Comparison of three large language models in recognizing ophthalmological examination and supporting preoperative toric IOL planning.

PURPOSE: To evaluate the performance of three large language models (LLMs) in automated recognition of IOLMaster 700 reports and preoperative toric intraocular lens (IOL) planning.

METHODS

The retrospective study analyzed preoperative examination reports of patients who underwent cataract surgery with toric IOL implantation. Three models (ChatGPT-5, ChatGPT-5 Thinking and DeepSeek Thinking) were instructed to extract key biometric parameters, evaluate a patient's suitability for toric IOL implantation, and generate a plan. Model performance was evaluated based on structured-data recognition, refractive prediction outcomes and thinking times.

RESULTS

Fifty-four eyes of 54 patients were analyzed. ChatGPT-5 Thinking model consistently achieved the highest agreement with clinical reference for all extracted parameters, and demonstrated more reliable extraction of axis information. ChatGPT-5 showed intermediate performance, while DeepSeek Thinking was the least consistent in axis-dependent fields but performed adequately for basic biometry. Refractive and axis prediction errors were smallest with ChatGPT-5 Thinking, yielding the largest proportion of cases within prespecified clinical thresholds and the highest concordance with the calculator-based reference plan. Analysis of thinking times showed that longer processing did not necessarily correlate with better accuracy.

CONCLUSIONS

Advanced LLMs show promise for automated interpretation of ophthalmic biometry reports and calculator-based toric IOL planning workflows. These findings support the feasibility of LLM-assisted workflow automation, with ChatGPT-5 Thinking providing the most favorable balance of accuracy and efficiency in this setting.