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The Eyes Have It 4432

Advanced Medical Optics chairman and CEO James V. Mazzo on creating a vision for the future.

Steve Halasey

March 1, 2008

15 Min Read
The Eyes Have It


Few medical device executives know what it is like to start a new company that already has 2000 employees and half a billion dollars in revenue. Fewer still are executives like James V. Mazzo, chairman and CEO of Advanced Medical Optics (AMO; Santa Ana, CA), who has had the thrill of presiding over the gathering momentum of an industry powerhouse in the making.

Following its 2002 spin-off from Allergan Inc. (Irvine, CA), AMO hit the ground running and hasn't looked back. Over the past six years, the company has doubled in size, both in terms of revenue and employees. Doing so has required a blend of sizable strategic acquisitions, as well as the development of a robust in-house research and development (R&D) function. Noteworthy acquisitions since AMO's spin-off have included its $450 million purchase of Pfizer's ophthalmic surgical business in 2004 and its $1.3 billion purchase of Visx Inc. in 2005. And, just last year, AMO acquired WaveFront Sciences Inc. (Albuquerque) and IntraLase Corp. (Irvine, CA), further strengthening its product pipeline for years to come.

Today, AMO is a major player in multiple ophthalmic technology sectors, including cataract removal and implants, laser vision correction, and contact lens care. Establishing market leadership in multiple segments has not been without its hurdles. According to Mazzo, however, virtually every challenge AMO has faced over the years has provided an opportunity for the company's leaders to refine and strengthen their vision for the future. Despite last year's setbacks—including a massive recall of a contact lens solution and an unsuccessful bid to acquire eye care giant Bausch & Lomb Inc. (B&L; Rochester, NY)—Mazzo says AMO has never been as well positioned for sustained growth as it is today.

In this excerpted interview with MX editor-in-chief Steve Halasey, Mazzo discusses AMO's evolution since its spin-off, as well as the company's strategy for continued growth across all stages of the vision care life cycle. The full text of the interview can be accessed via the MX Web site at www.devicelink.com/mx.

MX: In 2002, AMO spun off from Allergan Inc. (Irvine, CA), where you served in several executive-level roles. What technologies did AMO bring with it in the spin-off, and how has its technology base evolved since then?

James V. Mazzo: At the time of the spin-off, I had been with Allergan for 22 years, and I'd been living overseas for about 12 years. At that time, I had dual responsibilities. I was president of Allergan's Europe–Africa– Middle East business, and I also ran the company's global marketing for its surgical and eye care divisions.

During an off-site meeting of our management team, the company's leaders discussed the fact that Allergan had both a pharmaceutical and a medical device business under one roof. And as you know, they're fundamentally two different businesses. They're run differently, their regulatory landscapes are different, and even the analysts that cover the industries are different.

We discussed various avenues for separating the two businesses—doing an initial public offering (IPO), doing a spin-off, or even just selling the medical device franchise. We had already decided that Allergan was going to stay in the pharmaceutical business, especially considering its blockbuster products such as Botox.

We decided the best move for shareholders was to create a tax-free spin-off in which we would essentially cleave the company into two separate public entities. Most people are more familiar with an IPO than with a spin-off, in which two completely separate companies are created. When you do a tax-free spin-off, the resulting companies can't have any affiliation. So it truly creates a new entity with a new board of directors and a new management team.

How did you come to take on the leadership role at AMO?

I left that initial meeting thinking, ‘Good luck to the individual that takes on that new role.' And then David Pyott (Allergan CEO) and the Allergan board of directors asked if I would be interested in becoming the CEO of the spin-off. Obviously, I was very interested. Being able to lead a company of that size—with a global presence and about $500 million in annual revenue—certainly has its merits. And I had spent 22 years in that business, so I knew everybody quite well.

At the end of January 2002, the Allergan management team announced to the rest of the company and to the external community that we were going to create two separate companies through a tax-free spin-off by the end of June that year. Obviously that was no small task.

In which eye care markets does the company currently operate? What portion of AMO's business does each represent?

Well, today AMO has a little more than $1 billion in annual revenue and a market cap of about $1.5 billion. We're a global company.

Our cataract business, which entails the removal of aged lenses and encompasses several different products, represents about 50% of our revenue. Our refractive business—laser vision correction and refractive intraocular lenses—represents about 33%. And our eye care business, which primarily focuses on contact lens care products, represents about 17%.

The eye care product revenue is currently a little lower than what we would traditionally expect because, unfortunately, we had to recall one of our contact lens solutions last May. That tempered our 2007 revenues. However, we have come back quite well with a new product in that category.

You're not the only company that's been hit by that problem.

That's true. But it was definitely a learning experience.

I meet with the employees periodically throughout the year. Recently, during one of these meetings, a new employee asked me what I thought AMO's finest moment had been since the spin-off six years ago. And I told him that it was the day after the recall was initiated. To this day, I've never seen a team coalesce around a critical juncture the way that we did on that day. Ultimately, the recall cost us about $175 million on the bottom line. Our stock had been trading at nearly an all-time high, and obviously it took its hit. But it's moments like those—when you have to recall a major product globally—that really test an organization's fiber.

The day after the recall, AMO's management team gathered in the boardroom, and we determined that we would have a new product on the market within three months—and that it would be a better product. We decided that we were going to handle all the patients correctly, we were going to get the doctors involved, and that we would ultimately regain about three-quarters of the market share by the end of 2008.

How well has AMO been able to execute that plan?

We've either achieved or are in the process of achieving each of those goals. Nobody believed we could execute our plan to regain market share—and, in fact, some still have doubts—but every day we're seeing a growing market share.

In which eye care markets does AMO not compete? Are there any plans to enter new areas in the near future?

The two primary segments that AMO does not compete in today are contact lenses and back-of-the-eye technologies, such as retina products. There are also adjunct areas where we could grow our presence. For example, we may currently be participating in a market, but we might identify an outside party with technology that, in our hands, could build a better mousetrap.

The great thing about the ophthalmic sector is that, just when you think the technology can't get any better, it can. So if somebody else has an attractive, available technology that we think would benefit from our large machine, our global nature, our strong R&D pipeline, and our sales force and marketing, we'll make the acquisition.

Acquiring Minds

Since the spin-off, AMO has gone from $500 million in revenue to more than $1 billion. What percentage of AMO's growth has been achieved organically and what percentage has been a result of acquisitions?


(click to enlarge)
"Just when you think the technology can't get any better, it can."

To some extent, the question is, ‘When does an acquisition become organic?' For example, we bought Pfizer's surgical ophthalmology unit, Pharmacia, in 2004. Since then, we have made many iterations based on Pharmacia's technologies. To us, that's organic growth.

Currently, AMO's five-year revenue from new products is 48% of total revenue as of January 1, 2008. But our three-year revenue from new products is 62%. Our goal on a five-year basis is to have 50% of our revenue coming from new products. That number doesn't just reflect the impact of acquisitions. Today, our R&D team's goal is to put 50% of our business out to pasture. And in three years, our goal is 70%. It's a very aggressive approach.

In 2007, AMO purchased WaveFront Sciences Inc. (Albuquerque) and IntraLase Corp. (Irvine, CA). How did these acquisitions broaden AMO's reach?

The IntraLase and WaveFront Sciences acquisitions did two things for AMO. They enabled us to move into an area that complements our existing refractive business. But mainly, the R&D of both of those companies was the most appealing element of the acquisitions. Those companies brought with them pipelines of technologies that we'll be launching for the next several years—and their offerings are well ahead of where the industry is today. That's what really appealed to us about the acquisitions—their people and their methodologies.

Last year, AMO offered to purchase Bausch & Lomb Inc. (B&L; Rochester, NY) for an estimated $4.3 billion. However, Bausch & Lomb was ultimately taken private by private equity firm Warburg Pincus. What initially attracted AMO to the possibility of acquiring Bausch & Lomb? Has AMO adjusted its business strategy in light of Bausch & Lomb's decision to go private rather than be acquired?

The process surrounding the B&L deal was unique. It's the first time our company had to communicate to outside parties that we were considering buying something while we were still evaluating the merits of a purchase. Usually you wait to communicate externally until after you've made the decision to buy.

However, Warburg Pincus put B&L into what is called a ‘go shop' process. We only had 50 days to publicly state whether we were interested in potentially acquiring B&L.

Acquiring B&L would have enabled AMO to move into the category of contact lenses in a very quick fashion. That was the main appeal of a potential acquisition. However, it became quite apparent through the go-shop process that B&L's true intention was to go private. Despite our best efforts—including a better share price offer, representing a $10 premium—at the end of the day, their desire was to go private with Warburg Pincus. So we decided to pull out of the process.

But you know, if you don't learn from going through a process, then it's a waste of time. In this case, we learned a lot about AMO as a company—where we were strong and where we needed to improve.

Going forward, do you expect AMO's acquisition strategy to be as aggressive as it has been in recent years? If so, what types of technologies are of greatest interest to the company?

Today, we are in the best position organically that we've ever been in. And frankly, even if AMO doesn't do another acquisition, we still have enough in the pipeline to continue our market leadership in the categories in which we operate.

However, the day my team and I stop evaluating potential acquisitions and start thinking that we're the smartest people on the face of the earth in our markets, that is the day we'll lose. I've witnessed several examples in the medical device industry—both in ophthalmics and in outside sectors—where executives have said, ‘If we don't make it, it must not be very good.' With that attitude, you'll fall flat on your face.

Is AMO funding R&D more heavily now than it has in the past?

Yes. As a percentage of revenue, our goal is always 6–61⁄2%. But, of course, when a company grows its revenue from $500 million to $1 billion, that percentage equates to a doubling of the investment in R&D. Our R&D expenditure has gotten as high as 7%, but our goal is right around 61⁄2% of revenue.

Our three businesses represent different investments in R&D. Our eye care franchise usually only requires somewhere between 3 and 4% of revenue, whereas our ophthalmic surgical division tends to be a little higher, around 8–9%, simply because of the way in which those products are approved. But regardless of division, we will never miss an opportunity to invest in R&D if such an investment means we can accelerate a project or add one.

Markets and Research

To what extent does the current deterioration of the U.S. economy negatively affect domestic LASIK procedure volumes? In what ways is AMO looking to offset such declines?

In the United States right now, you can't pick up a newspaper or look at the TV without seeing news about the state of the economy. It's become the number-one presidential election issue—even over the war in Iraq. And those economic concerns have affected the number of people walking in and having LASIK—because LASIK is still a cosmetic procedure. It comes out of the consumers' own pockets.

On our earnings call in February, we accounted for what we believe will be a degradation in the growth of the LASIK market in the United States. We think there will be double-digit growth outside the United States, but we think economic concerns are going to degrade the U.S. market itself.

Overall, the rest of our businesses are not likely to be affected by the economic downturn—especially those businesses that are reimbursed through the government.

What significant clinical research is the company undertaking?

We're extremely active in clinical research. For example, we are developing an accommodating intraocular lens that we plan to launch early in the next decade. The product is state-of-the-art, so we've spent a lot of time and money working with physicians on a global basis to test iterations.

Oftentimes, a new design will go through seven to 10 iterations before coming to fruition. After all, you're working with optics. You're replacing something natural with an intraocular lens, which uses the mechanism of the eye. Supplanting that is not easy to do.

In terms of marketing, what are your primary channels and how do you relate with your customers? In many cases, the marketing of LASIK therapies is conducted by clinics or individual clinicians. What role does AMO play in devising or paying for such marketing activities?

Our customers—ophthalmologists, optometrists, and opticians—are the primary mechanisms through which we reach end-users. Even with LASIK, the consumer might want the procedure, but they don't make the decision as to what type of laser is used.

That said, we are very cognizant that consumers are playing a much more active role in identifying who they think are the best physicians. And they're investigating the technologies used by those physicians. Thus, we've created some innovative marketing programs, especially for LASIK, that we provide to physicians.

One such campaign is what we call iLASIK. It is a branded campaign for physicians who use the three mechanisms of our product line: WaveScan mapping and guidance, corneal flap creation with the IntraLase femtosecond laser, and the excimer laser vision correction procedure using VISX technology. These physicians are included on the Web site www.ilasik.com, where patients can go to see who is using the best technology.

Eyes on the Future

Looking at the big picture, what do coming decades hold in terms of technological advances?

First off, our technology addresses a wide range of demographics. There's the Gen-Y and Gen-X groups —that 18- to 34-year-old range. Then there is the 35- to 60-year-old crowd, which includes the baby boomers. And then there is the 60-plus club. All three of those groups are heavily influenced by their visual outcomes.

Beyond that, there's the question of how crisp of vision can be achieved with an intraocular lens. Two or three years ago, we introduced a lens called Tecnis. The government decided to give practitioners a $50 premium on reimbursement when they chose the Tecnis lens because AMO was able to demonstrate its safety profile in relation to driving. It's a safer, more technologically advanced lens. And so, that example just goes to show that there is no limit to where technology can go.

Five to 10 years ago, if a patient had a lens put in, it required a two- to three-day hospital stay. Patients would have sutures on their eye, and they'd have to wear glasses. Today, a patient can have surgery at 8 o'clock in the morning and be driving or reading with their grandkids at noon. No hospital stay, no sutures. The lens goes through a 2.8-mm incision—and we're looking to get that below 2 mm—meaning even less trauma to the eye.

Across all ophthalmic sectors, we continue to see advances. Contact lenses today are very comfortable to the eye. They're thin and have a high water content. With LASIK, one of the greatest advances has been lasers—they're less intrusive and provide better outcomes. AMO is the leader in this area. We have both an excimer and a femtosecond laser. Going forward, lasers will be used more to treat ocular conditions—even ones that our company isn't focused on today, such as back-of-the-eye conditions.

In short, we're in an evolving marketplace. All three demographics are heavily influencing our business, and technology plays a very important role in how we go forward.

Copyright ©2008 MX

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