TL;DR a mess

Broken UI - Selecting difficulty modifiers like enemy HP simply does not work properly. You need to click on the slider, then move it - if you click again it does not actually properly deselect it though and depending on how you move your mouse afterwards it'll keep moving for a moment, possibly selecting a value that's wayyy different than you wanted. That way, i've had modifiers at ridiculous levels without intending to and only realising afterwards after dying a bunch and wondering why it was so difficult. Love being able to adjust modifiers like this though to increase rewards! Just wish the UI wasn't so broken. How this passed any playtesting is beyond me.
There are other UI issues too, like why do you have to click on a specific button on the screen to open chests? It's super annoying. Just auto open, or be able to click anywhere.

Lack of balance - pretty much everything seems not well balanced. Some weapons seem rather pointless, are so OP they become a no brainer. There is basically no run ever where you'd want to pass up on damage bonus for example. You can also have so many equipments that it takes away a bunch of the choice in what to take, and at the same time making it feel really overwhelming.
Level difficulty also feels off, you can be utterly bored by level 1 yet get absolutely get crushed by level 2. I also very early on started playing on at least +50% or +100% speed just because it's sooooo boring otherwise. +100% is okay.
Some characters are just awful to play - Quickling is really difficult to control. Berserker background also is simply awful, you can never regenerate HP.

Bad design - You can take over skills of bosses you defeat. The problem is that this means, there can be projectiles on the screen that look exactly the same - they could be friendly or hostile. And while theoretically you could always know which it is since you can only take the skill after defeating the boss, it means you simply cannot build a reliable habit of either needing to avoid it, or not. The projectiles need an obvious visual difference at the very least.
Chests also give you a level up, but putting you at 0 XP for the next one - meaning, if you just got a level it's more efficient, if you pick one up just before you level up you waste all the XP. Which means you'll always be micro-managing when to pick up chests, picking them up accidentally is frustrating etc.

It's not super accessible either. Lots of skills have some at times pretty intense flashing, including some area effects that can cover the whole screen. Not great.

Overall it just feels like a mess. With some more polish, it could be much better, and it's sad to see a couple rather fixable things are holding Nomad Survival back quite a bit. Although it still lacks some of the really interesting mechanics that Vampire Survivors has like evolving weapons, which add a lot of strategy. So even with better QoL and fixed bugs it would simply not hold up. And it certainly does not with the present issues.

Just a boring Vampire Survivors copycat. There are better options these days. Gave it two runs, both utterly boring. Welp. Not necessarily bad, considering the reviews, just a genre you only need a single game to pick and I wouldn't pick this one.

This game is ultra meh. With so many good games in this category there is no reason to play this one. It has no interesting unique features and makes some really terrible design choices. For example the sound it plays when you collect an experience gem is awful and annoying.