Blinded by Borders: Immigration Crackdown Threatens U.S. Ophthalmology Workforce

Visa woes are making it harder for international grads to train—just as U.S. demand for eye care grows. 

Imagine you’ve just nailed your interview for a prestigious fellowship in the United States. You walk away feeling hopeful…perhaps even confident. 

But then comes the email. 

It’s polite, maybe even apologetic, but the message hits hard: the school’s ophthalmology department is not sponsoring visas this year. And just like that, the opportunity vanishes. 

That’s the new reality facing many international medical graduates (IMGs) as they pursue training opportunities in the United States. Under the Trump administration, sweeping changes—the revocation of hundreds of student visas, an expansion of deportation targets and the temporary pause of J1 visas—have created deep uncertainty for both applicants and institutions.

One ophthalmology fellow, who spoke on condition of anonymity due to fear of reprisals, experienced the fallout firsthand. 

“I received an email from the program director who told me that the department’s chief of education had a ‘no visa policy this year’ and they could not rank me—to my shock and that of the program director,” the fellow recounted. 

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These policies could have far-reaching implications for an American health care system already under fire for its many failings. Are we entering a troubling new era in ophthalmology—one where visa status matters more than qualifications when it comes to landing top fellowships? And how will a system already stretched thin by staffing shortages keep up?

A narrowing field of vision

Within its first 100 days, the Trump administration rolled out what the National Immigration Forum called “sweeping changes to U.S. immigration.” Among them is the controversial “catch and revoke” program, which uses artificial intelligence to monitor visa holders’ social media.¹

By mid-April 2025, nearly 1,500 student visas had been revoked under this program, affecting students at more than 200 institutions across the country. After public backlash, the administration walked back the revocations, but the broader impact on medical education has been harder to undo.¹ 

“As a resident who applied to fellowship last cycle, there were a few programs—which historically provided H1Bs to fellows—that said they would not be able to as they were not sure if I would be able to start on time or whether the visa would go through, given the immigration policies implemented by the current administration,” the fellow explained. 

Meanwhile, a broader crackdown has deepened the sense of uncertainty. The administration has set a target of deporting one million immigrants per year, a dramatic jump from the previous high of 267,000 in 2019. Enforcement has since widened in scope, with increased use of expedited removals, daily arrest quotas and activity in areas that were previously off-limits.¹  

These moves have sent a strong signal across academia: visa sponsorship is risky. In fields like ophthalmology, where subspecialty training is already competitive, many international graduates are finding fewer doors open. 

The fellow, for instance, recalled ranking far fewer programs than mentors had recommended, knowing some institutions wouldn’t consider an application unless the candidate transitioned to a J1 visa, an option the fellow wanted to avoid while pursuing a green card on an existing H1B. 

Yet even the J1 route proved uncertain, as the administration briefly paused new issuances earlier this year, raising fresh concerns about program eligibility. 

“With all of the uncertainties throughout the process, I decided to stay at my current institution as I knew they would be able to continue my H1B visa,” the fellow explained. 

This lingering unpredictability around visa policies has programs hesitating and candidates second-guessing whether to apply. As visa policies grow more unpredictable, the pipeline of international talent narrows, even as demand for specialists climbs.

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The bigger picture

Supporters of the administration’s approach argue they protect U.S. jobs, especially in high-demand sectors like healthcare. But that stance is increasingly difficult to reconcile with the workforce crisis looming in ophthalmology.² 

A 2020 report from the American Academy of Ophthalmology paints a stark picture: a growing elderly population, rising rates of age-related eye disease, and a retirement wave among current specialists. By 2035, the U.S. is expected to face a shortfall of around 6,000 ophthalmologists.^3,4  

Here’s where foreign-trained physicians come in. They make up more than 25% of all practicing doctors in the U.S., including roughly 8% of ophthalmologists.⁵ 

In underserved areas, their presence is even more critical. In communities where over 30% of residents live below the poverty line, nearly a third of doctors were trained abroad. In majority non-white neighborhoods, that figure climbs to 36.2%.⁵ 

As demand continues to climb, especially in aging and underserved populations, restricting the pipeline of IMGs could worsen the very access issues these policies claim to protect against. 

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Seeing beyond current policies

This administration’s policies have created a kind of double vision in academic ophthalmology. On one side are the ambitions of the field itself: innovation, clinical excellence and research leadership. On the other is a shrinking pipeline of international talent that has long helped sustain those very goals. 

For program directors and department chairs, the question is becoming harder to ignore: how can institutions maintain high standards in care and training while navigating increasingly unpredictable visa policies? 

Despite the complications, some in the field remain cautiously optimistic. “I hope these visa programs continue to be supported by every administration as they contribute to training residents and fellows,” the fellow said. “These medical professionals not only are the backbone of hospitals across this nation but also provide much-needed care, especially in underserved areas.” 

As the unnamed fellow prepares to enter another year of training, these concerns echo those of many international medical graduates. Through the looking glass of current immigration policies, the future appears uncertain for those whose only desire is to learn and to heal.

References

1. Benenson L, Mattey N. The first 100 days of the second Trump administration: Key immigration-related actions and developments. National Immigration Forum. April 28, 2025. Available at: https://immigrationforum.org/article/the-first-100-days-of-the-second-trump-administration-key-immigration-related-actions-and-developments/. Accessed on July 16, 2025. 
2. Agenda47: Donald J. Trump’s Vision to Make America Great Again. Trump Campaign Official Site. 2024. Available at: https://www.donaldjtrump.com/agenda47. Access on July 16, 2025. 
3. Parke DW. The ophthalmology workforce. American Academy of Ophthalmology. February 1, 2020. Available at: https://www.aao.org/eyenet/article/the-ophthalmology-workforce. Accessed on July 16, 2025.
4. Berkowitz ST, Finn AP, Parikh R, et al. Ophthalmology workforce projections in the United States, 2020 to 2035. Ophthalmology. 2024;131(2):133-139.
5. Foreign-trained doctors are critical to serving many U.S. communities. American Immigration Council. January 2018. Available at: https://www.americanimmigrationcouncil.org/wp-content/uploads/2025/01/foreign-trained_doctors_are_critical_to_serving_many_us_communities.pdf. Accessed on July 16, 2025.