Importance Language concordance between patients and physicians may improve health outcomes; the extent to which academic ophthalmology centers meet the needs of limited English proficiency populations remains unclear. Objective To evaluate alignment between ophthalmologists language skills at US academic ophthalmology centers and linguistic needs of surrounding limited English proficiency populations. Design, Setting, and Participants This cross-sectional study included ophthalmologists affiliated with 32 ophthalmology programs across 28 metropolitan areas, identified from overlap of 2024-2025 US News &amp; World Report “Best Hospitals for Ophthalmology” rankings and 2024 Blue Ridge Institute for Medical Research data on National Institutes of Health funding. Language and training data were collected from institutional websites and public sources. Exposures Ophthalmologist language offerings and local limited English proficiency (LEP) language composition derived from institutional websites and US Census Bureau American Community Survey data. Main Outcomes and Measures Language coverage (proportion of limited English proficiency languages represented by ophthalmologists), adjusted ratios (proportion of ophthalmologists speaking a language relative to the limited English proficiency population speaking it), and ophthalmologist availability (number of ophthalmologists per 10 000 limited English proficiency patients). Regional differences were tested using χ 2 and ANOVA tests. Results A mean of 330 (range, 314-367) ophthalmologists were evaluated per region. Across regions, total coverage was 45 of 82 ophthalmologists (54.9%) in the Northeast, 31 of 59 (52.5%) in the South, 29 of 72 (40.3%) in the West, and 24 of 74 (32.4%) in the Midwest. Coverage in the Midwest was lower than in the Northeast (difference, −0.22; 95% CI, −0.42 to −0.02; P = .03). Across 49 identified languages, only Spanish (mean adjusted ratio, 0.64 [95% CI, 0.28-1.00]) and Vietnamese (mean adjusted ratio, 0.86 [95% CI, 0.05-1.67]) were present in every region with consistent underrepresentation. Ophthalmologist availability was lowest for Spanish (mean adjusted ratio, 4.97 [95% CI, −4.49 to 14.43] per 10 000 limited English proficiency patients overall; &lt;3.0 in 3 regions) and Chinese (mean adjusted ratio, 33.25 [95% CI, −33.26 to 99.76] per 10 000). Conclusions and Relevance In this cross-sectional study, academic ophthalmology centers demonstrated substantial gaps in language concordance, with Spanish-speaking patients disproportionately affected despite representing the largest limited English proficiency population nationally. These findings extend prior evidence of patient-level disparities by identifying potential workforce-level contributors to inequities in ophthalmic care and support targeted recruitment, training, and reporting strategies to expand Spanish-language capacity and address region-specific shortages.