
Financial Performance and Funding - The company has incurred net losses of approximately $57.7 million since inception, with net losses of $21.2 million and $17.3 million for the years ended December 31, 2019 and 2018, respectively [237]. - As of December 31, 2019, the company had federal net operating loss carry-forwards of approximately $45.0 million, with about $10.8 million expiring between 2034 and 2037 [243]. - The company requires substantial additional funding to continue research and development activities and advance commercialization efforts, which may not be available on acceptable terms [231]. - A recent private placement raised approximately $6 million, but additional capital may cause dilution to existing stockholders [234]. - The company has not generated any product sales revenue and expects to continue incurring substantial losses while preparing product candidates for the market [236]. - The company has substantial doubt about its ability to continue as a going concern without additional funding [229]. - The company may need to significantly scale back or reprioritize research and development activities if additional capital is not available [231]. Research and Development Challenges - The company may face significant delays in clinical trials due to various factors, including patient enrollment challenges and regulatory approvals [249]. - The company’s approach to developing therapeutic product candidates is new and may never lead to marketable products, increasing investment risks [256]. - The company’s research and development activities may be impeded by scientific or technological difficulties, potentially delaying commercialization [258]. - The company is preparing for Phase III clinical trials for its lead product candidates, MicroLine and MicroPine, which are critical for obtaining regulatory approval and launching commercial sales [260]. - The success of the company's business strategy relies on developing several pipeline product candidates over the next 3-4 years, requiring substantial investment and regulatory approvals [263]. - The company faces significant competition in the specialty pharma market, which is characterized by rapid technological change and the potential for competitors to achieve regulatory approval before the company [271]. Market and Commercialization Risks - The commercial success of the product candidates will depend on market acceptance among ophthalmologists, optometrists, and third-party payors, as well as the safety and efficacy of the products [269]. - The company must establish effective distribution processes and maintain adequate sales and marketing capabilities to achieve commercial success [276]. - Regulatory approvals are essential for commercialization, and any delays or failures in obtaining these approvals could materially impair the company's ability to generate revenue [283]. - The company is exposed to risks related to product liability claims, which could divert resources and limit commercialization of its products [279]. - The company must comply with extensive regulatory requirements, including post-marketing studies and safety monitoring, which can be costly and time-consuming [291]. - The company may face penalties for non-compliance with regulatory requirements, which could include fines, product recalls, or withdrawal of marketing approvals [293]. Legal and Regulatory Environment - The company is subject to various federal and state healthcare fraud and abuse laws, which could lead to substantial penalties if compliance is not achieved [296]. - The U.S. federal anti-kickback statute prohibits remuneration for referrals related to services covered by federal healthcare programs, impacting business arrangements [296]. - Legislative changes, including the Medicare Modernization Act, have altered reimbursement methodologies, potentially reducing coverage and prices for approved products [304]. - The Affordable Care Act (ACA) includes provisions that impose fees on manufacturers and increase rebate requirements, affecting profitability [305]. - The Budget Control Act of 2011 mandates up to 2% reductions in Medicare payments to providers, impacting revenue streams [308]. Operational and Management Considerations - The company relies on a small workforce of 27 full-time employees as of March 25, 2020, and may face challenges in managing growth and infrastructure [323]. - Future performance is contingent on the ability to attract and retain qualified personnel amidst intense competition in the pharmaceutical industry [321]. - Compliance with anti-corruption laws, such as the FCPA and the Bribery Act, is critical and may incur significant costs and legal risks [312]. - The company may face delays in product launches due to pricing regulations in foreign markets, affecting revenue generation [311]. - The potential for legislative measures aimed at reducing drug costs could adversely impact anticipated revenue from product candidates [310]. Intellectual Property Risks - The company’s success depends on its ability to protect intellectual property, with potential challenges from competitors that could harm its competitive advantage [344]. - The patent application process is expensive and time-consuming, and there is no guarantee that patents will be issued to protect the company's technology [344][354]. - The company may face challenges in enforcing patent rights, which could limit its ability to prevent competitors from commercializing similar technologies [350]. - The company cannot be certain it was the first to file for patent protection, which could lead to disputes over patent rights with third parties [353]. - The patent application process is subject to numerous risks and uncertainties, which may result in partial or complete loss of patent rights in relevant jurisdictions [355]. - Competitors may seek or have already obtained patents that could limit the company's ability to make, use, and sell its potential product candidates [357]. - The company cannot assure that any of its patent applications will be found patentable or will issue as patents, which could materially harm its business [361]. - The lifespan of patents is generally 20 years after filing, and the company may not obtain adequate protection for its products if patents expire before commercialization [369]. - The company may face challenges in enforcing its intellectual property rights globally, particularly in jurisdictions with less favorable patent laws [376]. - Legal proceedings to enforce patent rights could result in substantial costs and divert resources from other business aspects [379]. - The company’s commercial success depends on its ability to develop and market product candidates without infringing third-party intellectual property rights [383]. - The company may face substantial intellectual property litigation risks, including potential infringement claims from third parties [384]. - If found to infringe on third-party intellectual property rights, the company could be forced to cease development or obtain licenses that may not be commercially reasonable [385]. - The company relies on licenses for certain patent rights and proprietary technology, which may not provide exclusive rights, potentially allowing competitors to develop similar products [396]. - The company may be unable to control patent prosecution or maintenance under licensing agreements, risking the validity and enforceability of necessary patents [397]. Stockholder and Market Considerations - The company’s management and Board of Directors beneficially owned approximately 23% of the capital stock as of March 25, 2020, allowing them to influence stockholder decisions significantly [407]. - A significant portion of the company's outstanding shares may be sold into the market in the near future, potentially causing a significant drop in stock price [408]. - As of March 25, 2020, the company had 19,776,019 shares of common stock outstanding, including 2,675,293 shares issued in a recent private placement [409]. - The per share trading price of the company's common stock has fluctuated between $1.77 and $10.74 from the IPO in January 2018 to March 25, 2020 [412]. - The company is required to file a resale registration statement with the SEC within the next 30 days for shares issued in the private placement and warrants [409]. - The company has broad discretion in the use of cash from financings, which could impact operational results if not applied effectively [414]. - The company is subject to increased legal, accounting, and financial compliance costs due to regulations such as the Sarbanes-Oxley Act [417]. - The company identified material weaknesses in internal controls in 2017, which have since been remedied, but future weaknesses may arise [421]. - The company is classified as an "emerging growth company," allowing it to delay adopting new accounting standards [424]. - The company will remain an emerging growth company until certain financial thresholds are met, including a market value exceeding $700 million or total annual gross revenue of $1.07 billion [426]. - The stock market has experienced extreme price fluctuations, which could affect the company's stock price and trading activity [412]. - The company may face challenges in maintaining effective internal controls, which could adversely affect financial reporting and investor confidence [422].