TotalVisc™: The Cost-effective, Time-saving, 2 mL Next Generation OVD with Chemical and Mechanical Protection
In a recent conversation, Dr. Nathan M. Radcliffe discussed the features and benefits of TotalVisc, offering both mechanical and chemical protection provided by ClearVisc, dispersive and StableVisc, cohesive with the free radical scavenging properties of sodium hyaluronate and sorbitol in a 2 mL pack volume.1-3
TotalVisc – ClearVisc and StableVisc in a Dual Package
“TotalVisc capitalizes on the beneficial properties of StableVisc and ClearVisc,” Dr. Radcliffe explained. “The cohesive properties of StableVisc maintain space and sustain pressure during IOL implantation and facilitate removal, while the dispersive properties of ClearVisc coat and protect intraocular structures and the corneal endothelium during phacoemulsification.”4
“Both StableVisc and ClearVisc are specifically designed with a molecular weight and viscosity that optimizes endothelial cell protection.4,5 Both components of TotalVisc also feature a proprietary formulation of sodium hyaluronate and sorbitol to inhibit free radicals.2,3 These properties make TotalVisc™ the next-generation, complete solution with both mechanical and chemical protection.”4,5
“Most cataract surgeons now are using a combination of viscoelastics – one to protect the cornea and one to insert the lens. If you used only a dispersive OVD for the whole procedure, it would take up to 2 minutes to fully clear that viscoelastic out after the IOL insertion. This is where TotalVisc really speeds up the whole process. With a dual pack, you can fill the anterior chamber with ClearVisc during capsulorhexis, and use StableVisc for lens implantation. Then you can remove the viscoelastic efficiently and minimize issues with pressure spikes afterwards.”
“Using one dispersive viscoelastic would save on acquisition costs, but the speed of removing that viscoelastic at the end of the case means that the surgeon can perform more cases in the same amount of time. So TotalVisc makes sense from both a patient outcome perspective and a cost-effectiveness perspective.”
Pivotal Studies of the Components of TotalVisc
The pivotal StableVisc trial was a multicenter, masked, randomized, prospective clinical study that assessed the safety and efficacy of StableVisc compared with ProVisc. For the primary endpoints of endothelial cell loss and the proportion of patients with IOP ≥ 30 mm Hg, StableVisc showed noninferiority to ProVisc.4
The pivotal ClearVisc trial was a multicenter, masked, randomized, prospective clinical study that assessed the safety and efficacy of ClearVisc compared with Viscoat. For the primary endpoints of endothelial cell loss and the proportion of patients with IOP ≥ 30 mm Hg, ClearVisc showed noninferiority to Viscoat.5
The 2 mL Advantage
“TotalVisc includes both 1 mL of StableVisc and 1 mL of ClearVisc to create a strong physical barrier that provides mechanical protection of the cornea and was shown to provide free-radical eradication compared to other OVDs in a laboratory study.1-3,a This dual protection gives the surgeon the confidence that cataract surgeries are as safe and efficient as possible, while delivering excellent outcomes.”4
“The 2 mL fill volume of TotalVisc is the largest of any dual-pack OVD available in the United States.1,6,7 This extra volume reduces the need to open a second pack mid-procedure, keeps surgical costs lower, and helps to reduce medical waste.” 
aCompared to ProVisc®, Viscoat®, Healon® PRO, Healon EndoCoat®, Amvisc®, and Amvisc Plus®
Dr. Nathan M. Radcliffe is a cataract and glaucoma surgeon at New York Ophthalmology and an Associate Professor of Ophthalmology at the Icahn School of Medicine at Mount Sinai in New York. Dr. Radcliffe received his medical degree from the Temple University School of Medicine. He was Chief Resident at New York University for his ophthalmology residency and Chief Glaucoma Fellow at the New York Eye and Ear Infirmary.
Financial disclosure: consultant to Bausch + Lomb