarter earnings call. I'll begin by providing a brief update on our second quarter, overall market dynamics and recent performance. After my comments, Tim will discuss our second quarter performance and our updated outlook for the full year, then I'll wrap up with some closing remarks, and we'll open the call for Q&A. We had a very strong second quarter with the highest quarterly sales and earnings since our spin-off. This was driven primarily by demand from new product innovation and solid commercial execution, coupled with strong market recovery in the United States. Q2 sales of $2.1 billion were up 11% versus 2019, with increases across all sales categories in Surgical and Vision Care. Core operating margin improved to 18.2% and core diluted earnings per share improved to $0.56. Overall, our Surgical franchise continues to outperform the market. We're growing share with our latest advanced technology IOLs, consumables have returned to growth in line with the recovery in procedural volumes, and we continue to see strong demand for our equipment. Our Vision Care franchise also returned to growth over 2019. Our new product launches are gaining momentum and expanding our market share despite variable recovery in international markets. PRECISION1 continues to be our leading brand for new and switch fits, even though new fits are still down globally. Consumer demand for Pataday Extra Strength has been better than expected, and our SYSTANE brand family is posting strong growth, aided by our newest products, SYSTANE Ultra and Hydration Multi-Dose Preservative-Free. Moving to our end markets by franchise. In Surgical, the global cataract surgery market was down versus 2019, with the U.S. showing solid growth over 2019 and international markets below the 2019 levels. That's primarily due to suppressed markets like Japan…

Thanks, David. We're pleased to report second quarter sales of $2.1 billion, up 11% versus 2019, driven by 14% growth in the Surgical business and 8% growth in Vision Care and broad-based growth across all sales categories. Year-to-date, sales were up 9% versus the first half of 2019, with Surgical up 11% and Vision Care up 7%. Implantables continue to reach new highs, driven by momentum from our new product launches. Sales were $387 million in the second quarter, an increase of 29% versus 2019. PanOptix and Vivity continue to take share, and strong adoption is driving encouraging penetration rates. On a year-to-date basis, implantable sales were up 25% versus the first half of 2019. Consumable sales of $620 million in the second quarter increased by 4% versus 2019. We're pleased to see sales growth across cataract, vit-ret and refractive consumables. On a year-to-date basis, consumable sales were flat versus the first half of 2019. Equipment and other sales were $199 million in the quarter, up 23% versus 2019 due to several reasons. First, our phaco equipment continues to benefit from innovation and strong commercial execution. In Europe, we've been focused on actively upgrading customers from legacy INFINITI devices to our newest-generation Centurion machine. We've also seen healthy demand for innovation like the ACTIVE SENTRY handpiece. Second, given the significant backlog of procedures, we're seeing some accounts expand capacity into new operating rooms or alternate sites of care, which is driving demand for new equipment in the interim. And third, refractive has continued its trend of strong demand, which accounted for about half of the equipment growth. While we're enjoying the benefits of higher consumer discretionary income and increased focus on health and wellness, we don't expect to sustain the favorable trend in refractive over a longer period. On a…

Thanks, Tim. Before we open it up for Q&A, I want to thank all of our associates for a great quarter. Our results today demonstrate what we can achieve with great innovation, commercial execution and manufacturing excellence. Pleased with our ability to deliver growth and outpace the market. Our share gains are remarkable considering current conditions, and we're confident that we're well positioned to capture an outsized benefit as the global markets recover. Until then, we remain laser-focused on supporting doctors and patients while we deliver long-term value to shareholders. So with that, let me open it up for Q&A.

Thank you. We’ll now be conducting a question-and-answer session. [Operator Instructions]. Our first question today is coming from Michael Leuchten from UBS. Your line is now live.

Oh, thank you very much. A quick question on your comments around capacity expansion in some of your key accounts. Does that come with some inventory fill that would suggest that maybe some of the Surgical growth we see in the second quarter we shouldn't translate into the third quarter and further? And then the second question, just as we see the Delta variant increase and have some impact in the U.S. -- you made a bit clear what your assumptions are with your outlook for the international markets and Europe. But it sounds like you're not worried about the U.S. at this point in time. Is that a fair interpretation of your comments? Thank you very much.

Well, on the second one, Michael, I think we are comfortable that we understand where we are right now. But again, the Delta variant is moving around the U.S. quite quickly. And I think we have a trajectory on it. We kind of have a view of it. I don't know that anybody really knows what's going to happen there. So it's baked into our thinking for sure, but I would just say that there's no certainty around what's going to happen. On the capacity expansion, I'm not sure I understood your question precisely, because if it's referring to our surgical growth and are we expanding for surgical, that's not really where we're adding capacity right now. We have plenty of capacity in our surgical business right now to manage key accounts and/or expansion around the Surgical business. Capacity expansion is going on principally to kind of keep up with demand in the Vision Care. That's our principal expansion effort. And again, our expansion is related really to our interpretation of demand. Right now, demand has been better than we expected, but we're going to keep a close eye on it and evaluate capacity as we go forward.

Thank you.

Thank you. Your next question today is coming Veronika Dubajova from Goldman Sachs. Your line is now live.

Hi, guys. Good morning, and thank you for taking my questions. I will also keep it to two. One, just would love to understand, David, kind of the type of momentum that you saw as you moved through the quarter, obviously, very strong performance. I'm kind of trying to see was it weighted more towards May and June? And how is that continuing into July? Or was that kind of growth momentum that you saw pretty steady throughout Q2? And just maybe kind of try to push you a bit more on this Delta variant, have you seen any deceleration in the U.S. since you've reported Q2? Just to give us a sense for where you are? And then a big-picture question just on Vivity and PanOptix. Where do you think we are with AT-IOL penetration? And now that we've seen continued uptake here, are you more confident in seeing a step change here in momentum as you look forward? Thanks, guys.

Hey, Veronika, thanks for the questions. Let me try and give a little bit of color on the quarter itself. I think, inside the quarter, we had pretty steady momentum. It wasn't choppy. I think what was happening really was the U.S. was doing really well coming back through April, May, June, kind of consistently. And again, it was -- it's relatively consistent month-to-month in terms of its growth. I don't know that we have seen any real signs of deceleration in the U.S. around Delta. I would say, outside the U.S., in the second quarter, we actually saw a little bit of improvement in Europe. But obviously, some real challenges in India and Japan. And so the international markets broadly are quite complicated to describe, but I would just say that we think it's going to take a fair bit longer for the international markets to get back to 2019 levels. We said kind of early 2020 -- sorry, they'll get back to '19 levels early next year, which is 2022. U.S. should grow. Our assumption is U.S. is going to grow through the rest of the year. And again, the rate of that growth is kind of hard to know based on the Delta variant. But the only thing we've seen really is few hospitals here and there where they've shut down some elective procedures. But in the U.S., our business is dominantly in the ASCs, and those ASCs are not shut. So again, we haven't really seen any material impact on surgical procedure volume in the U.S. Internationally, again, it just depends on what market we're talking about, and I think that's going to be more of a slow grind. On the second one on penetration, Vivity looks like it's adding about 300 basis points over the…

Very clear. Thanks.

Thank you. Next question today is coming from Larry Biegelsen from Wells Fargo. Your line is now live.

Good morning. Thanks for taking the question and congrats on a nice quarter here. One for you, David. One for Tim. So I'll ask them both here. David, do you think Q2 benefited from catch-up procedures and you expect that to continue for a few quarters? I know you talked about potentially cataract procedures, for example, running hot, to use your words, coming out of the pandemic. And then, Tim, one thing, big picture that was interesting to me is we've seen the Surgical margin increase about 700 basis points since 2018 to 27%, but the Vision Care margin has actually decreased by 200 to 300 basis points over that time. Why has the Vision Care margin eroded? And what's the outlook for each? Thanks for taking the questions, guys.

Yes. Thanks, Larry. Listen, on 2Q for surgical procedures, our understanding of the market at this point was that it was up mid-single digits. So if you do that over '19, mid-single digits, let's just cut it in half for each year, that would be pretty much the normal procedural growth that we would have expected to have seen during that period of time. So given that there really wasn't any last year, there must have been some made up. But what I would say is that the capacity to make up a lot of this in the United States is relatively small. Most ORs are running, we think, in the kind of 85% to 90% capacity -- or sorry, of their capacity. And so that really only gives us, let's just call it, 10% to 15% of additional makeup. So if you figure, we lost 1 million cataracts over the last year or so, maybe 1.1 million. It's going to take us a while, given that we do, what, 4.5 million of procedures a year. 10% would only get you through -- if everybody in the system worked at nearly a 100% capacity, it would take you a couple of years to get through it. That's how we're doing the math right now. That could change. We are seeing a little bit of additional capacity being added. Some of the equipment volume you see in our business right now is a function of additional -- people adding additional ORs, not a lot of it, but a little bit of it. So we're cautiously optimistic. But I think what you're going to see is kind of a slightly warmer than normal -- we would normally call procedural growth 3%. I think it's going to be a little better than that going forward for several years.

Yes. And then on the Vision Care lines, I would just say this, if you take -- to your point, if you go back, I'll just take 2019, the end of 2019, I think the Vision Care margins were around 18%. And we just reported, obviously, 16.4% in Q2, so there has been some pressure. Again, that is primarily driven by the Vision Care lines and the installation of those lines. So if you go back to that Capital Markets Day presentation and you look at the lines that we have put in, you'll see that there were a bunch of lines put in, in '19, even more so in '20, and we continue to put lines in '21. And we'll continue to meet demand as we go forward. So that pressure is really driven by the fact that it takes anywhere between 18 to 24 months to get those things fully up and running. So we've got sort of a pressure point up right now as we talked about it at the Capital Markets Day. Again, I think what our plans are is you'll start to see that those margins pick up probably in the '22, '23 time frame as we get through this sort of catch-up phase on the CapEx front.

Our next question today is coming from Scott Bardo from Berenberg.

David, I wonder if you could give us some sense of the relative share then of your presbyopia-correcting business. So can you split that roughly now between PanOptix and Vivity and other monofocals? Just give us a sense really of how Vivity is taking up. And furthermore, can you perhaps discuss a little bit then how DAILIES TOTAL1 is trending amid the PRECISION1 launch. That would be helpful. And follow-up question, please. Obviously, Michael Onuscheck has gone on to pass to his new. I just wondered if you could talk a little bit about the global business and innovation position and what your stance is in terms of filling that management capacity.

Sure. Let me start with the first one. Directionally, we continue to gain unit share globally in the PC-IOLs, particularly, it's really on the U.S. strength. Vivity and PanOptix have done really well. And obviously, in value, we get a real benefit from that, particularly when we upgrade toric patients or monofocal. So as the penetration has gone up, we've done well. And our -- I think we said our share in the United States is 80-plus. And I think our global share is somewhere around 50-plus. So we've been a little bit coy below that saying what Vivity and PO split -- PanOptix split was. But I think directionally, you can assume that PanOptix is the majority of it right now. And Vivity is relatively new. So it's gaining share nicely. And as we said, a lot of that share seems to be additive, which is what we think is kind of driving the opportunity to kind of see penetration grow a little bit more. DT1 is trending fine. It's down a little bit relative to Q1 launch just as we had expected. I think we always knew there would be a little bit of cannibalization in both DAILIES Aqua Comfort Plus and DAILIES TOTAL1. PRECISION1 has done so well. I think that it's a lot of the new patients that would normally come in and reach for DAILIES TOTAL1 maybe don't want to spend that with as good a product we have at this price point. I do think that's one of the reasons we're going to launch our DAILIES TOTAL1 toric, and we're excited about that. Given the experience with PRECISION1 toric and its positive impact on our sphere, we think it's a good time now in this fourth quarter to begin to get that launch out.…

Our next question today is come from Cecilia Furlong from Morgan Stanley.

And I'll ask both upfront. But just on the recent capital equipment strength, could you provide some more color around your outlook for the second half following the recent strength? And then just on Total 30, the outlook for 2021? Or is this really more of a 2022 dynamic in terms of contributing to contact sales?

Yes. Let me start with the equipment business. We had a good quarter. We're up 23% over 2019, which is unusually warm, really, from what we would normally expect. I think, historically, we've said we can grow in that mid-single-digits, that would be terrific. So this is a good bit better than what we expected. Now half of that growth was from our refractive equipment, which was up 90% over 2019. So we continue to see an accelerated demand for LASIK, which continues to be the world's most popular procedure. And obviously, our WaveLight platform continues to be the world's leading equipment. So as a function of that, we are pleased with the refractive performance. What we've been careful around refractive is not to portray it as a durable idea because, again, we got pretty spooked about this in 2009 and at the last recession. There is a lot of economics and patient momentum tied up in this. I hope for a long-term sustainability. I wouldn't plan it that way necessarily because I think we're cautiously thinking about what's happened in the past. So we're very careful on that one. The other half of the growth is really from our core cataract business, which has been kind of a combination of Centurion, which remains the most advanced fluidics platform in the world, helped by ACTIVE SENTRY, which is giving the Centurion an upgrade decision that's super easy for customers right now. So if you've got an older machine, it's -- this is still the best machine on the market. There's a number of competitors coming in right now. We are seeing tremendous response regardless of any of that to both our Centurion and its ACTIVE SENTRY piece. So that, along with some new stuff, ARGOS and [Rivoli], which are really…

Next question today is coming from Rich Newitter from SVB Leerink.

Just maybe a little bit on the comments you made in the back half margin outlook implied by your guidance. I think you bucketed a couple of things that would weigh on the margin, including product mix, spend timing and inflationary pressures. Can you maybe just calibrate us a little bit on how much in each of those buckets will weigh and which dominates? And then how do we think about those items as we look ahead into 2022?

Yes. So obviously, if you take the first half, we're at about 18% from a margin rate perspective, that would imply 17% in the second half to get you to the approximately 17.5%. So to your point, the 3 components are investments, some inflationary pressure and mix. I'd say the investments are roughly half of that pressure point. And that's primarily driven by the fact that we're going to continue to invest behind our new launches. So if you think about, to David's point, T30 sphere and toric in the U.S., we got DT1 toric in the U.S. and Europe, PRECISION1 in Europe and Japan. So we still have quite a few launches in the second half that we're going to continue to invest behind. I'd say the other half is probably a 50-50 split. Inflation being part of that. Again, we did see some inflation in -- particularly in Q2. We were able to mitigate that. We'd expect to see continued inflation in the second half. If you think about raw materials, wages, freight, we plan on offsetting some of that, but probably won't be able to offset all of it. And then the other component is mix, and it's really a combination of geographic mix and some product mix. So those are kind of the components and the breakdowns. As far as 2022, again, we would expect to see continued margin progression. We'll give you more color on the '22, but we're still on track, obviously, for that low 20s in 2023 and then the guidance we gave at the Capital Markets Day.

Our next question today is coming from David Adlington from JPMorgan.

The first one, just be interested to get your thoughts on the impact of J&J's larger synergy in the U.S. and how that's impacted the dynamics, the competitive dynamics there? And then secondly, just to follow up on that second half margin question. Just wondered how much of that cost base you can flex in response to either the sales coming in better or slightly worse than expected. In particular, if they come in better, will you be able to spend enough to keep the margins down as low 17%?

Okay. Let me take the first one. On the J&J Synergy launch, we've -- again, we saw that one coming. We obviously know that product pretty well from Europe. And again, it is a diffractive lens. I think it's a combination of a diffractive lens and EDOF. So it doesn't really do much to improve the halos and glare. And I think some of those visual disturbances are what has kept people from using AT-IOLs in the past. So we're very comfortable that Vivity is a very good alternative to complement PanOptix, which is going to give you, I think, a profile that in and of itself has very low disturbances, but has very sharp focal points at near intermediate and distance. And so I think we've got kind of the best of both worlds kind of triangulating the best in -- if you want, near vision, very sharp, intermediate very sharpened and, obviously, distance, that's the PanOptix lens, which, again, will be kind of uncompromised or unbeaten on that level. And then if you really are concerned or the patient is concerned about visual disturbances, you really do need to use something like Vivity because the competitive lenses that are diffractive are not going to help you. So I think we're comfortable with it. People are going to try these lenses. In the second quarter, as I said, we grew share in the United States against that launch, and we were up over 80%. So I think we feel like we planned for and expect competitive intrusion, but nothing that we don't expect.

Yes. And as far as the flexing on the cost base, again, if you just take the midpoint, and I think we've talked about this before, we feel like we have the right cost envelope. Our cost envelope is about the right size, if you think about G&A and all that type of stuff. So obviously, as you get more revenue, you get more leverage. If you have less revenue, you have less leverage. So the flexing piece, we haven't really broken it out. But think about -- you've got commissions in there that would go up or down with revenue, you've got advertising and promotion, particularly in the contact lens business, where that's a heavy component of driving incremental growth, and then you have samples as well as you launch those. So I think about those as the flexing pieces.

Our next question is coming from Matthew Mishan from KeyBanc.

My first is on the concentration of the number of surgeons that are doing the AT-IOL procedures. I mean I imagine that there was a larger concentration of surgeons that were performing those procedures making up that 14% penetration rate. Are you seeing just an expansion of -- in the high-propensity surgeons that are doing it? And -- or is that 14% to 17%, 18% change in penetration? Are you guys actually expanding out significantly the number of surgeons that are doing these procedures?

It's a really good question, and I can't answer it exactly because I haven't looked at it lately. But the question we often ask is, are we getting -- obviously, are we bringing more surgeons into AT-IOLs. Because you're exactly right. A portion of the relatively small portion of the surgical community do most of the AT-IOLs. And again, that's largely because, historically, if you needed to fix something at the end, and you didn't have access to a refractive laser, then it was unlikely that you would really want to get after this. Because even the best of surgeons are now again going to have to fix something. And what they do to fix it usually is, is they'll do a small correction with a LASIK laser. So it has been limited to certain surgeons. We have seen some surgeons coming back in, that are new. We have a number of one-off surgeons we talked to. I just came back from the American Academy of Cataract Refractive Surgeons, and it was a terrific meeting. And I probably heard a dozen or more surgeons. But that's -- it's very anecdotal what I'm telling you. I think there's more surgeons for sure. I don't think there's less. I just don't know if that's a meaningful number in the real scheme of things. What I do know is that the existing surgeons are -- that are using AT-IOLs are very excited about adding patients into the portfolio of patients that they would offer a lens to because it's very much the case that if they see somebody who does a lot of night driving or that they feel like would be concerned about a halo or a glare that they don't think would accommodate or the -- or they're very particular and they make a judgment about those lenses, they generally haven't kept -- put them in, and that was usually like 3 or 10, 3 out of 10 that would be in that zone. So we think we're adding some of those patients into the pool, and that's really what's driving the majority of it right now. I do think over time you're going to see more surgeons jumping in. Because I think the Vivity upgrade, particularly from -- if you're doing a toric right now, doing Vivity toric is, to me, a really obvious next step. It gives patients the opportunity for considerably better -- really good intermediate vision and a pretty good chance you're not going to have to wear reading glasses. So I feel like that's -- the rich part of the curve right now is the toric using kind of non-PC-IOL user, but that is -- again, that would only move the penetration a little bit, but I think it's a rich part of the market. Interesting question though.

And then next -- and then moving to contact lenses, I think last quarter you were talking about new fits being more difficult in this environment. Have you seen that change in 2Q, which is allowing more of the trade-up into PRECISION1s?

Well, let me give you a couple of data points, and then I'll try and answer best I can. The short version of that is I don't know. What we are using right now are some data that is survey data from optometrists. If you look at where optometrists are right now, in the U.S. at least, roughly, they're generating about the same number of visits they're reporting as they did in 2019. So visits are roughly back. What they're also saying, however, is revenue is back, but they're using about 25% telehealth. And so I think there may be a lot of existing wearers that are being refilled through a telehealth, telemedicine kind of scenario. I don't know that for sure. I think that's kind of directionally correct. What I do think is the case is that, outside the United States, the international business is a higher chain penetration and slower recovery of foot traffic. So they're having throughput issues in these offices. And again, that's going to reduce, I think, directionally, the number of new fits internationally. So we're a little slower internationally with new product uptake, and I do believe that's new fits. In the U.S., it doesn't appear to be holding us back much. So I think the U.S. right now, the market grew -- was up high single digits in contact lenses. And obviously, we grew 17% against that. So we feel really good about what happened in the United States. International, we did a little better than market or we're broadly in line with the market, but it was down mid-single digits. So that's kind of the current story on contact lenses.

Our next question is coming from Chris Cooley from Stephens.

I appreciate you taking the question. Just 2 quickly for me. If we think about the U.S. cataract market opportunity, help us kind of frame the way that you're contemplating Aetna's recent decision to require preauthorization. I realize it caused basically a temporal kind of disruption there from a scheduling perspective. But some overtones there about Clear Lens Exchange possibly getting cut down over time and some scheduling issues there. So I'm just curious if you think others will follow suit. And if that as a result, makes this a more protracted ramp back up as you recoup those loss procedures from COVID? And then I've got a quick follow-up.

Yes. I think we had a look at that. I think the best estimate on it was that they were affecting maybe 10,000 to 20,000 patients a month in the U.S. That's a slow up. It's a difficult thing for the surgeons in particular because it creates an administrative burden. Patients with cataracts are going to pass, and they're going to go through. Aetna's decision to kind of make it more difficult for them, I think, is broadly not appreciated by either the associations or the surgeons or us. I think there's very -- if the rationale was clear lens extraction -- and again, I haven't read the rationale -- but if that's it, I think that's highly suspect because there just isn't that much of that going on. If they have a standard they want to enforce, which is 2,100 cataract or something they should come out and say that. But I think what we believe right now is that, that will, over time be a poor decision for reapplying new patients because that's the kind of supply-demand issue that causes problems with patients that are enrolling in these plans, particularly seniors.

I appreciate that additional color. And then just as my follow-up, I wanted to stay on cataract. And just similarly ask, at ASCRS, a lot of new technology when we look at the premium lens category. Just curious how you're thinking about additional efforts to grow the category. Because if you're already a little bit north of 80% share here in the U.S. just over half of share when we think about this category globally and seeing a little bit more of an inflationary environment right now, just curious what you think you have to do to keep driving that share or that category growth over time because it's hard to accelerate growth and you already have 80% market share without growing the cataract.

Well, yes, that's 80% in the U.S., and I always like to say to the sales team, 80% means we got 20% left. But in truth, you're 100% right, which is we've got penetration as a primary idea now going forward in the United States. And so we are working very carefully on how do we get more patients involved in what is the best outcome. And I actually think, broadly speaking, increased innovation is good for market growth. And so we welcome competitors in this space on AT-IOLs because it increases the amount of discussion around, it increases people's choices. And I think that brings more patients into it. And there's plenty of room here. The real money is in moving penetration up in this category and more surgeons in. And so if you were going to trade something, you'd definitely trade a share point for a point of penetration because the share point is worth a lot less than 1 share point of penetration, especially as we carry kind of 50-plus share around the world. I'll also say, though, that there are markets, plenty of them that -- where we have share opportunities. We don't have Vivity in China. We don't have Vivity in Japan. We don't have a couple of other markets that are still left to go for that product, and it's toric. We don't have PanOptix toric in China. So we're still working on opportunities where we have lower than our U.S. share, and there are many. Our European share is going nicely up, but I would say, directionally, there is still a lot of opportunity in the international markets for AT-IOLs, particularly the portfolio that we have.

Our next question today is coming from Anthony Petrone from Jefferies.

I'll stick with AT-IOLs and maybe just a recap on pricing trends. Just when you consider that there is more competition in the space and some reimbursement pressures for monofocals in the U.S., how are pricing transfer AT-IOLs? And if they are stable, what is the recap on the premium relative to, say, a monofocal? And then the follow-up would be on Simbrinza. I think that was a $50 million run rate that's coming in this quarter. Maybe just remind us what is the growth profile on Simbrinza and maybe sort of the views on the glaucoma space going forward in terms of expansion. Will we see more products added in pharma devices or a combination?

Yes, Anthony, thanks for the questions. Pricing looks pretty stable right now around the world. I mean I think there are -- I would say, internationally, it's more difficult than the United States. The pricing against the mono -- monofocals tend to run around $100, plus or minus probably $20. The pricing around our AT-IOLs -- PC-IOLs, in particular, is roughly $800 to $1,000. So obviously, we're very keen on watching the pricing around that. We've been pretty good about discipline in the U.S. so far. And I think -- my observation historically has been is that, if you've got a similar lens to -- if the lenses are similar, the surgeons are very interested in pricing. If the lenses are significantly different, surgeons are very interested in providing the absolute best care they can to their patients. And most of the time, that's really what's driving the behavior. So I think we're in a pretty good place relative to AT-IOL pricing. But in general, pricing in these categories, as you know, over the years, will always come down a little bit, and we always plan for that. So I would expect to see some pricing pressure in every market, every year. And we apply a little bit of that to our planning every year. On the glaucoma market, I think what we've seen is that the device category is a very interesting device category, too. We think it's going to be a $1 billion-plus category. We're still thinking about how to get into it. We're watching it carefully, as you probably know. There have been some reimbursement changes in that space, so we're continuing to think about what it looks like to get in there and how we might do that. I do think that we're very patient, very…

We reach the end our question-and-answer session. And ladies and gentlemen, that does conclude today's teleconference and webcast. You may disconnect your lines at this time, and have a wonderful day. We thank you for your participation today.