From DrQuakerJack on SDN:
I feel a lot of pressure to do a fellowship and would love to hear from people why someone should do comprehensive.
I think it really depends on your comfort level with ocular surgery in general. I know of many very successful "general" ophthalmologists who never did a fellowship. One difference is that they trained during a time when people did a bit of everything. Thus, in addition to cataract surgery, they had good exposure to stuff like glaucoma trabs and tubes, eyelid plastics, and even more retinal exposure. Unfortunately, many residency programs are not training residents the same way anymore. For example, your glaucoma attendings may not let you perform too many tubes since they may (mistakenly) believe it is a "waste of time" teaching you how to do one. Also, there seem to be many more fellows out there associated with training programs. These fellows will be given preference for surgical cases in their respective subspecialties.
But back to encouragement -- like someone else said, some of the most successful and rich Ophthalmologists out there are the ones doing high volume cataract and LASIK. Unlike what you may believe in the bubble of academia, the most volume of LASIK is being performed by non-fellowship training ("comprehensive") Ophthalmologist. I think the reason being is that very few corneal/"refractive" fellowships really have great volume in refractive surgery.
If you do decide on the non-fellowship route, your first job out of residency will be extremely important. You probably want a high surgical volume job with some mentors to help hone your skills (and maybe also teach you new ones like LASIK).