Alcon (ALC), Bausch + Lomb (BLCO): US Cataract Volume Stops Growing

Between 29 July and 11 August 2026, Alcon (ALC) and Bausch + Lomb (BLCO) both told investors on their fiscal Q2 2026 earnings calls that US cataract surgery volume has stopped growing, and that the revenue growth they do report now comes from what each eye is worth rather than from how many eyes are treated [1][2].

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What sets the ceiling on US cataract surgery volume

The number of cataract procedures a country performs is set by how many ophthalmic surgeons it has and how much operating-room time they can give. A cataract is a clouded natural lens; surgery removes it and replaces it with an intraocular lens (IOL). Basic monofocal lenses are covered by insurance, while advanced-technology lenses (AT-IOLs) that correct astigmatism or provide a range of vision require the patient to pay extra out of pocket. Only an ophthalmic surgeon can perform the operation, so annual capacity has a hard limit set by people.

Eye-device revenue in the US used to track procedure counts, with an ageing population adding patients each year. On the 11 August call, Alcon CEO David Endicott said demand is still there and that volume is flat because too many surgeons are retiring and the younger surgeons replacing them are not as productive as the ones leaving [1]. He added that surgeons are bringing optometrists and other professionals into their workflows to absorb the non-surgical work and free up operating time, but that this takes a while to show up [1]. Once surgeon time is the constraint, every supplier paid per procedure runs into the same ceiling, and only products that raise the value of each eye still have room to grow.

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Flat volumes, rising penetration, and a workforce projection

Alcon estimated that global cataract procedure volumes grew low single digits in the quarter while the US was flat, and that AT-IOL penetration rose roughly 110 basis points globally and 180 basis points in the US, about 50 basis points above what the company considers the historical average [1]. Management also put a price on the two paths: one point of market growth is worth about $10 million to Alcon, while one point of penetration is worth about $15 million, and given the choice the company would trade the first for the second [1].

Bausch + Lomb disclosed a four-year series on 29 July: premium IOLs made up 6% of its surgical revenue in 2023, 7% in 2024, 9% in 2025 and 13% in the second quarter of this year [2]. Its description of the market matches Alcon's — monofocal procedure volume roughly flat, growth coming from premium — but its attribution does not, since management credits better lenses rather than a capacity ceiling [2]. The surgeon-supply explanation does have quantified support from outside the industry: a workforce projection published in Ophthalmology in February 2024 estimates that the US supply of ophthalmologists will fall by 2,650 full-time equivalents, a 12% decline, between 2020 and 2035, while demand rises 24% [3]. A third company confirms the flat volumes without the attribution: LENSAR said on 8 May that overall cataract volumes have been roughly flat since 2025, and that in a market like this the growth large companies report is share or mix rather than a bigger market [4].

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Revenue shifts from procedure counts to out-of-pocket spend per eye

The point that decides who grows on this chain has moved from getting patients into the operating room to how much can be sold on each eye. Consumables, drugs and devices implanted during the same procedure follow the same ceiling, while lens makers that can sell a patient-funded upgrade still have room, which is why Alcon would rather have penetration than market growth [1]. Even capital equipment is sold differently now: Alcon pitches the payback on its UNITY surgical platform in recovered surgeon time, saying a surgeon doing 20 cataract procedures a day could probably do 21 [1].

Two other readings of the same flat volumes are on the record. RxSight said on 7 July that overall cataract volumes showed unusual declines in the first quarter, naming patient confidence and the broader economic backdrop as two possible factors [5], and Bausch + Lomb attributes its growth to lenses without mentioning a capacity ceiling [2]. Alcon remains the only company that has explicitly pinned flat volumes on surgeon supply. Three things are worth tracking from here: whether US procedure counts return to their historical growth rate, whether quarterly AT-IOL penetration gains stay above the historical average, and whether the US revenue of companies paid per procedure goes flat alongside the volumes.

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Companies exposed to this change:

• Glaukos (GKOS): Makes minimally invasive glaucoma surgery devices, which are typically implanted during the same session as cataract surgery, so its implant count follows the same procedure base. It does not sell a patient-funded lens upgrade, so it has no equivalent way to earn more per eye.
• Johnson & Johnson (JNJ): Its Johnson & Johnson Vision unit is a major supplier of intraocular lenses and faces the same arithmetic as Alcon and Bausch + Lomb: with US procedure counts flat, growth has to come from the premium share of its own shipments.
• STAAR Surgical (STAA): Sells implantable refractive lenses placed by the same pool of ophthalmic surgeons, competing for the same operating-room time as cataract procedures.

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Sources

[1] Drillr · Alcon (ALC) · 2026-08-11 · FY2026 Q2 earnings call

"And as we do that, it's going to take them some time to do that, but that allows them then to find more time for more cataracts because the demand is certainly there. It is just a matter of retiring -- too many surgeons retiring and too many young folks taking their place that aren't as productive as the ones retiring."

[2] Drillr · Bausch + Lomb (BLCO) · 2026-07-29 · FY2026 Q2 earnings call

[3] Ophthalmology · Berkowitz ST et al., "Ophthalmology Workforce Projections in the United States, 2020 to 2035" · 2024-02-01 · journal article · https://pubmed.ncbi.nlm.nih.gov/37739231/

[4] Drillr · LENSAR (LNSR) · 2026-05-08 · FY2026 Q1 earnings call

[5] Drillr · RxSight (RXST) · 2026-07-07 · FY2026 Q2 earnings call

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