I understand your dilemma. Having been through the match process, I don't think that not getting honors during your core clerkships is really going to matter. I don't ever remember any of my interviewers mentioning clinical grades at all. Step 1, AOA status, recs, med school ranking and research seem to matter more. Obviously, try your hardest to honor your ophtho electives if you can. If you're just interested in getting into an East Coast program & not necessarily a top-tiered one, I don't think you need to take a year off to do research. You do have some research experience, albeit not in ophtho, but it looks impressive nonetheless. Your Step I is above average for matched candidates, and the fact that you go to a top 10 school is probably going to help you more than you think. Applicants who go to top med schools usually get more interviews, and at better programs, than those who don't. Just get to know the leadership at your home program so you can make connections and schedule a couple of away rotations at top programs and you should do fine. Good luck.
