Reducing Waste In The Ophthalmic Operating Room

The aim of this project was to decrease environmental and financial costs in ophthalmic operating rooms (ORs) by identifying unused equipment on surgical trays for cornea, glaucoma, and cataract surgeries. In this initiative, we identified and removed unused surgical equipment on prearranged trays for multiple common eye surgeries, to reduce associated financial costs and environmental impacts of purchasing equipment, cleaning instruments and tray reprocessing. In this effort, we also emphasized patient safety, quality of care, and OR efficiency, by working with the OR team to determine which tools are essential for providing the highest level of care to our patients. 

This project took place across two publicly funded, tertiary care centres in Ottawa, Canada. These sites are the University of Ottawa Eye Institute and the Riverside Eye Care Centre. This includes 6 dedicated ophthalmic operating rooms, used routinely by 56 surgeons including comprehensive and sub-specialized ophthalmologists, performing a vast array of ophthalmic surgeries. The project started in January 2021 in response to the COVID-19 pandemic, and continued through until February 2026. 

This quality improvement initiative aimed to identify unused surgical tools in ophthalmic surgical trays including those used for cornea, glaucoma, and cataract surgeries, at high-volume Canadian based surgical centres. Data collected included the number of surgical tools on trays, cost of each instrument, frequency of use, costs of processing and washing, number of surgeries, and costs saved. The frequency of use was obtained by a formal surgical audit, where a team member observed the procedure (including set-up and turnover) and recorded each tool used. To ensure changes weren’t made without the support of staff, a formal feedback survey was distributed, in addition to open-ended discussions with staff to gather comments and suggestions.

A total of 140 surgeries were audited, including 18 cornea, 28 glaucoma, and 94 cataract surgeries, performed by 16 surgeons. For the corneal trays, 38% of tools (n=9) were never used during any operation. In 2025, based on our recommendations, the trays were updated, saving over $10 000 in unused instruments. In the glaucoma trays, 21% of tools (n=6) were never used and will be removed; tools that are seldom used (n=3) will be wrapped separately. Bleb revisions used less than 30% of the tools; as result, we propose designing a new, condensed bleb revision tray. For cataract trays 32% of the instruments were used in less than 2% of cases. Removal of these tools from the 60 trays would result in a projected cost savings exceeding $120 000.

Removal of unused instruments from high volume surgical trays decreases environmental and financial waste in the ophthalmic ORs. It reduces waste by diminishing costs and environmental impacts associated with processing, sterilizing and replacing damaged microsurgical tools. The recent evolution of instrument usage with modern glaucoma and keratoplasty techniques led to many tools becoming unused, serving as a large source of waste. Our combined technique of formal surgical audit with open-ended feedback from staff serves as an efficient model to reduce waste. This technique may serve as a guideline for continued waste reduction at our centres or may be modeled by other ORs in efforts to reduce waste and promote long-term sustainability.