Adam Szaronos, Trukera Medical - Handheld Osmolarity Testing Device | LSI USA '24

Adam Szaronos  0:04  
My name is Adam Szaronos. I'm the CEO of Trukera Medical our company is focused on advancing the quality of image and premium cataract and refractive surgery today, we do that by helping practices incorporate rapid point of care laboratory testing, focused on a silent but chronic condition known as hyperosmolarity. I'll share more about in a minute here. First, some quick backgrounds on our company. We are a commercial Stage Company formerly publicly traded, went private a few years ago when I joined the organization to help initiate a turnaround in market and a relaunch of the organization. Today, we're cashflow and EBIT a positive. We provide a unique starting point in the patient Dr. journey and I care doing about 2 million unique patient touches a year. So it's an exciting platform strategy opportunity with many downstream diagnostic and therapeutic bolt on opportunities. We're in about 50 markets with 4000 active systems in the US today. So I'll say more about hyperosmolarity. But to help you appreciate the unique problem we're solving for and mark it I want you to put on your doctor cap and gown and imagine you're an ophthalmologist, there may be one or two here at the meeting today. But let's pretend you leave the beautiful Waldorf Astoria this week. You're back Monday morning in your practice, and the very first patient exam you're about to walk into as a one month postdoc and the techs have done the workup you pull the chart out of the exam Lane door and you read the following. This is a premium IOL patient typically spend five to $10,000 for an elective visual results on top of cataract surgery. There one month post op no significant odns left eye right eye refractive errors patients approximately 2020 J one a measure of near Reading, reading visual acuity phenomenal unpaper anyone would regard this as an objectively great one month post op. So as you open the door hoping to see smiles on the other side, you're unfortunately met with frowns and I love this body language here. Patient is giving you comments like you know, it's just not as crisp as it was in the first week after surgery. My vision just seems to be fluctuating. Do you think and I love this when they hear it all the time? Do you think it's that fancy lens I spent all the money on could it have moved the implant ship doctor says everything's fine. You know, the patient's either got crazy expectations, you know, I don't get what's going on. This puts a lot of good surgeons on their heels. And this is what's known and I cares the dreaded 2020 Unhappy outcome objectively a good result subjectively a dissatisfied result. And this happens all the time in premium care. And these patients we know take a lot of work recent data has shown from the Akos group and Dr. Maloney and team premium vision patients take almost twice the amount of resources and time in clinic postoperatively to get to a 2020 Satisfied result. So the question is what's missing? You know, I've been in the eye care space for almost 20 years, there's clearly no shortage of innovation, regarding the investment in hitting a visual target. That's mathematical equation, how accurately Can I measure the eye? How accurately Can I plan the surgical steps? How accurately Can I execute the steps and align the implants? You do all those things right, you should produce a crisp focal point on the retina. That's a mathematical outcome visual acuity. So our argument is that there's no technology shortage here talented surgeons with the right technology should be able to consistently deliver 2020 2025 outcomes in surgery today. But what's missing is a better understanding of other factors that might be contributing to the patient's perception, the quality of the vision, and that's where we believe rapid osmolarity testing comes into play. So just to quickly orient you, I know this is a health focused community. osmolarity is very prevalent in medicine. It's relatively new to eye care, though. So osmolarity simply is a measure of salt, the body works very hard to have not too much and not too little. In fact, the blood keeps a homeostasis almost always between 290 and 300, as well as all sensitive organs and tissues. The cornea a very sensitive tissue is absolutely no exception to that rule. So you see corneal epithelial cells here in a controlled setting. The normal blood homeostasis level of that corneas to 90 Green is good, red is bad. In controlled settings, we expose them to elevated osmolarity levels only 24 hours later ramp and cellular death begins to occur. The good news, Corneal epithelial cells constantly replenish themselves. The bad news is it creates a turbulent environment of constant turnover. So this is more common than you think. In general, ophthalmology majority of patients will present with abnormal osmolarity if you test for it. And most important, you can't see this at the slit lamp it doesn't correlate with other signs and symptoms. It's like trying to detect a blood blood glucose or cholesterol by looking at you know weight and visual symptoms. It doesn't exist. So you've got to do a lab test to know if it's present. And here's why it matters. In surgery, especially cat refractive surgery. This concept of light scatter is very common. Is there anything in the optical path that's going to confuse the quality of the image on its way to the retina? Cataracts are the best example. Cataracts are taken out millions of times around the world every year. The typical cataract removed is is a grade two or a grade three. So we can actually objectively score on a light scatter scale using HD analyzers, what amount of scatter cataracts produce the big insight here. And this comes from new work done by Pablo Pablo Artel in Spain is we can actually see the presence of hyperosmolarity. This silent chronic condition introduces as much scatter in the patient's vision as a cataract being removed. You see it's eclipsing the grade two and three levels, you'll notice cataracts are fixed, they're not constantly replenishing, right? hyperosmolarity is variable. And this is explained, because when you blink, you put a fresh coat of tear on the eye, and then that chronic environment, expose it to hyperosmolarity. So this is why and it's such an insight in our space, a patient can literally blink their way in a post op exam lane to a 2020 Snellen. chart, but will express things like Yeah, but it's not what I thought it would be. It's not good quality, it feels like it's changing. So we can put in a name to that. And we can actually show the data now to surgeons. And here's why it really matters in the end result. This was an independent study published last year, we were not involved in it, we found out about it, peer reviewed, but it actually showed in a similar cohort of patients where osmolarity was diagnosed versus where it was normal results one month postoperatively. Those patients that were hyperosmolar self reported seven times greater dissatisfaction with the result. And the authors noted this was not correlated to the visual acuity result all patients in both camps were roughly 2020 2025. So an amazing insight in this world of conquering the 2020 but unhappy patient. And for these reasons, the leading society in our space and cataract refractive surgery has now deemed osmolarity as an essential test in the preoperative guidelines. And this is a growing market. If you're not familiar with ophthalmology, specifically cat refractive surgery. It's an elective medicine procedure on top of a well known procedure. Cataract surgery creates enormous value creation and capture opportunity both for patients in terms of the visual result, the industry and providers alike. We've just repositioned in this space in CAD of refractive surgery were only about 3% penetrated to date of us procedures in cataract refractive surgery of a 200 million plus total addressable market. So for all these reasons, you'd probably think we'd be much higher than that. But there were key barriers to working in a busy premium practice. Our older generation technology was a large fixed sight laboratory unit is great for research, eye care clinics or specialty dry eye practices, totally inadequate for high volume throughput, cat refractive surgery, doing 1000s of pre and post op visits every sometimes every month. So we needed a solution that was portable, practical and precise. Last year, we introduced the world's first and only handheld objective osmolarity test. It's an all in one specimen collection, to analysis to visual output in your hand, it's portable and practical. You don't need to change anything in the practice protocol techs can put in their pocket or wall mounted and is ready to go. And the precision is built off of a proven 25 million global tests we've done to date on the core engine here because we don't really have an analogue in ophthalmology. But testing is medical testing is very prevalent other specialties we look to gold standards like glucose and cholesterol, where you can see we have a very tight CV. This is the secret sauce. Laboratory Medicine is really always two technologies, you need a means of collecting a specimen and then you need a way to analyze it, we simply put them together using infrared thermometry sensors in the chip, we can now simultaneous to the collection run the full temperature and osmolarity analysis. Now it's interesting years ago, you know quick labs or rapid labs usually meant like same day 24 or 48 hour turnaround like think about getting bloodwork before you go to the doctor COVID kind of redefined rapid, we're now it meant 1015 20 minutes when we say rapid we mean sub 15 seconds, you've got to be fast in a busy ophthalmology practice. So I'm going to play the video in real time. This is my wonderful assistant Linda for a hippie for HIPAA champions out there, she did provide consent to share her likeness in her lab results. But you're going to see a couple of things take place in 15 seconds. First, they're going to put the disposable tip on it's a razor blade business, the consumable, you'll hear a beep recognizing a tip, they'll take a 50 nanoliter tear sample, which is the size of a.on your business card and it'll run an immediate analysis. So that's recognizing the proprietary tip that's recognizing the 50 nanoliter sample. And now it's doing in a couple in a couple of seconds here real temperature sensing and it's going to do a molecular osmolarity analysis. So Linda, here's a great example. 367 is pretty high, completely asymptomatic, relatively young cataract aged female, this would be a great red flag for that surgeon to talk about managing the ocular surface back to homeostasis, or this patient even with perfect surgery could come in complaining like the results you saw earlier. So in short, we have a unique reimbursement code, it's well reimbursed 22 and a half dollars per eye portable and precise. And now we have the data to show a direct correlation to helping to solve this puzzle of the 2020 Unhappy patients. Thank you for your time