Background/objective: Given the drastic increase in publication output in recent years, minimizing research waste should be a top priority. There are established areas of concern regarding research waste within ophthalmology along with a lack of systematic review usage to inform trial design in other areas of medicine. Given these concerns, the aim of this study is to evaluate the use of systematic reviews as justification for conducting randomized controlled trials (RCT) in top ophthalmology and optometry journals. Methods: We searched PubMed on December 5, 2018 for RCTs published in one of the top five Google Scholar h-5 index journals within Ophthalmology and Optometry. We used a pilot-tested Google Form and searched each RCT for systematic reviews. Each systematic review was then given the designation of “verbatim”, “inferred”, or “not used as justification for conducting the RCT” based on the context the systematic review was used. Results: Our analysis yielded 152 included phase III RCTs. We found 22.4% (34 of 152) of phase III ophthalmology clinical trials cited a systematic review as justification for conducting the trial. A total of 102 systematic reviews were cited in the 152 RCTs. Fifty-seven of the one hundred fifty-two (37.5%) RCTs cited a systematic review somewhere in the manuscript. Conclusion: Less than one-quarter of phase III RCTs cited systematic reviews as justification for conducting the RCT. We believe placing a higher priority on justifying RCTs with systematic reviews would go a long way to minimizing research waste within ophthalmology.