Alcon inc (ALC) Q3 2021 Earnings Call Transcript

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Alcon inc (ALC -1.51%)
Q3 2021 Earnings Call
Nov 10, 2021, 8:00 a.m. ET

Contents:

• Prepared Remarks
• Questions and Answers
• Call Participants

Prepared Remarks:

Operator

Greetings. Welcome to Alcon's Third Quarter 2021 Earnings Call. [Operator Instructions] Please note this conference is being recorded.

I will now turn the conference over to your host, Karen King, Senior Vice President, Head of Global Corporate Affairs and IR. You may begin.

Karen King -- Senior Vice President, Investor Relations & Communications

Welcome to Alcon's third 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 or 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 a reconciliation between our non-IFRS measures with directly comparable measures presented in accordance with IFRS in our third quarter earnings presentation, which can be found on the Investor Relations website.

As a reminder, for discussion purposes, we are providing comparisons of 2021 versus 2019, unless otherwise noted, as we believe this is more operationally meaningful since our results were impacted by the pandemic in 2020. We will continue this practice through the end of the year. 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.

And with that, I'll now turn the call over to David.

David J. Endicott -- Chief Executive Officer

Welcome to Alcon's third quarter 2021 earnings call. I'll begin by providing a brief update on our third quarter overall market dynamics and our new innovative products. After my comments, Tim will discuss our third quarter performance and our outlook for the full year. Then I'll wrap up with some closing remarks and we'll open it up for Q&A.

We're pleased to announce we had another strong quarter despite markets that are still recovering. Similar to the second quarter, this was driven primarily by demand for new product innovation, solid commercial execution and strong market recovery in the United States. Recovery in our international markets remains mixed, although we are encouraged to see signs of recovery in select European markets late in the quarter. Other countries like Japan, which is our second largest market, continue to be impacted by the pandemic.

Third quarter sales of $2.1 billion were up 13% versus 2019 with increases across all sales categories in Surgical and Vision Care. Core operating margin was 17.7% and core diluted earnings per share was $0.54. Customer interest and need for our new products are driving above market growth and in Surgical, our portfolio of advanced technology intraocular lenses is driving increased penetration rates of ATIOLs and we continue to see strong demand for cataract refractive equipment. In Vision Care, our new contact lenses are winning in the market and our Systane brand family is posting strong double-digit growth in all regions.

Now moving to our end markets by franchise. In Surgical, the global cataract surgery market was relatively consistent with last quarter. Excluding India, the global market was down mid-single-digits versus 2019. While the U.S. showed solid mid-single-digit growth over 2019, the international markets remained down high-single-digits, primarily due to emerging markets in Japan, which continue to be suppressed. Against this backdrop, our implantables business continued to outpace the market driven by our strong ATIOL performance.

In Vision Care, the contact lens market was flat to slightly up versus the third quarter of 2019. Similar to Surgical, the U.S. market has returned to growth, while international markets are approaching 2019 levels. Our contact lens business grew significantly faster than the market, driven by the strong performance of Precision1.

Now moving to innovation. In Surgical, we maintained our strong market share in PCIOLs, solidifying our position as the market leader. This was driven by strong demand for our new innovative products PanOptix and Vivity despite new market entrants. We continue to see ATIOL penetration rates increasing sequentially as existing surgeons increase their use of advanced technologies and as surgeons, who traditionally preferred monofocals and torics, are now implanting Vivity. Vivity is the first and only PCIOL with wavefront shaping technology and a clinically proven exceptionally low rate of visual disturbances. Surgeons appreciate the consistency of patient outcomes without the worry of halo's and glare.

In our equipment business, our products and innovations remain a favorite of surgeons, including our market-leading phaco equipment, our Active Sentry handpiece, the LuxOR Revalia microscope and the Argos Biometer. Earlier this week, we unveiled the latest evolution of Cataract Connectivity with SMARTCataract. Designed specifically for ophthalmology, this new cloud-based application delivers planning, connectivity and analysis to improve cataract surgery efficiency, reliability and accuracy. This is the next step in the evolution of our equipment ecosystem and further enhances the value of our new innovations. Installations of our first application SMARTCataract are underway with select customers in the United States.

In Vision Care, we're expanding our contact lens offerings to the premium and middle-market segments by launching a steady stream of new silicone hydrogel daily and reusable products. In the premium segment, we're building out our total brand with a complete portfolio of design options. In addition to our existing DAILIES TOTAL1 sphere and multifocal lenses, we're now adding DAILIES TOTAL1 for astigmatism to capture the premium toric market and also TOTAL30 to capture the premium reusable market. DAILIES TOTAL1 for astigmatism has been eagerly anticipated by eye care professionals for years. This lens provides a significant opportunity in a fast growing segment where only one in four astigmatic patients are wearing toric lenses. Select customers in the U.S. are already fitting the lens, early feedback has been very positive and we're excited for the broader commercial launch early next year.

Now, TOTAL30 addresses the large $4 billion reusable market, which hasn't seen any significant innovation in years. TOTAL30 is now available to wearers in the U.S. and Europe and early reception has been strong. This lens brings the Water Gradient feature of DAILIES TOTAL1 into a monthly lens creating a comfortable lens which feels like nothing on Day 1 and on Day 30.

Now moving to the middle-market segment. The strong performance of Precision1 and Precision1 for astigmatism continues to drive our above-market growth in the total DAILIES market. Both the sphere and toric designs are currently available in the U.S. and Europe and Precision1 sphere is available in Japan. As more international markets recover, we believe we are well-positioned to drive steady growth with Precision1.

Finally, in ocular health, we're building out our eye drop portfolio. Systane sales continue to grow globally, reinforcing our leadership in artificial tears. If you recall, about 25% of the fast growing U.S. market for artificial tears is the Preservative-Free category, compared to over 50% [Phonetic] in some international markets. Our Multi-Dose Preservative-Free formulations of Systane Ultra and Hydration are now available in Europe and the U.S., where we're seeing a favorable customer response. We also continue to see strong demand for Pataday family of allergy products which has been aided by our recent launch of Pataday Extra Strength earlier this year. And finally, this is the first full quarter where we've added Simbrinza to our growing portfolio of eye drops.

Now, before I pass the call to Tim, I wanted to touch on our recent announcement regarding our intention to acquire Ivantis. We're very excited for the opportunity to expand our glaucoma portfolio in this large $500 million market growing in the low-to-mid teens. Glaucoma is the second largest cause of blindness after cataracts and impacts more than 75 million people globally. Ivantis' flagship product is the Hydrus Microstent, a minimally invasive glaucoma surgery device. Importantly, the Hydrus is unique as the only MIGS device with safety and efficacy data out to five years. The five-year horizon clinical study of Hydrus is the longest continuous follow-up of a MIGS device. It demonstrated that 65% of Hydrus patients remained medication-free at five years. Hydrus has a combination cataract indication in the U.S., which means the device is implanted during cataract surgery in both combo cataract and stand-alone indications in five international markets. We intend to leverage our global commercial footprint and our development capabilities to create even greater value for existing and future Ivantis products. In a few minutes, Tim will walk you through some of the financial aspects of that deal.

Our third quarter performance demonstrates the resilience of our business, the strength of our innovation engine and the expertise of our commercial organization. We are executing on our new product launches and growing faster than the markets around the world even as they continue to recover. For Surgical, we're expanding our leadership in equipment by developing an equipment ecosystem to improve efficiency and accuracy, while we're expanding our implantables business in surgical glaucoma. And for Vision Care, we're using our Water Gradient technology to create differentiated new silicon hydrogel contact lenses for both daily and monthly Use.

With that, let me pass it to Tim, who will take you through our financial results.

Tim Stonesifer -- Senior Vice President and Chief Financial Officer

Thanks, David. We are pleased to report third quarter sales of $2.1 billion, up 13% versus 2019, driven by 14% growth in Surgical and 12% growth in Vision Care. Year-to-date, sales were up 10% versus the first nine months of 2019, with Surgical up 12% and Vision Care up 9%.

Implantables sales were $375 million in the third quarter, an increase of 32% versus 2019. As David mentioned, we remain market leaders with our PCIOL portfolio and we continue to see adoption driving encouraging penetration rates above historical levels. On a year-to-date basis, implantables sales were up 28% versus the first nine months of 2019.

Consumables sales of $594 million in the third quarter increased by 3% versus 2019 with sales growth across all three categories of Cataract, Vit Ret and Refractive. On a year-to-date basis, consumables sales were up 1% versus the first nine months of 2019. Equipment and other sales were $192 million in the quarter, up 20% versus 2019. About 8 points of the growth was due to the Refractive sales with continued demand for LASIK procedures. The remaining growth was primarily due to strong demand in Cataract and new equipment. On a year-to-date basis, equipment and other sales were up 21% versus the first nine months of 2019.

Now turning to Vision Care. Third quarter sales of $923 million grew 12% versus 2019. Contact lens sales were $562 million in the quarter, up 7% versus 2019. This was driven by strong demand for Precision1 and Precision1 for astigmatism, as well as continued growth from DAILIES TOTAL1. As David mentioned, we are also rolling out TOTAL30 in the United States and Europe, where customer feedback has been extremely favorable. Based on the strong performance of our contact lens portfolio, we continue to add new manufacturing lines and assess the need for additional capacity to support product flow of our new products, especially Precision1 for astigmatism. On a year-to-date basis, contact lens sales were up 5% versus the first nine months of 2019.

Now moving to Ocular Health, where sales of $361 million in the quarter increased by 20% versus 2019. About half of the growth is attributed to Systane, which grew double-digits in all regions, underpinned by a growing artificial tear market. This was aided by our new Multi-Dose Preservative-Free launches in Europe and U.S. The other half of the growth is primarily due to new additions to our portfolio, including Pataday and Simbrinza, which had no comparable sales in 2019. On a year-to-date basis, Ocular Health sales were up 16% versus the first nine months of 2019.

Now moving down the income statement. Third quarter core gross margin was 63.7%, broadly in line with 2019. We continue to see inflationary headwinds related to raw materials, freight and labor despite our best efforts to mitigate these pressures through active management of supply and selective price increases. Core operating margin was 17.7% in the quarter, driven by operating leverage as higher sales outpaced increases in SG&A. As we mentioned on our last call, we do expect to see incremental margin pressure in Q4, primarily due to product mix and timing of spend as we continue to invest in our commercial activities and sales force as markets recover.

Third quarter interest expense was $31 million, down from $35 million in 2019. While we've taken on incremental debt, we've benefited from lower variable interest rates and lower debt in affiliates. The core effective tax rate was 17.5% in the quarter compared to 18.2% in the third quarter of 2019. The current rate benefited from a build up of inventory in certain international markets that had a favorable product mix and a favorable mix of pre-tax income and loss across tax jurisdictions. For the first nine months of the year, the core effective tax rate was 17.5% in the quarter compared to 18.2% in the third quarter of 2019. The current rate benefited from a build up of inventory in certain international markets that had a favorable product mix and a favorable mix of pre-tax income and loss across tax jurisdictions. For the first nine months of the year, the core effective tax rate was 19.1%. Core diluted earnings per share in the third quarter of 2021 were $0.54, up $0.08 versus the third quarter of 2019, driven primarily by operating leverage.

Next, I'll touch on a couple of cash flow and balance sheet items. Free cash flow, year-to-date, was $578 million compared to $260 million for the same period in 2019. Higher core operating income and lower separation spend were partially offset by increases in capital expenditures and inventory to support new product launches and expected upcoming demand. Capex was $380 million for the first nine months of the year, with the increase driven by our contact lens manufacturing expansion. As a reminder, historically, capex spend has been heavily weighted in the fourth quarter and we expect that trend to continue this year. Transformation costs were $14 million for the third quarter and $141 million life-to-date.

Turning now to business development. As David mentioned, we announced our intention to acquire Ivantis for $475 million in cash, plus potential future payments contingent upon the achievement of certain development and commercial milestones. Ivantis offers attractive sales and earnings growth potential in a fast growing category where we currently do not participate. We estimate Ivantis will have sales of approximately $60 million for the full year 2021. In 2022, we estimate that Ivantis will be broadly neutral to core operating income with some pressure on the core operating margin rate. We expect the acquisition to be accretive to core operating income in 2023. We anticipate to close the transaction in the first quarter of next year, subject to customary closing conditions, including regulatory review.

As we discussed earlier in the call, we continue to see broader macroeconomic burdens such as inflation and tightness in the supply chain. We have been proactively working to manage these challenges, but we've seen pressure to date and expect that to continue going forward. In addition, the U.S. dollar has appreciated significantly since the first half of the year. If the U.S. dollar remains at current rates, we would expect to see FX headwinds in 2022 as compared to 2021.

Despite that backdrop, and based on the strong performance year-to-date, we expect to come in around the higher end of our 2021 guidance. This outlook continues to assume that global markets return to 2019 levels by the end of the year; U.S. markets continue to grow above 2019 for the remainder of the year; and on an aggregated basis, international markets reach 2019 levels early next year, with emerging markets and countries like Japan remaining subdued.

Now, I'll turn it back to David for some closing remarks.

David J. Endicott -- Chief Executive Officer

Thanks, Tim. To briefly wrap up, we're pleased with the strong results we saw this quarter with sales up in every category, exemplifying the resilience of our business, the strength of our innovation engine, and the expertise of our commercial organization. Our new product launches are gaining momentum and taking share as markets around the world will continue to recover. We're pleased to be expanding our Surgical portfolio, both through our smart solution ecosystem and through our intended acquisition of Ivantis. And in Vision Care, our robust pipeline of innovative products are bringing new options for doctors and patients in contact lenses, dry eye, allergy and glaucoma drops.

We're pleased with our ability to deliver growth and outpace the market and we are well-positioned to capture an outsized benefit as the global markets recover, delivering long-term value to our shareholders.

And with that, let's open up the line for Q&A.

Questions and Answers:

Operator

Thank you. [Operator Instructions] And our first question comes from the line of Ryan Zimmerman with BTIG. Please proceed with your question.

Ryan Zimmerman -- BTIG -- Analyst

Great, thank you for taking the questions and congrats on the quarter. Tim and Dave, when I think about your markets last year, in the height of COVID, ophthalmic markets really took a pause and yet now they're proving far more resilient. And so I'm wondering if you could just kind of speak to that dynamic as to why that is, and we've heard from many of your peers about staffing challenges into next year. Are you anticipating that or not, particularly in the U.S. market, where again it's sounding to be -- it's proving to be more resilient? I'd love just to hear some comments on that.

David J. Endicott -- Chief Executive Officer

Yeah. Ryan, we have seen a lot of strength in the markets. And I think it probably speaks to the underlying fundamentals in the quarter. You kind of think about getting through this, not everybody -- I think we weren't 100% sure how it's going to happen, first of all. As you recall, we were a little bit off on the early guidance. But I think what we really believed is that these cataracts aren't going away. And that they are coming back. But again, even through this point in time, I think if you look at them, we've used 2019 as comparators so that you kind of divide by two and see if it's still there. And I think through a couple of years, we still think the market is not yet back to full growth. So I think in the U.S., it was 4% procedures over 2019. So if you do that by -- divide by two, you're still not quite what the normal growth would be. We would have expected normal growth to have been about 3%.

So, yeah, it's been solid coming back. And again although it paused last year, a lot of the underlying things in Vision Care, for example, were better than we expected. So I think Vision Care, we don't see necessarily, for example, the visits back to where we'd like to see them, but we are seeing revenue come back and that seems to be a phenomenon of some renewal remotely for prescriptions and also larger purchase per patient. So we're seeing some of that happen as well. So I think there has been some unique circumstances, but I think more importantly, the underlying fundamentals on eye care leads you to believe that these are relatively resilient markets.

And so I do think they are going to, as we said, come back largely by the first part of next year, all in. We think this year the U.S. is growing now, as I said. But international is going to take a while, it's going to take a little longer and some markets may drag into the middle part of the year. But I think, in aggregate, international should be back sometime early next. So we'll get there, but I think it's likely to be a slow steady climb from here, maybe slightly above historical numbers as opposed to any kind of quick bounce back that looks a little bit more steep. I think it's much more likely to be a gradual climb that's just slightly warmer than historical growth rates.

Tim Stonesifer -- Senior Vice President and Chief Financial Officer

Staffing?

Ryan Zimmerman -- BTIG -- Analyst

Okay.

David J. Endicott -- Chief Executive Officer

And staffing. Yeah, I'm sorry, thanks. On staffing, yeah, we still see that. I would tell you that staffing in optometry, in particular, I think is difficult right now. The surgical centers I think are generally pretty good, but it is difficult for them to kind of go way beyond what they were doing and I think this kind of -- earlier we had hoped that there would be a steeper bounce back perhaps. I don't really see that, partly because, frankly, it's hard to get more throughput out of the current capacity that we have and there are staffing issues in Vision Care similarly. I think if you were seeing 20 patients a week -- sorry, 20 patients a day in '19 you are probably seeing 16 or so right now, and it is tough without additional staff to get back up to that 20. So again, I think that will climb slowly, but I think over the long haul, you're going to see that these markets are kind of roughly returning as we would expect next year and kind of back to kind of historical growth rates.

Ryan Zimmerman -- BTIG -- Analyst

Okay and then just on cataract, I mean obviously there has been some product introductions in the market competitively. And so what are your expectations for when you could or could not see that impacted? I mean, it seems like you're PanOptix and Vivity are doing well despite that -- those introductions. And so I would imagine, though, that you're baking in some expectation there. If you could speak to that a little bit, I'd appreciate it.

David J. Endicott -- Chief Executive Officer

Sure.

Ryan Zimmerman -- BTIG -- Analyst

Thank you for taking the questions.

David J. Endicott -- Chief Executive Officer

Yeah, no, I mean, look, we've seen these products in the market around the world for a while. So really the only new market here is the U.S. And I think we expected to -- we had a very high share up in the 80s. Certainly that's going to come down. So it's just a matter of, is it more or less than we planned. And I think, we're seeing pretty much what we expected. I think people will try the lens, it's a good product. But I think they're going to find that particularly Vivity has no halo's and glare really, I mean, to speak of. And I think it's very similar to a monofocal when you really cut all through it, but it's giving you intermediate and near vision. So this lens has turned out to be a much better alternative for a lot of folks than trying some of the newer lenses I think that have a lot more of the visual disturbances. So I think somewhere between PanOptix, if you really want near vision, 100% -- pretty much guaranteed near vision, that's going to be a PanOptix patient. But you can get a lot out of this Vivity product and we are seeing a lot of benefit from that.

And remember that again, even with the share dynamic, what we're really trying to do now is move more to the penetration side of this thing. And so we've been talking a lot about how do we get more people involved in ATIOLs, how do we get more patients through the end of these practices. And I think that will be the dynamic that's probably more important over the long haul because I think we said in the past, as you know, there's probably, for every 100 basis points of penetration, we can pick up $100 million. So we're very interested in right now the penetration rates because our share is pretty solid. And I feel really good about the competitiveness of our current position.

Ryan Zimmerman -- BTIG -- Analyst

All right. Thank you.

Operator

And our next question comes from the line of Julien Dormois with BNP Paribas. Please proceed with your question.

Julien Dormois -- Exane BNP Paribas -- Analyst

Yeah, hi, good morning, Dave and Tim, thanks for taking my questions. I have two. The first one relates to Vision Care and more precisely the launch of TOTAL30. If I'm right, you currently have a share in the mid-teens in that category of premium reusable. How do you think -- what is the reasonable share objective that you have for this specific segment, and how long do you think it could take to get you there? And my second question is on Surgical, and I know I've already asked the question on other calls but I'm still very puzzled by the very different growth patterns that we still see between consumables on the one hand and implantables and equipment on the other hand and that's obviously compared to 2019. So, is it just a function of implantables and equipment growing above their historical trends or do you still expect to see a catch-up effect at some point in consumables, for example, in 2022?

David J. Endicott -- Chief Executive Officer

Sure, Julien. Let me let start with the first one. We are very excited about T30. I mean, TOTAL30 is a unique product that I think adds Water Gradient to a material that is durable for 30 days and so you're getting that -- the two best elements of what we want, which is durable material that will last 30 days and yet at the same time, feels like nearly nothing on Day 1 and actually out to Day 30, very similar to the first day you had it in your eye. So that's a big change from what -- the kind of products that are available right now and we are excited about the reception we see to that right now. So I think that would [Technical Issues]. The beautiful thing about the contact lens market is it takes a while to move share.

And so on the one hand, you'd like to see it -- the aggressive part of this is you'd like to see it run up, but what you're really doing is turning a small part of the market every year. So remember, if you're happy in your lenses, you're likely to stay in your lenses and that's probably 70% of the patients who walk in through the door, they're going to end up basically in the lens they walked in with. If you're unhappy or you're having a trouble or it's not as comfortable, that's a switch or a new patient and you need to think about those as really about a third or less of the total market that churns.

And so that's the available opportunity every year to move some share. And so that takes several years, in many cases, DT1, for example, we've had out nearly 10 years, it's still growing share. And we will see a long rise of these products. They're not super steep, they're relatively stable. When you get them on a share trajectory they tend to grow every year a little bit and that's really the outlook. And in a lot of ways that's a very helpful financial trajectory because you got a pretty good pattern and it's got long-term sustainable growth. So we're excited about what it could be. Again I wouldn't forecast a share objective per se for this product right now, but we're excited about what we see early days.

On the Surgical side, there isn't really -- the way to think about implantables and equipment are different, but you start with the market growth and again historically, the market growth in procedures you can pretty much approximate with unit growth in implantables. And again typically it's been kind of in that three -- somewhere between kind of three and four globally. It's been hotter than that occasionally, but somewhere in there is usually the procedural growth. The unit for implantables is going to grow very close to that procedure rate, because of course one surgery usually means one implantable. Consumables similarly should grow roughly. In other words, one pack or one unit of use idea will come along with that same surgical piece. What you're seeing in implantables is a trade-up in volume -- value. So you're trading a unit that was a $1 -- was in excess of $100, let's just say, for a monofocal, now trading at $600 [Phonetic] to $800 to $900 in some places. And that's what's driving the value difference between those numbers.

Equipment is slightly different. Equipment has just been unusually robust and we would normally say that equipment should run just slightly in advance of procedural growth. So if you figure the market has enough equipment, to service the equipment, there is some changeover every year. So that's usually, let's call it, somewhere between 10% and 20% of the market should be retiring equipment and buying new equipment. And then you basically got growth on the market that is procedural growth. And so that is how we think about that growth. And it's usually again typically slightly warmer than the procedural growth, depending on the price of the equipment. And then if you're upgrading on a price then again the value grows a little bit faster. So that's probably the way to think about it.

But I don't think there is a ton of of catch up here for consumables because whatever procedures grow, I think is where you're going to see the consumables rate grow generally. And so that's kind of where we are. And part of the difference you're seeing in some of our markets is that we index more heavily to markets that right now have recovered versus the global markets and in many cases we exclude India because it really hasn't recovered, there's a monster number of procedures, but we're not benefiting from those right now.

Julien Dormois -- Exane BNP Paribas -- Analyst

Helpful. Thank you very much.

Operator

Our next question comes from the line of Scott Bardo with Berenberg. Please proceed with your question.

Scott Bardo -- Berenberg -- Analyst

Yeah, thanks guys for taking the question. So two questions. So I'll start with the first, please. Just on guidance, so obvious question would be, why didn't you include any comments on guidance in your release? I think that confused quite a bit of capital -- the capital markets this morning and I don't think we've seen it before. I appreciate, Tim, also you highlighting comments about inflation and logistic costs and so forth. So what I'm trying to understand is, are they significant enough to drive the 16% margin in Q4 implied by your guidance? And do you still hold your 20% margin by 2023 despite this acquisition? So that's the first question. Thanks.

Tim Stonesifer -- Senior Vice President and Chief Financial Officer

So a few questions in that question. Yeah, I was -- to be honest with you, I was a little surprised with the reaction to the no guidance in the press release. I mean, our philosophy has typically been that we don't update the guidance unless there is a change to the guidance. So obviously, we provided a little bit more color on the script that we think will be at the high end of the guidance, but there were no changes overall. From a 16% perspective, there are a couple of things in there. I mean, Q4, historically from a seasonality perspective, is typically lower than Q3. That's primarily driven by Vision Care and a couple of other elements. We also had, as we mentioned, some timing of spend. So we've got some spend that we thought we would spend in Q3, that has now shifted to Q4.

So I think as you think about how material are things going to be, as you project out into 2020, I would just provide the following color. I think first of all, I would take the high end of our guide. So as an example, if you start with revenue, take the $8.2 billion and then we've said in the past that we're going to grow mid-single-digits, I would just take into account that we have a lot of momentum exiting 2021 from a revenue perspective. So if you think about implantables, to David's earlier comments, really strong performance in Vivity. We're going to continue to launch that in new geographies next year so that momentum will continue. If you look at contact lenses as an example, we have a lot of momentum in P1. We've got two new lenses coming out, T30 and DT1 for astigmatism. So again, I would expect to see more growth there. And then dry eye, we're very well-positioned with our Systane family. So I would take that into account from a revenue perspective. The one caveat I would add is the comment around equipment. I don't think equipment is going to run as hot next year as it did this year, because I don't think Refractive stays at those levels. So -- but nonetheless, that's how I think about revenue.

Now, when you go to gross margin in my inflation comments, I do expect to see some gross margin pressure year-over-year next year. I mean, we, like everybody else, we continue to see pressure on raw materials, if you think about resins, if you think about electronic chips, I mean that continues. I think freight pressures continue, labor wages continue to be pressured. So we would expect to see some gross margin pressure next year, year-over-year. If you think about R&D, just to keep going through the P&L, we said 7% to 9%, we've been running at the high end of that range. I think next year, now that we've -- not -- I don't want to say caught up, but just given the profile of our innovation pipeline, I would expect that to be more at the midpoint of that 7% to 9%. And then SG&A as we've continued to say, I would expect to continue to get some nice operating leverage. I mean if you look particularly and if you look at the G&A side of the house, I mean, there are going to be modest increases in that, given all the transformation work we've done and then obviously we will invest behind the markets that are growing.

So that's how I would tee it up. And then the only thing I would say, on top of that, is looking at FX, if you just look at the rates as of last Friday and compare that to take the average rates for September year-to-date, I mean, all the currencies are moving and you've got the dollar has strengthened a couple of percent versus the euro. It's roughly 2% or 3% versus the pound, it's 4% versus the yen. So assuming rates stay at those levels, we would expect to see that type of pressure going forward into 2022. And as far as 2023, we feel very comfortable with the guidance that we gave at Capital Markets Day in reaching the commitments in both '23 and '25.

Scott Bardo -- Berenberg -- Analyst

That's a very comprehensive answer. Thank you. And maybe if I can just sneak in a quick one. David, I'd love to hear your thoughts about Ivantis and the acquisition here. I'm just curious to understand why you decided to buy this business when you could have arguably acquired the market leader with four times the revenue. Just share with us what it is about this business that particularly appeals?

David J. Endicott -- Chief Executive Officer

Well, look, I mean, this -- one of the things we've thought a lot about is because we've been in this space a number of times is where is the market need. And I think this particular product, I mean, the Ivantis folks have done a terrific job with the data that they've created, with the safety of this product, and importantly, this is a uniquely effective product. And we've always thought -- I've always thought that with the space that needs to get filled here is something that is effective over a long haul. And when you think about the data that they're showing, which is 65% of patients medication-free at five years. This has got a demonstrable efficacy that we think is very powerful. And I think if we put our muscle behind that, put some more data behind that, give that the commercial footprint that we have, we think that this has got a lot of runway. And so I think the opportunity here is per dollar paid, if you will, I think it's just a better value.

Scott Bardo -- Berenberg -- Analyst

Very clear. Thank you.

Operator

Our next question comes from the line of Veronika Dubajova from Goldman Sachs. Please proceed with your question.

Veronika Dubajova -- Goldman Sachs -- Analyst

Good morning, guys and thanks for taking my questions. Two, please. One just on the IOL or PCIOL momentum. David, I was hoping you could talk about to what extent the growth that we saw in the quarter is being driven by Vivity versus PanOptix. And maybe just give us a little bit of flavor for the type of market share that you've seen with Vivity in Europe and kind of how you think that informs your views going forward. And if I can sort of interpret your comments on continued higher penetration and uptake of IOLs, I think I ask you this question every quarter, but just your degree of confidence that, that continues as we move into next year, has it increased or decreased?

And then my second question is a bit of a financial one for Tim. Tim, just thinking about the bridge from the '21 margin to the 2023 margin and would love to get your thoughts, to what extent you think that margin progression is, '22 versus 2023, weighted. Is this an even keel or should we be thinking about some element of phasing, especially in the context of the Ivantis deal as well? Thanks.

David J. Endicott -- Chief Executive Officer

Hey, Veronika, good to hear from you. Listen, on the PCIOLs, look, the Vivity product on a growth rate basis is growing really well and obviously it's growing faster than PanOptix because it's wrapping around on a really tiny number. PanOptix's still growing nicely, to be fair, double-digits. But I think what we're seeing really is what we said before, which was, you're going to see, as PanOptix peaks and comes over and starts wrapping around on all the launches that it has had, that it kind of settles down. And then Vivity becomes really that next booster, if you will, for us. So we're excited about what we see with Vivity. We are excited about the utility that we see with Vivity. There's a lot of surgeons doing a lot of kind of important things, I think, and able to treat patients without this halo and glare that is bringing patients, for example, from a monofocal toric to a multifocal toric. And that's a big move, right? Because if we can upgrade our toric business to multifocal toric, really pretty risk-free. I think that's a really nice opportunity. That seems to be a big part of the Vivity growth for us right now.

But I would say that our share growth in -- around the world has been mostly -- at this point is being driven mostly by Vivity. PanOptix, pretty stable, slight growth. There are several markets yet to launch Vivity. So again, I think what we saw in PanOptix for about 12 or 18 months is what we'll probably see with Vivity for about 12 or 18 months, which is as it wraps around on its prior year, we'll get steady launches around the world. We still got to get it into Japan. We still got China to go. We've got a couple of other markets. We haven't got the toric out yet in a couple of markets. So we are -- we've got more, I think, share to be had.

But my point on penetration has been that, look, I mean there's going to be competitors to us. We've got a very high share right now. So we don't expect that, that's the main driver of growth going forward. So your second question makes tons of sense, which is we are excited about what we see right now with Vivity, in particular. We think there is some additional patients coming into the PCIOL business and that's a little bit of what I said before with monofocal and monofocal torics converting into patients now that are interested in doing this because of the lack of halo's and glare or at least the very similar profile it has to a monofocal. I think that's really what it is.

Now the confidence I have around it is a little bit tough because I feel good about that it's definitely driving greater penetration right now, but I would be careful with it, because again right now the penetration rate has a denominator that lacks a lot of monofocals in it. So if you look around the world, we're still recovering internationally in particular. So there's millions of procedures that were not done. Let's just pick India, Brazil, Russia, a bunch of other kind of developing countries where when you add back all of those units to the denominator, I think the current penetration rate, which is pretty high, would probably come down a little bit. So I -- we're waiting to see the market stabilize. But I think what's fair to say, because we see it with individual surgeons, is year on prior year inside of individual surgeons markets, we see their individual penetrations growing. And we know we're not losing surgeons in that direction. So I think we feel confident that it's growing. The durability of it, we'll have to see, and the size of it, again, I think it's still -- jury is still out on. But again we're of the mind that this is the right thing to be thinking about and tracking.

Tim Stonesifer -- Senior Vice President and Chief Financial Officer

Hey, Veronika. And on the margin profile, I'd say, our story is still the same. it's -- that margin improvement is really roughly 80% driven by operating leverage and, call it, 20% driven by gross margin improvement. So I think from an operating leverage perspective, it should be relatively linear because again revenue is really going to drive that improvement. So as we continue to grow at mid-single-digits and keep our cost base at inflationary-type levels, that should go over -- that should move in sort of a linear perspective. On the gross margin perspective, I think the view is there's probably be a little bit more improvement in '23 as compared to '22 and that's really driven by two things. I'm not sure how long this inflationary pressure is going to last. I'm not sure we'll see as much pressure in '23 as '22 or '21. We'll have more time, obviously, to put in mitigating actions and what have you, and see how the market responds. And then you have less pressure on the P1 line installations in '23 as compared to '22 and '21. So that's how I would see the progression.

And then as far as Ivantis, if you recall our Capital Markets Day, the guidance we gave did not include any acquisitions. So we feel very good about the '23 and '25 commitments. Ivantis isn't really material enough to impact those when you think about the longer-term, anyway.

Veronika Dubajova -- Goldman Sachs -- Analyst

Fabulous. Thank you, guys.

Operator

Our next question comes from the line of Larry Biegelsen with Wells Fargo. Please proceed with your question.

Lawrence Biegelsen -- Wells Fargo Securities, LLC -- Analyst

Good morning, thanks for taking the question. So David, just one on Ivantis. Could -- do you guys -- it sounds like you guys think you can grow the product from here from the $60 million despite the reimbursement change. Can you grow that product in 2022 and beyond? And any color on the U.S.-OUS breakdown of sales? And Tim, could you just help us quantify the FX headwind, the Ivantis headwind and inflation in 2022? Thanks for taking the questions.

David J. Endicott -- Chief Executive Officer

Yeah, Larry, on the Ivantis, yeah, we believe we can grow the product long term. I think it's -- we were very aware of a number of situations that we wanted to see resolved before we got into an acquisitive mode with Ivantis. The CMS ruling was one of them and, as you know, that settled out last week. It was very improved from the very difficult price they gave us at the beginning. But again it is going to have some downward effect on what was, I think, a low-to-mid-teens growth rate on the market. That said, again, we think the market continues to grow and we think this product, in particular, can gain share. So as we see it, the market is a fast-growing market where with the right amount of energy on this product and the right amount of messaging and, frankly, the great amount of data that the team at Ivantis has pulled together for us, we're excited about what we can do with it, and we'll see how that adds into it. And this is right in our wheelhouse. Right? I mean we're in surgery every day with the surgeons doing this procedure. This is -- it's a -- it's an easy an important kind of add to our service to the surgeons.

And on the OUS to U.S. sales, the way to think about is it's just -- it's predominantly U.S. sales right now, there's not a significant amount of OUS right now. We look forward to trying to change that, but we'll work principally on reimbursement first before we get very far out, get a bunch of sales folks out there, we're going to work through that. And again I think they're in five countries right now. As you know, we are thinking about a lot of other markets than that.

Tim Stonesifer -- Senior Vice President and Chief Financial Officer

Yeah. And as far as the -- some of the quantifications, Larry, I'll start with FX. I rattled off some of the currencies that have been increasing. I mean, if you were to take the entire bucket of the currencies that really matter, it could be 2 or 3 points and -- but again that's as of rates as of last week, and we're just going to continue to monitor those as we progress through and before we give guidance next year. On the inflation front, it's -- I'm a little bit hesitant to say, because again we have pricing actions out there, we have our manufacturing guys driving a bunch of productivity initiatives that we're still shaping up. So that's one we're going to continue to monitor. I would expect to see some pressure but we'll give you some more color when we give our guide next year. And as far as Ivantis, it will put some slight margin rate pressure. I mean, I would think about, take the $60 million in sales and grow that at whatever you think is appropriate next year. And there won't be a lot of core operating income with that. So that will give you some rate pressure.

Lawrence Biegelsen -- Wells Fargo Securities, LLC -- Analyst

Thank you, guys.

Operator

Our next question comes from the line of Daniel Buchta with ZKB. Please proceed with your question.

Daniel Buchta -- Zurcher Kantonalbank -- Analyst

Thank you very much, gentlemen, for taking my two questions. And the first one, maybe on the Vision Care margin, I mean, it was pretty nice to see that Vision Care had a relatively good margin in Q3. Obviously, they are all working well with the capacity additions you have and the drag they are causing on operating margins here. But can you really feel like it's a turning point here so that going into 2022, Vision Care should really -- should turn the tide and show rising margins? And then the second question on the one-offs. I mean you had this one impairment in the amount of $178 million. And can you clarify a little bit more what this was related to? And also you have $60 [Phonetic] million legal expenses. What does that cover and what are the risks here? Could there be bigger burdens to come still on the legal front? Thank you very much.

Tim Stonesifer -- Senior Vice President and Chief Financial Officer

Sure. Thanks for the question, Danny. Yeah, as far as Vision Care margins, we were pleased with Q3. We continue to make progress. I would caveat that -- though, that Q3 is impacted by seasonality. So we had a very strong revenue performance and some of that is driven by, if you think about, allergies or allergy season as an example, we have a heavier revenue mix in Q3 as compared to Q4. If you look at the back-to-school programs that we were on, particularly in the U.S., that gives you a stronger Q3 as compared to Q4. So operating leverage is driving a significant amount of that improvement, but nonetheless, we're very pleased with how the Vision Care business is performing.

From a impairment perspective, yes, we did impair, we had a Surgical asset that we had purchased in 2017. And as you know, given the portfolio that we have, we manage all of our assets, all of our investments, on a continuous basis and given some of the successes we've had in other pieces of the Surgical business, which is where this asset was, we decided to suspend our R&D and any potential commercialization. So we did take an impairment. That was $178 million, that is a one-time non-cash item. And then lastly on the legal provision, we don't really comment on outstanding legal cases. So what I would say is, every quarter, we look at our -- at the legal landscape and we look at the balance sheet and we provide provisions to make sure that we are adequately covered. And we feel like we're adequately covered in Q3.

Daniel Buchta -- Zurcher Kantonalbank -- Analyst

Okay, just to clarify there is no bigger issue you are particularly worried about on the legal side.

Tim Stonesifer -- Senior Vice President and Chief Financial Officer

I'm sorry, what was that?

David J. Endicott -- Chief Executive Officer

He was asking about the -- no, look, we are -- again on the legal stuff, we look at it every quarter, we aggregate it and then look at our risk and we make an appropriate provision. So that's what we've done.

Daniel Buchta -- Zurcher Kantonalbank -- Analyst

Okay. Thank you very much. Very clear.

Operator

The next question comes from the line of Cecilia Furlong with Morgan Stanley. Please proceed with your question.

Cecilia Furlong -- Morgan Stanley -- Analyst

Hey, thank you for taking the question. Two questions and I'll ask them both upfront. But just in terms of new fits, I'm curious if you could talk a bit more about what you saw in OUS markets during the quarter as well as your outlook going forward from a recovery standpoint. And then also just between TOTAL30 and ramping DT1 toric, can you talk a bit more about just how you're thinking about balancing those two and your comments on ramping manufacturing lines into '23 [Phonetic]? And thank you.

David J. Endicott -- Chief Executive Officer

Yeah. So new fits right now are going quite well for us. I would say in the U.S., we continue to make a lot of progress, particularly in the DAILIES. Now, T30 is brand new so we don't have a lot of data to give you on that one. But Precision1 has done very well, DT1 is also -- continues to do well for us. Outside the U.S., it's a bit slower. And I would say that what we've seen is that the markets really have -- new fits coming into the office have been down and remain down, particularly Japan, which is our second largest market. Europe has gotten a little bit better. It's slowly working its way back. But as you -- I think you're correctly pointing out, you need to be in a situation where new patients are coming into the office and/or patients who are having trouble with their current lenses are coming in and looking for some alternative.

And so as the market comes back in those areas, and I think we believe the Vision Care International business will largely be back to the 2019 levels in the beginning of the year. Again, I think that's really positive for the new fits for new products. But I do think that we've been trailing our trajectory in the U.S. because the new fits really aren't there yet. So -- but we'll get there, and I think what we see, which is encouraging, is that when we get these products into the hands of patients and optometrists, they are really performing well. And so people really like our Precision1 for astigmatism, they really like the Precision1 sphere. Our DT1 for astigmatism has gotten great reviews in the U.S., same thing with T30, both in Europe and in the U.S. And so we are working through all of those and obviously, we look forward to a more normal market next year where we can get a little bit more share outside the U.S.

But I would say on the ramp up of manufacturing, we are in a good place. We did -- we've had a greater than expected demand for Precision1 and so we were a little bit off guard with how well Precision1 for astigmatism did and we did have sporadic back orders around the U.S., and we've had to delay some rollouts because of that, but it just took off on us. And so the good news is we got a great reception and we've had some nice movement on that product. But what we do need to do is really look at now what do we expect from these products and do we need more line time and do we need more machines, what are we going to do about it. So I think we're working through that now. Again, I don't anticipate any major changes per se, but we may want to invest a little bit more manufacturing for next year. So we'll see.

Cecilia Furlong -- Morgan Stanley -- Analyst

Great. Thank you for taking the questions.

Operator

And ladies and gentlemen, as we've reached the top of the hour, we have time for one more question and which leads us to the line of Jeff Johnson from Baird. Please proceed with your question.

Jeff Johnson -- Baird -- Analyst

Thank you. Good morning, guys. Thanks for squeezing me in. David, just on that contact lens point, I'd be interested to hear primarily your expectations, what you're seeing for trade-up versus trade-down from DT1, the trade-downs and trade-ups from DACP and some of the other older focus products, number one. And number two, let's say, you grow a couple of points above market in the contact lens market over the next couple of years, do you think that will primarily be driven by net, kind of, trade-up benefits within your own portfolio or do you expect that you'd also be taking unit or patient share on eye share, however you want to think about it, relative to competition?

David J. Endicott -- Chief Executive Officer

Yeah, a little bit of both, Jeff. I mean, I think, let's start with the cannibalization question. We expected to have some cannibalization with P1 of DACP in particular. In truth, I think the DACP has been a little bit more stable than we expected and DT1 was probably a little bit more than we expected. But directionally, the all-in value change was pretty much as expected. So I would say the mix might have been a little bit different than we expected, but we're also working hard to make sure that people really understand what these products are and their proposition. And I think as we get DT1 -- one of the reasons we pushed DT1 toric out a little bit sooner than maybe we had wanted to, was because P1 toric took off on us and that put some pressure on DT1 because the TOTAL1 product -- obviously, great product, but we didn't have a toric for it. So we were seeing a little bit of P1 eat into DT1. So now that we've got the toric out there, again that stabilizes our premium product. Now we've got a -- and we've got both the P1 and P1 toric out there. So we've got a middle-market product and again that line-up seems to be doing quite well for us going forward.

Over time, look, I think there is a lot of trade-up going on between reusables and DAILIES that's gone on for years. And I think one of the really great things about the Vision Care market is it isn't fast moving or it isn't -- it's steady and strong. And so, you're seeing a very fundamental shift from reusables to DAILIES, which is going to continue. And I think that drives value growth even in a market where EQ growth would be 1%-ish maybe 2% on a good day. So I think that we expect to see some competitive share for sure, but we don't have to go steal share from everybody in this space to grow nicely in the mid-single-digits or higher. So I think that's the beauty of what we're doing right now.

The other piece of this, of course, is that our reusable business is under-represented in our share position as one of the earlier questions came to us. And so as we think about that, we actually think we can gain share in the reusable space pretty easily, particularly with this technology and that margin profile is a good margin profile for us. Right? I mean, that's a much better margin than the DAILIES margin, albeit a lower growth at market. So we can gain share, improve margin there and then gain revenue and maybe a less attractive margin, but still positive. We got a good mix going and I think that's how we see moving forward. Remember too that when we go to the specialty lenses, torics in particular, that's the sweet spot of this market right now, growing very quickly in the silicon hydrogel space and at a premium price to the sphere. So again, I think we're well-positioned to grow for a good bit of time here.

Jeff Johnson -- Baird -- Analyst

Understood. And a quick follow-up, it's been a little quite here recently, maybe that's a good thing, but haven't heard any updates recently on VBP in China. Any timing updates there, any kind of way to look at public versus private mix within your business, just how to think about exposure, and if there is a timeline to think about when that exposure might have to be factored into models? Thanks.

David J. Endicott -- Chief Executive Officer

Yeah, I mean, I think China has obviously gone down this path for some time. The IOL was implemented at a provincial level in most of the provinces at this point. In October, there was probably only one VBP tender. I think it was a joint tender for two provinces. But in previous IOL VBPs, the ATIOL -- some of them included ATIOLs, but mostly they were having price impacts on our monofocal -- on the monofocal business and we are, I would say, under-represented in the public monofocal business generally. So where we're kind of over-represented in China tends to be in the private ATIOL business. So again, I don't really have a split for you, but I'll just tell you that directionally, most of our money is kind of in the private sector ATIOL business. Now, look, there is some crossover impacts here that we're watching very carefully, but again I think, directionally, we probably have less exposure than some.

Jeff Johnson -- Baird -- Analyst

Thank you.

Operator

[Operator Closing Remarks]

Duration: 61 minutes

Call participants:

Karen King -- Senior Vice President, Investor Relations & Communications

David J. Endicott -- Chief Executive Officer

Tim Stonesifer -- Senior Vice President and Chief Financial Officer

Ryan Zimmerman -- BTIG -- Analyst

Julien Dormois -- Exane BNP Paribas -- Analyst

Scott Bardo -- Berenberg -- Analyst

Veronika Dubajova -- Goldman Sachs -- Analyst

Lawrence Biegelsen -- Wells Fargo Securities, LLC -- Analyst

Daniel Buchta -- Zurcher Kantonalbank -- Analyst

Cecilia Furlong -- Morgan Stanley -- Analyst

Jeff Johnson -- Baird -- Analyst

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