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Please note that on today's call, we will be discussing products, product concepts and candidates, some of which have yet to receive FDA approval. Please also note that certain information discussed on the call today is covered under the safe harbor provisions of the Private Securities Litigation Reform Act. We caution listeners that during the call, Eyenovia's management will be making forward-looking statements. Actual results could differ materially from those stated or implied by these forward-looking statements due to risks and uncertainties associated with the company's business. These forward-looking statements are subject to a number of risks, which are described in more detail in our annual report on Form 10-K.
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This conference call contains time-sensitive information that is accurate only as of the date of this live broadcast, March 18, 2024. Eyenovia undertakes no obligation to revise or update any forward-looking statements to reflect events or circumstances after the date of this conference call, except as may be required by applicable securities law.
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With that said, I'd like to turn the call over to Michael Rowe, Eyenovia's Chief Executive Officer. Michael, the floor is yours.
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Thanks, Eric. And welcome, everyone, to our fourth quarter and full year 2020 financial Results Conference Call. Last quarter, I talked about how [indiscernible] to pull on as we continue our growth into a development and commercial organization. Those levers were revenues, agreements and sources of capital. Today, I will share with you how we have been executing against these 3 levers particularly in terms of our advancing commercial strategy, which continues to accelerate with 2 approved products and 2 in Phase III. I will also share news about us entering into 2 significant agreements that will complement our own sales efforts as well as provide an update on our plans for dry eye. Bren will then take us through the build-out of our manufacturing capabilities, which are now fully integrated and producing commercial supply of MydCombi. And finally, John will provide an update on the third lever, our financials and the options we are exploring towards ultimately reaching a breakeven point for the company.
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So let's dive right into it with our 2 FDA-approved products sobetosole propionate ophthalmic suspension 0.05% and MydCombi. As you may recall, the U.S. commercial rights for Clobetasol were acquired from Taiwan based for most of pharmaceuticals last August. Just last week, we transferred the NDA for clobetasol from Formosa over to Eyenovia. Pobetazole was approved just 2 weeks ago on March 4. This unique postocular surgery steroid is the first product developed using Formosa's proprietary APMT nanoparticle formulation platform. That technology reduces an active pharmaceutical ingredients particle size with high uniformity and purity, thereby allowing penetration to relevant compartments in the eye and ultimately enhancing bioavailability.
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Clobetasol is a potent steroid indicated for pain and inflammation following ocular surgery. This is the first time that this molecule is available in ophthalmology. Its efficacy and safety profile is highly desirable with nearly 9 out of 10 patients achieving complete absence of postsurgical pain and 6 out of 10 achieving total absence of inflammation within 15 days post ocular surgery. Clobetasol has an advantageous dosing profile of twice a day without titration versus existing treatments, which require dosing up to 4 times a day. This is particularly important as eye surgery patients are often on multiple drugs during recovery. So any advancement which simplifies the treatment regimen would be welcomed by eye doctors and patients alike. And in terms of safety, side effects we're seeing in no more than 2% of patients. And our label mentions that some of these side effects could have been the result of the surgical procedure itself. You can find additional information and full prescribing information at clobetasolbid.com.
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It is estimated there are more than 7 million ocular surgeries in the U.S. each year. most of which are treated with topical ocular steroids and steroid combinations currently totaling $1.3 billion in sales. This is a very significant market opportunity and 1 that we think we can capture a mid-single-digit market share over the next 3 to 4 years. We view clobetasol as a key addition to our commercial product portfolio, which will allow us to further leverage our existing sales force. Together with MydCombi, our mydriasis product, we believe that we can bring significant value to eye care offices and surgical centers, and we are working toward a robust commercial launch of Clobetasol as soon as our partner has received their Taiwanese export license later this year.
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Longer term, we see a potential opportunity to develop a formulation of clobetasol for our Optojet dispenser as a potential treatment for dry eye, a market estimated to be worth over $3.6 billion. To that end, we plan to engage with the FDA in the coming months to discuss a path forward in that indication. While mobetazole is a great product for us, it is only half of our revenue story. MydCombi is the other half. As you know, MydCombi is the first and only FDA-approved fixed combination of 2 pupil dilation drugs, tropicamide and phenylephrine and the first ophthalmic spray using the Optejet platform. When our sales force talks with customers, they highlight how our products can help book ahead the surgery by using MydCombi as their Mitriata-agent presurgery and clobetasol as their steroid post surgery. We have now hired, trained and deployed half of our 10-person field sales force with the remainder set to come on board in the coming weeks. Also, we continue to make excellent progress satisfying state commercial licensing requirements where required, with MydCombi now licensed for sale in 16 states representing more than half of the U.S. targeted population. We have a dozen other license applications in process.
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In terms of manufacturing, in November, we were very pleased to announce that our contract manufacturer, Coastline International was approved by the FDA for MydCombi commercial manufacturing. We also recently announced FDA approval of our Redwood City facility as a commercial manufacturing facility. With Redwood City, Reno and coastline now all online, we have commenced the manufacture of commercial supply of MydCombi and we now have finished product moving into and out of our warehouse. Bren will provide a more detailed manufacturing update in a moment.
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Customer feedback on MydCombi has been excellent. And to further illustrate that point, we are very pleased to announce that Vision Source, a leading network of approximately 3,000 locally owned optometry offices has added MydCombi as an approved product for its membership. We have great expectations for the sales channel as MydCombi has particular benefits for those offices that are patient-focused and choose to incorporate MydCombi to enhance the comprehensive eye exam experience of their patients. As we like to say, these offices and doctors use MydCombi because they care for their patients. The current U.S. market for pupil dilation is valued at approximately $250 million and we feel we are well poised to take a good portion of that market share over the coming years, especially when we move to our next-generation device.
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Staying on the topic of MydCombi for a moment, we recently completed the study to determine if there was a lower dose that could be effective to achieve pupil dilation for drug-sensitive patients. The study was conducted by [ Dr. Denis Pencil ]of the State University of New York School of Optometry. 29 subjects were treated with a half dose of MydCombi which is 8 microliters per eye. In that study at 30 minutes post-dose, clinically relevant pupil dilation was [ achieved ] in approximately 2/3 of patients and that percentage increased by 60 minutes. Almost all patients returned to a pupil size of less than 5 millimeters between 3.5 hours and 6 hours post installation. This is similar to the time seen in published studies of patients exposed to tropicamide eye drops and a mydriasis reversal drug. The dose was well tolerated with minimal adverse events reported with 3 subjects reporting mild installation site pain and 1 with mild dry eye upon installation.
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Given that a standard of care mydriasis agent, senolefrin, may present safety risks in a few older patients the greater dosing flexibility enabled by MydCombi and the Optejet could address an unmet need among the approximately 100 million comprehensive and diabetic eye exams and over 4 million cataract surgeries performed in the U.S. each year. We plan to publish the full results in a peer-reviewed journal later this year. As previously mentioned, we will soon have 10 sales representatives and 2 sales directors in the field to commercialize MydCombi and clobetasol. Half of this team is already trained and in place, working every day to present the benefits of our products and pull the revenue lever. Additionally, we recently announced a co-promotion agreement with NovaBay, a leading developer of anti-infective eye products. Per the terms of that agreement, NovaBay will promote vobetazole to hundreds of eye care professionals that our salespeople are not calling on through its telephone-based sales real. They will also conduct outreach to eye doctors in those geographic areas that our salespeople are not currently covering. Meanwhile, our field sales force will promote their prescription Avanova antimicrobial live and lash solution to our doctors who can include this product in their suite of pre and postsurgical offerings. In addition to the benefit of additional promotion and potential sales for both sides, each party will also get a percentage of the sales that they generate. This is an extremely cost-effective way to boost our commercial sales reach we believe this agreement will be very beneficial to both parties.
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In summary, we are actively promoting MydCombi and we'll be leveraging our new agreement with Vision Source. We are preparing to commercialize Clobetasol and will [indiscernible] our new agreement with NovaBay, and we are reloading our pipeline by bringing MicroPine back through reacquiring the commercial and development rights this past January for the U.S. and Canada from Bausch & Lomb. MicroPine is an investigational microliter ophthalmic spray avatropine delivered by the Optejet. MicroPine is being evaluated as a potential treatment for pediatric progressive myopia or worsening near sightness which is characterized by elongation of the sclera and retina. We estimate that more than 25 million children in the U.S. suffer from myopia, and of these 5 million are believed to be at high risk for progressive myopia. If left untreated, progressive myopia can ultimately lead to significant vision loss and potential blindness. Prior studies have demonstrated that atropine can slow myopia progression by as much as 60%, and there is a significant unmet need for safe and effective FDA-approved pharmaceutical treatment options.
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In terms of next steps, we are continuing to advance Phase III CHAPERONE study, and we plan to meet with the FDA to explore options to expedite development and registration of MicroPine in a capital-efficient manner. [ One action ] we are working on is a planned interim look at the CHAPERONE data later this year. If that interim analysis is successful, we could potentially be looking at a substantially derisked program that could be very attractive either for us alone, or for a commercialization partner. Lastly, we are maintaining MicroLine or Apersure in our portfolio should [indiscernible] market shows signs of improvement. Right now, our opinion is that we can make better use of our capital elsewhere in our portfolio, but we can turn very quickly back to this product candidate if the situation should change. So this gives us line of sight to 3 and possibly 4 commercial revenue-generating products. We continue to explore development of novel therapeutics levering the Optejet for dry eye, glaucoma and other large market indications as part of our second lever towards success. These potential partnerships are moving forward, and we anticipate sharing more information when they reach the stage of a full development agreement after all of the device compatibility work has been completed.
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At this point, I'd like to turn the call over to our Chief Operating Officer, Bren Kern, for our manufacturing update. Bren?
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Thank you, Michael. During the fourth quarter and through early this year, we continue to execute on our strategy to maintain control of our manufacturing processes, ensuring our products meet high levels of reliability and stability. As a reminder, we use contract manufacturers to supplies with drug substance, which we then used to fill our cartridges at our Redwood City facility. These cartridges are then married with our electronic base units which are manufactured at our Reno Nevada facility. We are now fully capable of supporting our current anticipated MydCombi commercial demand as well as the needs for ongoing micropoint development in 2024. More specifically, last month, we were very pleased to receive FDA approval of our Redwood City facility with no significant concerns raised on the part of the agency. This approval will provide Redwood City with the ability to perform final assembly, packaging and labeling activities in support of MydCombi and complements our Reno facilities and contract manufacturers.
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As previously announced, Coast Lining International also received FDA approval and is now producing MydCombi commercial supply. Redwood City will also be the manufacturing site of our Gen 2 device which has significantly fewer parts than our existing device, making its manufacturing easier and more reliable. We are targeting MydCombi as the first product that will be available in Gen 2 and our Redwood City facility is actually making a product to begin engineering stability studies and registration batches before the end of the year. Our strategy for moving from the Gen 1 to the Gen 2 will be the subject of an FDA meeting this summer, and assuming we come to an agreement, demonstrating comparability between the 2 devices should provide a path for Eyenovia to introduce the Gen 2 platform into the commercial market. Our Reno facility is also producing the Optejet injector in base in support of MydCombi and continue to expand production capabilities by refining our state-of-the-art equipment. When complete, the capabilities of this new facility will provide significant increase in injector manufacturing capacity enabling fulfillment of both our commercial and clinical product needs.
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As noted earlier this year, Eyenovia has reacquired the rights to MicroPine. MicroPine is an investigational 8-microliter ophthalmic spray of atropine delivered by Eyenovia's proprietary Optejet device being evaluated as a potential treatment for pediatric progressive myopia characterized by elongation of the retina. We are actively uplifting our MicroPine clinical management capabilities in this regard which we expect to be complete in mid April of this year. With MicroPine our management, Inovio will be speaking with the FDA to discuss opportunities to accelerate the completion of the study. I continue to be excited about our recent successes and the progress we are making. We now have 2 FDA-approved manufacturing sites that we manage, preparing us to meet the market demands for our products. I'm looking forward to expanding on these significant achievements to be made in this year.
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I would now like to turn the call over to our Chief Financial Officer, John Gandolfo, to provide a financial update. John?
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Thank you, Bren. For the fourth quarter of 2023, we reported net loss of approximately $8 million or $0.18 per share and approximately 45.4 million weighted average shares outstanding. This includes a $0.02 loss related to the onetime repatriation costs for bringing MicroPine back to Eyenovia from Bash. This compares to a net loss of $6.1 million or $0.17 per share and approximately 35.9 million weighted average shares outstanding for the fourth quarter of 2022.
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For the full year 2023, we reported a net loss of approximately $27.3 million or $0.66 per share and approximately 41 million weighted average shares outstanding. This compares to a $28 million or $0.83 per share and approximately 33.6 million weighted average shares outstanding for the full year 2022. Research and development expenses totaled approximately $4.1 million for the fourth quarter of 2023, and this compares to $2.2 million for the fourth quarter of 2022, an increase of 84.6%. For the full year 2023 research and development expenses decreased approximately 3% to $13 million, and this compares to $13.4 million for the full year 2021. The full year decrease was driven primarily by lower direct clinical and nonclinical expenses, as well as deferral of costs related to the future delivery of clinical supply to our license partners.
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For the fourth quarter of 2023, general and administrative expenses were approximately $3.4 million as compared to $3.2 million for the fourth quarter of 2022, an increase of 7.3%. For the full year 2023, G&A expenses decreased approximately 8.1% to $12.4 million as compared to $13.5 million for the full year 2022. The full year decrease was driven by a reduction in legal expenses and executive recruitment costs on a year-over-year basis. Total operating expenses for the fourth quarter of 2023 were approximately $7.5 million as compared to $5.4 million for the same period in 2022. This represents an increase of approximately 39%. Total operating expenses for the full year 2023 decreased approximately 5.6%, $25.4 million as compared to $26.9 million for the full year 2022. As of December 31, 2023, company's cash balance was approximately $14.8 million as compared to $22.9 million as of December 31, 2022. We are currently reviewing -- evaluating various structures and alternatives to increase our cash resources in order to fund our corporate strategy going forward.
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I'll now provide an update on our existing licensing agreement with Arctic Vision for all 3 of our products in China and South Korea. Regarding our prior partnership with Bausch and Lomb, as Michael mentioned earlier, we reacquired the development and commercial rights to MicroPine and have taken over continued execution of the ongoing Phase III CHAPERONE trial. Our agreement with Arctic Vision covers MicroPine, MicroLine and MydCombi and provides us sales royalties in addition to development milestones. MicroPine in particular, is a significant opportunity in China for pediatric myopia. If approved, MicroPine could be a potentially meaningful source of nondilutive funding for our company over the long term. To date, our license agreements have generated approximately $16 million in license fees, and we have the potential to earn additional $25 million in net license and development milestones from Arctic Vision over the next 3 to 4 years. If our products are approved on commercialization, Eyenovia is also eligible to earn significant sales royalties as well. We are continuing to assess potential pipeline expansion opportunities similar to our Formosa agreement and we will continue to leverage the Optejet technology to address unmet needs and additional large ophthalmic indications beginning with dry eye.
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In conclusion, we are very pleased with our performance in the fourth quarter of 2023 and as well as the subsequent period. To summarize our key highlights today, we reacquired the development and commercialization rights to MicroPine in the U.S. and Canada from Bausch and Lomb. MicroPine is in Phase III and a potential treatment for progressive pediatric myopia, a potential blockbuster opportunity for the company. We announced FDA approval of Clobetasol for the treatment of pain and inflammation following ocular surgery. We announced 2 important agreements to complement our own sales efforts, one with Vision Source for MydCombi and one with NovaBay for clobetasol and AVANOVA. We finalized the build-out of our manufacturing capabilities to support MydCombi production with cosign manufacturing and our Redwood City facility is now online in addition to our facility in Reno. And finally, our licensing agreement with Arctic Vision is progressing well and remains a promising avenue for significant development and regulatory milestones as well as the potential for sales royalties and commercialization.
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That concludes our prepared remarks. We would now like to turn the call over for questions. Operator?
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[Operator Instructions]. Our first question comes from the line of Tim Lugo with William Blair.
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Now that the MicroPine has been brought back into the company and you have the rights, can you talk about this accelerating the development of the program? I know in the prepared remarks, you mentioned you'll engage with the agency about this [indiscernible] maybe I'd love to hear some initial thoughts around what you could do for this acceleration of the development?
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Yes. Tim, thank you for the question. Our intent is to do a protocol amendment and put in an interim analysis later this year when we believe we would have sufficient power to detect a significant results from one of the arms of this study. And we'll be talking to the FDA about that as well because if we do that and if we are successful, as a placebo-controlled study, we may be able to make the argument that it's really not ethical to continue as it is with a placebo arm. If we can show that we already have a significant event, and that could shave a number of years off this study and enable us to bring it to an NDA that much faster. So the strategy is to do the interim analysis towards the end of this year. And if that is successful to talk to the FDA about how we can close that study earlier so that we can move to an NDA.
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That's very helpful. And regarding the half dose study, is that something that Optejet can adjust to? Or do you need to submit an sNDA to get this onto the label?
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Well, to get that on to the label, we would have to submit to the FDA. That study was done to answer a very specific medical question for a specific population. So we are able to adjust to that with the Optejet because we did want to get that answer to see if you could go lower for this particular need.
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Okay. Fair enough. And for the NovaBay co-promotion, could you -- again -- and maybe you have this in the comments and I missed it, but can you just kind of scope out what capabilities they're bringing to the margin in clobetasol.
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They are bringing an in-house sales force that's very experienced doing telephone sales into cataract surgeons. They do it now for their product, AVANOVA. So they would take that experience and do the same for fobebazole in those areas where we do not have salespeople. So essentially, they will extend our reach into those offices. And every time they're successful, they will get a percentage of that sale. And likewise, we can hand carry their product AVANOVA into cataract surgeons, where we do have salespeople because it is part of many of their practices. And where we are successful, we get a portion of that. So basically, it's a way to extend our promotional reach with no additional cost and the opportunity to pick up some money at the same time.
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Our next question comes from the line of Matt Kaplan with Ladenburg Thalmann.
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Just wanted to first focus on your commercial programs. Can you help us understand the kind of potential launch trajectories for both Clobetasol and MydCombi and what we should expect, I guess, this year and going into next, specifically?
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Matt, it's good to have your call. John, I believe that there have been analysts out there that have spoken to this. I know we haven't given guidance, but maybe you can talk to what our reaction has been to the analysts.
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Yes. So we're -- the analysts do have numbers in their model out there, and we're very comfortable with the analyst estimates that are out there for the balance of 2024. At this point, we're not going to give revenue guidance ourselves. We'll reevaluate that at the end of the year after these products have been in the market for a while. But overall, I think we're comfortable with the analyst estimates, et cetera, out there.
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Okay. That's helpful. And maybe just to focus in on a little bit with your new lease signed agreement with Vision Source. You mentioned that there are out 3,000 offices that are associated with that. Should we expect more or additional deals or collaborations such as these kind of going forward as you continue to launch on MydCombi and Clobetasol?
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Yes, absolutely. So this is the first one that's signed. We do have others that are in the signature phase and they are a mix. Some of them are like Vision Source, whereas for the retail optometrists, others are with large institutions where they are looking to replace their disposable use of [indiscernible] agents. What they do now is they use the model once and they throw it away. And it's costly to them, it's like $15 every time they do this to a patient. So they would replace that with MydCombi. And we are working right now to get some of these agreements signed where we would essentially be on their formulary replacing what they're doing now.
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Great. And then just shifting to your pipeline, your second-generation device. Can you tell us a little bit more about that and how it differs from the first gen and when we should expect it potentially to be used with MydCombi in the marketplace.
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Bren, would you like to give a high-level discussion about Gen 2?
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Absolutely. So our Gen 2 product offers simplification from a manufacturing capability, enabling us to produce these more easily with a high reliability. With MydCombi being the first platform that we're going to take that into. We're actually actively working on our registration batches to be completed this year. And then we'll be speaking with the FDA on getting the Gen 2 platform into MydCombi, hopefully early next year after we get the registration batches put up.
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Okay. Great. And then -- with respect to your dry eye program, can you tell us a little bit more about that and when we -- do you expect to move that into the clinic this year?
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Yes. We actually have 3 things that we're working on. We have acute dry eye that we're in discussions with Formosa for Clobetasol. We have chronic dry eye that we're actually actively collaborating with a company where we're working on taking their drug and putting them into the option and making sure it's entirely compatible. And then we have a third one that we're -- also would be in chronic a different molecule that we're working on. So what we want to do is we have collaboration agreements in place. And what's happening in that collaboration agreement is we're working out all of the CMC issues of how do we get your drug over to our facility in a sterile fashion and how do we make sure it's compatible with our device. All of that takes anywhere between 4 and 6 months. when that's done, that leads to an option for a development agreement, and that's when we'll talk about it publicly.
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Our next question comes from the line of Matthew Caufield with H.C. Wainright.
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So with Clobetasol plans for Optejet development in dry eye, are there any comparable advantages to ultimately utilizing Optejet within the approved indication for postoperative pain?
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Thank you, Matthew, for that question. The answer is yes. It would be a lot easier for cataract and other postsurgical patients to use the Optejet in my opinion than an eye dropper, and we could certainly go back and look at that again. What we would have to do basically is run a pain study, although only one of them pain and inflammation because according to the FDA, the Optejet delivers an opthalmic spray which is a different form than a thalamic solution. So it requires a Phase III study. Why that's a good thing is that it makes it impossible to replace the Optejet with an eye drop. So from a generic point of view, you can't simply take a molecule we put into the Optejet, and replace it with something that's in an eye drop form. So that's a good thing. But on the other hand, it causes us a little bit more time to get something approved. So the strategy was let's get this additional indication for dry eye, which is a much bigger indication for the product. And then we can make the decision to pivot back and redo a pain and inflammation on study to add that on to the Optejet and then ultimately just be on the Optejet platform.
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Understood. Very helpful. And then with the $14.8 million in cash and equivalents through year-end '23, I don't know if I missed this, but did you give any sense of the current cash runway just for the near term?
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Yes, I'll take that. So as I mentioned in the prepared remarks, we're actually evaluating all different opportunities that we have, and we'll raise cash in order to fund the company's strategy going forward. The historical burn has been about $4.5 million to $5 million per quarter on an operating basis. We don't expect that to change at all. We will see some decrease in R&D expenses, some increase associated with the MicroPine study. So that's basically where we think the operating [ burn ] will come in for the year. We are expecting close to $2 million from Arctic Vision as well for a product development milestone going forward. So that gives you somewhat of a sense of where we see us from a cash standpoint.
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Our next question comes from the line of Kemp Dolliver with Brookline Capital Markets.
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I have 2 questions. First, with regard to Aperture, what needs to change for you to start advancing that program again?
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Thank you. It's good to have you on the call and a good question. So right now, that market is pretty stable and [indiscernible] is selling about $14 million or $15 million, maybe not even that high. per year. So to be successful in this market is going to require, in my opinion, a strong promotional effort to basically do a relaunch of this. So if I look at it, if we do it, it's $1 million to do the registration batches, it's $4 million to file the NDA. So that's $5 million, and that's without making the investment try to lift the market. And that's pretty pricy in a market right now that's doing less than $15 million. So there is already one approved product that's waiting on the sidelines, an eye drop to come in. There's another one that's in Phase III. I think in the end, there may be multiple eye drop competitors in the market, but we would be the only Optejet. So if 1 or 2 of them come in and they're able to resurrect this market, we are entirely comfortable with letting someone else do that and coming in with what we perceive as the better product, better for patients and better for the doctors as well and coming in after they do the heavy lifting. So we'll be happy to take our money and use it elsewhere and then wait and know that we can pivot to this at any time.
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Is this something you would partner out possibly?
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We would, and we certainly could be talking with people, but I don't think at the moment, there's a tremendous amount of interest in the market. So again, I think there's a lot of -- the big players are waiting by the side to see what happens as well.
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Great. And second question is with -- on Clobetasol and with your market share guidance, just to take the other side of the thought process. So you have a product with superior dosing. What's the gating factor with the update given that -- or the uptake given that advantage.
positive
So if you look at the glaucoma market as a surrogate, because it's very similar, you basically have 80% or 85% of the units are actually sold our generics. And then you have a small group of branded products that make up 15% of the units, but they make up about 50% of the value. So it would be very similar in the steroid market. There's one other brand that's in there that I think does about $35 million a year that's been out there maybe 2 years. So we would be coming into that. So we do have the better product, but we're always going to be up against people who will want to go with the generic option. And this is why we are pricing our product basically at the same as a generic co-pay so that the economics do not become an issue when using us. And we're going to see what happens over the next 2 years by doing this strategy of what we call value pricing. And if it takes off the way we suspect after talking with customers, then I would be very happy to come back here a year or 2 from now and say, that number is much higher than I thought.
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And have you started speaking with payers? Do you have any progress to report yet?
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We're doing the entire thing, cash. We're working with an e-pharmacy as well as getting the wholesale licenses because about 85% of ophthalmic surgeons sell the steroid right out of their office. And so the way we're doing this is as a wholesaler, we'll be supplying the physician offices. And for individual patients, they'll be using an e-pharmacy, one, they're very familiar with and the entire thing is cash, again, the same as a branded co-pay. So there's no insurance issues, there's no callbacks. There's none of the things that are both timely and costly for the physicians.
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We have reached the end of our question-and-answer session. And with that, I would like to turn the floor back over to Michael Rowe for closing comments.
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Thank you, and thank all of you for joining us today. and that concludes today's call. We are very pleased with our progress to date, and we are very well positioned to continue our current momentum as our long-term commercial plan and strategy continues to emerge. So thank you again for joining us, and we look forward to talking again with you for our first quarter update in the spring.
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This concludes today's telenference. You may disconnect your lines at this time. Thank you for your participation.
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My name is Celine, and I will be your conference operator today.
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(Operator Instructions)Please be advised that today's conference is being recorded.
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I would now like to hand the conference over to your speaker today, Anil Gupta, Vice President, Investor Relations.
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Good afternoon, and welcome to the Coinbase Third Quarter 2021 Earnings Call.
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Joining me on today's call are Brian Armstrong, Co-Founder and CEO; and Emilie Choi, President and COO; and Alesia Haas, CFO.
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I hope you have all had the opportunity to read our shareholder letter, which was published on our Investor Relations website earlier today.
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Before we get started, I'd like to remind you that during today's call, we may make forward-looking statements.
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Actual results may vary materially from today's statements.
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Information concerning risks, uncertainties and other factors that could cause results to differ from these forward-looking statements is included in our SEC filings and shareholder letter available on our IR website at investor.coinbase.com.
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Our discussion today will include references to adjusted EBITDA, a non-GAAP financial measure.
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We believe that certain non-GAAP measures of financial results provide useful information to management and investors regarding trends relating to our financial condition and results of operations.
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Non-GAAP financial measures should be considered in addition to, not as a substitute for or in isolation from, GAAP measures.
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You can find additional disclosures regarding adjusted EBITDA, including a reconciliation to net income as a comparable GAAP measure, in our shareholder letter and current report on Form 8-K, which are posted on our IR website.
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I want to note that we are once again using the Say Technologies platform to enable our shareholders to post questions to our management team.
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In addition, we will take some live questions from our research analysts.
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And with that, I'll turn it over to Brian and Alesia for some introductory comments.
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Thanks, everybody, for joining us as well.
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So we've had another solid quarter, and this is amidst the volatility happening out there in the crypto market.
positive
So we never know exactly what's going to be happening this quarter in crypto, but we are seeing really strong and accelerating pace of crypto adoption globally.
positive
So in the letter, we actually shared some insights on the pace of this adoption and how it mirrors that of the Internet 25 to 30 years ago and looked at some third-party research, which indicates that crypto users have doubled in the first half of this year, now over 200 million people, and that growth is accelerating.
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So what are we going to focus on at Coinbase?
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We're a product-led company, and we focus a lot on how we can improve the customer experience to get 1 billion people accessing the cryptoeconomy through our products every day.
neutral
Well, we're investing in our core apps, the main retail app.
neutral
We're also investing in our Prime brokerage app for institutions.
neutral
We're building Coinbase Cloud, which is our AWS-like developer platform, for any business out there that wants to build into the cryptoeconomy.
neutral
And we're even investing in new initiatives like our NFT marketplace and our direct deposit offering.
neutral
The second area is around customer service.
neutral
So you saw that we announced 24/7 phone customer support, which we're going to be rolling out next quarter.
positive
We're also investing in site reliability.
neutral
Amidst of all this growth, we're very focused on maintaining adequate uptime for our apps and websites in this unprecedented growth period.
neutral
And then lastly, we're focused on our policy and government relations efforts and in regulation.
neutral
And so this is continuing the tradition that Coinbase has had since the beginning of seeking out regulators, being the most trusted; getting licenses; and actually being an educational resource to help educate folks around the world about how this industry can be something very positive for the world.
positive
So I know there's lots of questions to get to.
neutral
But let me stop there, and I'm going to turn it over to Alesia next to share a summary of our financial performance.
neutral
As Brian shared, Q3 was a strong quarter for Coinbase.
positive
We provided a lot of disclosure in our letter, but I thought I would share a few perspectives.
neutral
The story of our third quarter really centers on lower volatility that we saw early in the quarter.
neutral
Our monthly transacting users and trading volumes, and therefore, transaction fee revenue, all correlate with volatility.
neutral
So it's a very important driver of financials.
neutral
Trading volume across the entire crypto spot market declined quarter-over-quarter in Q3.
negative