Optometry students in clinical years are usually faced with the challenges of making a career choice in or outside optometry. This cross sectional study was conducted to investigate the career aspirations of optometry students in Ghana. All students in their fourth to sixth year who consented to participate in the study responded to a questionnaire which explored: demographic characteristics, career aspirations, and factors influencing their choices. Descriptive statistics was used to present data as frequencies, proportions and percentages. Chi-square test and logistic regression analysis were used to evaluate relationships between variables. Two hundred and nine students from the two optometry training institutions in Ghana; Kwame Nkrumah University of Science and Technology (49.8%) and University of Cape Coast (51.2%) responded to the questionnaire. The mean (SD) age of students was 23.6 (1.9) years (males = 65.6%). On seeking admission into the university, optometry (65.6%) and human biology/medicine (28.2%) were the leading first choice programmes among participants. Participants largely aspire to be in clinical practice (64.6%) or Academia/Research (28.2%). The major factors which influenced career choices were interest in career field (64.1%) and potential good income (38.3%). Females were twice more likely to practice optometry and pursue an interest in paediatric optometry than males. Institution of study (p = .028) and information on career opportunities (p = .018) were significant predictors of students' decision to pursue a career in academia/research. Optometry students in Ghana largely aspire to be in clinical practice, a finding which is useful for optometry training institutions and relevant stakeholders in developing the optometry programme and projecting its future in Ghana.