220s will make it very tough to match in to ophthalmology but obviously not impossible. The reality is that ophtho is a top 5 specialty in terms of competitiveness, they truly pick from the cream of the crop. To match with a lower step1 score, you'll almost certainly need some other rockstar credentials on your app such as a top tier med school, impressive pubs, national conference (AAO, ASCRS) poster presentations, or letters from big wig type people. Away rotations are "okay" in ophtho, but in no way guarantee you an interview or even increase your chance of matching. There are many PDs who advise against them, and some that advocate for them.
If you look at the stats, the % of applicants who match off cycle (anything other than an MD MS4) is laughable. I would not advise you to take a year off and apply unless youre thinking of doing one of the ophtho research fellowships which have become quite competitive as well.
good luck