Impact of Letter Writers on Ophthalmology Residency Match Success

Background: Ophthalmology residency applications have surged in recent years, and with USMLE Step 1 now evaluated on a pass/fail basis, program directors increasingly rely on subjective metrics. Letters of recommendation (LOR) offer valuable insight into applicants’ interpersonal skills and are among the most important selection factors. This study investigates how characteristics of LOR writers influence residency match outcomes. Purpose: To examine how the characteristics of LOR writers affect success in the ophthalmology residency match. Methods: Retrospective analysis of San Francisco (SF) Match application data for United States allopathic seniors from 2023 and 2024. Reapplicants, international medical graduates, and osteopathic applicants were excluded. Applicant match status and letter writer characteristics, including specialty, academic affiliation, and residency education leadership positions were collected, deidentified, and analyzed in aggregate. Logistic regression was used to describe the association between match status and letter writer characteristics, controlling for presence of a home residency program as a potential confounder. Results: A total of 1,398 applications were reviewed and 1,145 were included. The combined match rate was 73.1%. Applicants had a mean of 2.2 letters from ophthalmologists. Applicants with three letters of recommendation from academic ophthalmologists had the highest probability of success, with 76.2% matching (p < 0.0001). A letter from a faculty member in residency education leadership significantly increased the probability of matching (p = 0.024). Only 4.9% of applicants matched at a program where they received a letter of recommendation when excluding those who matched at their own home program. Conclusion: Applicants had the highest probability of matching into ophthalmology when obtaining letters from academic ophthalmologists, program directors, associate program directors, or department chairs.