Survey finds gaps in eye emergency care at Puerto Rico ERs
Emergency departments across Puerto Rico are grappling with a shortage of specialized eye care, according to a new study published in the Cureus Journal of Medical Science. Researchers found that only one-third of hospitals surveyed had ophthalmologists available on call for urgent cases.
The findings highlight both regional disparities and systemic challenges in providing timely treatment for conditions that can threaten vision if left untreated.
The survey, conducted between September and October 2024, included 43 emergency departments. Of those, 14 facilities (32.6%) reported having an ophthalmologist on call. Just six hospitals offered 24-hour coverage, while the other eight operated on a part-time basis.
Even with those numbers, only 14% of emergency cases were evaluated by an ophthalmologist, with most patients instead attended by whichever doctor was on shift.
“All EDs had emergency protocols, with 79.1% transferring acute cases,” wrote the authors, Camille A. Vélez-Morell, Daniela V. Martínez, María Díaz-Rosario, Gabriel A. Jiménez-Berríos and Lorena Montalvo of the University of Puerto Rico.
Transfers most often sent patients to University Hospital in San Juan. While such protocols ensured stabilization, researchers warned that reliance on transfers could create dangerous delays for time-sensitive emergencies such as retinal detachments, acute glaucoma or traumatic injuries.
Regional disparities were significant. Nearly 85% of emergency departments in the San Juan metro area had ophthalmology consults, compared with 29% in Arecibo and 20% in Bayamón. Patients in rural areas face additional barriers including limited transportation and economic constraints, the study noted.
The authors also found a gap between what hospitals advertise and what they actually provide. While 22 hospitals (51.2%) listed ophthalmology as an in-house service on their websites, many did not offer on-call coverage for emergencies. This disconnect, they said, leaves patients vulnerable to misdiagnosis or loss of follow-up care once discharged.
Puerto Rico has about 165 ophthalmologists serving more than 3 million residents. Many are concentrated in metro areas, drawn by higher patient volumes and stronger hospital infrastructure. Smaller hospitals struggle to recruit and retain specialists due to limited financial incentives and professional isolation.
Researchers suggested possible solutions, including incentive programs for specialists to provide on-call coverage, structured referral systems and wider use of tele-ophthalmology to support rural hospitals.
Such interventions could “help bridge the gap in access to ophthalmology services and improve patient outcomes,” the authors wrote.
Despite the shortages, all surveyed hospitals had at least some emergency protocol in place, either through stabilization and transfer or referral to outpatient clinics.
Still, the study concluded: “Our findings highlight the limited access to ophthalmologic care in Puerto Rican EDs, underscoring the need for improved protocols and resources.”
