Luciano V. Del Priore

arXiv2026

VOLMO: Versatile and Open Large Models for Ophthalmology

Vision impairment affects millions globally, and early detection is critical to preventing irreversible vision loss. Ophthalmology workflows require clinicians to integrate medical images, structured clinical data, and free-text notes to determine disease severity and management, which is time-consuming and burdensome. Recent multimodal large language models (MLLMs) show promise, but existing general and medical MLLMs perform poorly in ophthalmology, and few ophthalmology-specific MLLMs are openly available. We present VOLMO (Versatile and Open Large Models for Ophthalmology), a model-agnostic, data-open framework for developing ophthalmology-specific MLLMs. VOLMO includes three stages: ophthalmology knowledge pretraining on 86,965 image-text pairs from 26,569 articles across 82 journals; domain task fine-tuning on 26,929 annotated instances spanning 12 eye conditions for disease screening and severity classification; and multi-step clinical reasoning on 913 patient case reports for assessment, planning, and follow-up care. Using this framework, we trained a compact 2B-parameter MLLM and compared it with strong baselines, including InternVL-2B, LLaVA-Med-7B, MedGemma-4B, MedGemma-27B, and RETFound. We evaluated these models on image description generation, disease screening and staging classification, and assessment-and-management generation, with additional manual review by two healthcare professionals and external validation on three independent cohorts for age-related macular degeneration and diabetic retinopathy. Across settings, VOLMO-2B consistently outperformed baselines, achieving stronger image description performance, an average F1 of 87.4% across 12 eye conditions, and higher scores in external validation.

cs.CV↗

arXiv2025

LEME: Open Large Language Models for Ophthalmology with Advanced Reasoning and Clinical Validation

The rising prevalence of eye diseases poses a growing public health burden. Large language models (LLMs) offer a promising path to reduce documentation workload and support clinical decision-making. However, few have been tailored for ophthalmology, and most evaluations focus mainly on knowledge-based QA without clinically relevant benchmarks or real-world validation. Here, we present LEME, a suite of open-weight LLMs developed through a two-stage process: (1) instruction tuning on 200,000 samples from clinical guidelines, textbooks, and case reports to enhance reasoning and task-following, and (2) reinforcement learning with ~30,000 preference labels to enhance accuracy and informativeness. LEME was evaluated on five curated zero-shot benchmarks spanning tasks such as patient QA, consultation, and treatment planning. It outperformed all seven baselines (all p < 0.004), exceeding GPT-4o by 3.32% (absolute ROUGE-L gain). It was further evaluated on three downstream tasks using deidentified patient data, reviewed by clinicians. In patient QA, LEME received the highest ratings from attending clinicians in 3 out of 4 criteria, with scores of 4.67 for factuality, 4.77 for specificity, 4.79 for completeness, and 4.88 for safety (1-5 scale). Its completeness score surpassed that of expert-written answers (4.79 vs. 4.56; p = 0.015). In visual acuity extraction, LEME achieved the highest F1, outperforming LLaMA-3 by 14.1% and Eye-LLaMA by 59.0%. In a pilot evaluation on assessment and treatment planning for diabetic retinopathy, AMD, and glaucoma, LEME received scores of 4.36 for factuality, 4.55 for specificity, 4.42 for completeness, and 4.36 for safety, approaching attending-level performance. All models, data, and code will be released to support further development and clinical translation, laying the groundwork for improved efficiency and patient care

cs.CL↗