If you are strong clinically and highly likable, you will do fine, plenty of people match with 220's every year - but yes, it is a challenge and you should start taking initiative as soon as you can. If you are not likable and can't shine during a rotation, and only you can be honest with yourself on that one, then it maybe tough. 2-3 away rotations are critical for someone like you; work your butt off during them without being the annoying gunner but just a normal likable person. Don't do your aways at schools that are unrealistic, do them at mid/lower tier programs that you know interview the applicants that rotate with them (or at least interview the ones they like, because there are schools that you can spend a month at and it may even appear that they like you and then you won't get an invite, so spend your time at places you carefully researched and that would actually overlook a board score for other strong qualities).
Be confident in yourself, don't draw attention to your board score or dwell on it, you maybe surprised that it goes overlooked if the programs like you otherwise.
That being said, outside of the schools that you get to know, I think getting interviews with that board score will be a challenge -- there are so many strong 250/240's and even 230's applicants nowadays, that those in the 220's rarely get programs to strongly consider their applications (but also not to say that you are 'screened' out). Board scores get you in the door for the interview, though it does not equal a spot if you can't interview well, but unfortunately, it rarely matters how amazing your app is if you don't have the score to cut the initial review process. So a couple things to keep in mind with this, you only need one school to love you to match so your focus and highest likelihood should be at schools where you rotated - give it your all there, find out who is involved in the interviewing and ranking process and really try to spend your time with them, get to know the residents who will push for you if they love you and that does matter. Lots of times, only a couple faculty at a place are the ones involved in the ranking process, so if you spend your time with the faculty who are not involved - while it can't hurt, it is not the most effective use of your time.
Don't freak out if you don't have the interview numbers as long as the ones that you do have are really solid leads. Try to get to know as many people as you can in the ophtho community, especially PD/Chairmen/people who can forward your application to those who actually make decisions. If your application gets looked at closely you will stand a solid chance of an interview invite, its just a matter of them making it down to the 220's in their pile to begin with and that is not happening frequently nowadays. Go to conferences, ask people to connect you - find a way to get some face time with these people and let them know straight up that you are interested and serious. If you know people who are well connected, ask them to call programs where you want to interview once your application is out, because you may need that extra push and unfortunately those invites rarely trickle in magically.
I actually would not harp on Step 2 -- if you can do a 240/245 + on it, go for it, it can only help, if you are risking lower than a 240 on it that I would actually recommend avoiding Step 2. If you are going for Step 2, make sure you have your score before August/when you submit your app - otherwise it will very likely get overlooked anyway, schools get inundated with 'updates' and rarely take the time to add them to your application. If you can squeeze in another away instead of Step 2 -- that maybe time better spent. Honestly, if they love you rotating, Step 2 won't make or break you, and ophtho tends to put little focus on Step 2 to begin with (your step 1 is not that bad, it's just not super competitive).
Spend time on your app, have people in the Ophtho world look it over (their insight will be more unique than just having friends and family review it for you), write a solid personal statement. Do research with the decision makers, its a great way to know people in the ophtho community and to show them you understand what it means to work hard and be a reliable individual. Talk to those who matched and even did not match in the last 1-2 years, talk to as many as you can and pick their brains, find out what they did wrong and what they did right, and find out what they know about programs you are interested in (not the kind of things you can find on their website, i mean tips about how to get in).
For various reasons, often times the unmatched are the ones with a perfectly fine board score and enough interviews to match in theory, but they dropped the ball somewhere else, and it is the underdogs who have a realistic awareness of where they stand that find ways to impress programs. You can do it and you should not settle for anything short of what you see yourself doing with your life - you worked too hard in medical school to give up now, but it won't come effortlessly without you being very proactive about it.
