Usually the chairman of a department will be familiar with the person and be able to pass judgment based on the strength of the letter. It may also afford a personal call on your behalf if necessary.In addition to AOA, strong Board scores (90th percentile or higher would be ideal), and Honors grades/GPA, letters of recommendation are carefully looked at. Wording in these letters can make or break the likelihood of receiving an interview. Research is a definite plus (almost a necessity nowadays). Having written or participated in research is something that will give your application an edge over another (i.e. ARVO, AAO, abstracts, case reports, posters).
Also, residency programs want someone who will get along well with the other residents, who will be reliable, and who is committed to ophthalmology. This should come through when reading your personal statement.An away elective is not a necessity contrary to popular belief. If, however, your medical school does not have a strong ophthalmology presence, an away rotation will serve many purposes
You can determine if ophthalmology is truly your passion and is what you want to do for the rest of your life. It can also provide that third letter of recommendation or that research project that can put you over the top It is difficult to do a research project in a short away elective, but if set up in advance, and with some serious elbow grease, it can be done. If you don't hear from a program by October, it is helpful to contact them to see where your application stands. All members recognize that they are extremely fortunate to have received such training when tens of thousands of young ophthalmologists are lacking the means or have no access to adequate modern training; therefore, members of SIS want to share their knowledge with these young ophthalmologists.