A Survey of On-Call Ophthalmology Consultation Availability Across Emergency Rooms in Puerto Rico

Introduction Ophthalmic emergencies pose a major challenge in emergency rooms (ERs), where timely access to specialized care is usually limited. However, most emergency departments (EDs) lack in-house ophthalmology services or the necessary diagnostic tools needed to manage acute eye conditions, which can potentially delay appropriate treatment. In Puerto Rico, limited access to ophthalmic care in some areas may lead patients to seek assistance in ERs for eye-related issues. This study aimed to evaluate the accessibility of ophthalmologic care in ERs across Puerto Rico by assessing the availability of on-call ophthalmology consultations during emergencies across hospitals on the island.  Methods Based on a list of hospitals from the Puerto Rico Health Department website, a phone survey was conducted from September to October 2024, targeting EDs to determine the availability of on-call ophthalmology consults and protocols in place if such consults were unavailable. Hospitals specializing in specific services, those that declined participation, or those that were no longer in operation were excluded. Data were analyzed by island region and overall using descriptive and statistical analyses.  Results Among the 43 EDs surveyed, 14 (32.6%) had an ophthalmologist on-call for emergencies, with six EDs (42.9%) offering 24/7 availability and eight (57.1%) part-time. Of these, six EDs (14.0%) reported that ophthalmologists saw emergency cases, while 37 EDs (86.0%) had on-shift doctors handle them. All EDs had emergency protocols, with 79.1% transferring acute cases. Additionally, 22 hospitals (51.2%) listed ophthalmology as an in-house service. Regional analysis showed significant variability in ophthalmology consult availability (p<0.0001), while no significant differences were observed between hospitals in terms of ophthalmologist consultations, 24/7 on-call availability, or part-time on-call availability (p>0.05). Conclusions Ophthalmology on-call consultation availability in EDs across Puerto Rican hospitals is limited, with availability being higher in the metro area. However, all hospitals included in this study have established protocols to manage ophthalmic emergencies. Our findings highlight the limited access to ophthalmologic care in Puerto Rican EDs, underscoring the need for improved protocols and resources.