{
  "abstract": "Large language models (LLMs) offer potential to alleviate the growing public health burden of eye disease; however, few models have been tailored for ophthalmology or evaluated against clinically relevant benchmarks and real-world workflows. Here, we present LEME, a suite of open-weight LLMs for ophthalmology developed via a two-stage framework: instruction tuning on 211,149 examples curated from authoritative sources, and reinforcement learning with 29,747 preference-labeled examples to enhance clinical reasoning and informativeness. LEME was evaluated under zero-shot settings using five curated benchmarks, covering question answering and patient-physician consultation. LEME outperformed all seven baselines (all p < 0.004), notably exceeding GPT-4o by 3.32% in average ROUGE-L. Furthermore, LEME was assessed on three downstream tasks using deidentified patient data. In answering patient queries, LEME received the highest overall ratings from attending clinicians; its completeness rating even surpassed that of the expert-written answers ( p = 0.015). For visual acuity extraction from clinical notes, LEME achieved the highest F1 scores, outperforming LLaMA-3 70B by 14.1% and Eye-LLaMA by 59.0%. Finally, in assessment and treatment plan generation, LEME achieved ratings approaching those of attending clinicians, demonstrating promise for ophthalmic decision support. All models, datasets, and code are made open to support further development and validation.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Biomedical Informatics and Data Science, Yale School of Medicine, Yale University, New Haven, CT, USA",
    "Centre for Innovation and Precision Eye Health, Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore",
    "Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore",
    "Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA",
    "Department of Ophthalmology and Visual Science, Yale School of Medicine, Yale University, New Haven, CT, USA",
    "Department of Computer Science, Korea University, Seoul, Republic of Korea",
    "Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore",
    "Department of Ophthalmology, National University Hospital, Singapore, Singapore",
    "Department of Computer Science, University of Liverpool, Liverpool, UK",
    "Byers Eye Institute, Stanford University, Stanford, CA, USA",
    "Institute of Health Informatics, University College London, London, UK",
    "Institute of Ophthalmology, University College London, London, UK",
    "Moorfields Eye Hospital, London, UK",
    "Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA",
    "Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA",
    "Research Informatics Office, Yale School of Medicine, Yale University, New Haven, CT, USA",
    "School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, USA",
    "Eye Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 30,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Hyunjae Kim",
      "orcid": "0009-0007-4831-127X"
    },
    {
      "affs": [
        0
      ],
      "name": "Xuguang Ai",
      "orcid": "0009-0000-2432-8316"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Sahana Srinivasan",
      "orcid": "0009-0008-3063-8722"
    },
    {
      "affs": [
        3
      ],
      "name": "Aidan Gilson",
      "orcid": "0000-0002-4770-4705"
    },
    {
      "affs": [
        4
      ],
      "name": "Maxwell Singer",
      "orcid": "0000-0001-9583-3846"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Krithi Pushpanathan",
      "orcid": "0000-0001-6263-8489"
    },
    {
      "affs": [
        0
      ],
      "name": "Qianqian Xie",
      "orcid": "0000-0002-9588-7454"
    },
    {
      "affs": [
        5
      ],
      "name": "Jungwoo Park"
    },
    {
      "affs": [
        4
      ],
      "name": "Serina S. Applebaum",
      "orcid": "0000-0001-9062-6178"
    },
    {
      "affs": [
        6
      ],
      "name": "Gabriel Dawei Yang"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Minjie Zou"
    },
    {
      "affs": [
        1,
        7,
        2
      ],
      "name": "David Ziyou Chen"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Ke Zou"
    },
    {
      "affs": [
        4
      ],
      "name": "Soshian Sarrafpour"
    },
    {
      "affs": [
        4
      ],
      "name": "Ji Liu"
    },
    {
      "affs": [
        8
      ],
      "name": "Yu Yin"
    },
    {
      "affs": [
        0
      ],
      "name": "Jimin Huang",
      "orcid": "0000-0002-3501-3907"
    },
    {
      "affs": [
        9,
        10,
        11,
        12
      ],
      "name": "Quang Nguyen",
      "orcid": "0000-0003-2665-3125"
    },
    {
      "affs": [
        13
      ],
      "name": "Erping Long",
      "orcid": "0000-0002-3502-5596"
    },
    {
      "affs": [
        14
      ],
      "name": "Peixing Wan"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Dianbo Liu",
      "orcid": "0000-0002-3042-9161"
    },
    {
      "affs": [
        15
      ],
      "name": "Richard Hintz"
    },
    {
      "affs": [
        16
      ],
      "name": "W. Jim Zheng"
    },
    {
      "affs": [
        9
      ],
      "name": "Sophia Ying Wang",
      "orcid": "0000-0003-0916-9403"
    },
    {
      "affs": [
        0
      ],
      "name": "Lucila Ohno-machado A",
      "orcid": "0000-0002-8005-7327"
    },
    {
      "affs": [
        0
      ],
      "name": "Hua Xu",
      "orcid": "0000-0001-9730-7276"
    },
    {
      "affs": [
        4
      ],
      "name": "Ron Afshari Adelman",
      "orcid": "0000-0003-4049-3551"
    },
    {
      "affs": [
        4
      ],
      "name": "Luciano V. Del Priore"
    },
    {
      "affs": [
        1,
        2,
        17,
        6
      ],
      "name": "Yih Chung Tham",
      "orcid": "0000-0002-6752-797X"
    },
    {
      "affs": [
        0
      ],
      "name": "Qingyu Chen",
      "orcid": "0000-0002-7573-7803"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/fcrs6mg8xhar4.bib",
  "cited_by": 12,
  "doi": "10.1038/s41746-026-03104-4",
  "fulltext_url": null,
  "id": "fcrs6mg8xhar4",
  "issns": [
    "2398-6352"
  ],
  "landing_url": "https://doi.org/10.1038/s41746-026-03104-4",
  "language": "en",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2718|Artificial Intelligence in Healthcare and Education"
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  "openalex": "W4403322150",
  "pdf_url": "https://www.nature.com/articles/s41746-026-03104-4_reference.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-25",
  "publisher": "Nature Portfolio",
  "ris": "https://research.draconitic.com/paper/fcrs6mg8xhar4.ris",
  "sources": [
    {
      "first_seen": "2026-11-11T13:20:35Z",
      "native_id": "W4403322150",
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      "url": "https://doi.org/10.1038/s41746-026-03104-4"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2718|Artificial Intelligence in Healthcare and Education",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "LEME: open large language models for ophthalmology with advanced reasoning and clinical validation",
  "title_text": "LEME: open large language models for ophthalmology with advanced reasoning and clinical validation",
  "type": "peer-reviewed",
  "updated_at": "2026-11-13T13:21:12Z",
  "url": "https://research.draconitic.com/paper/fcrs6mg8xhar4",
  "venue": "npj Digital Medicine",
  "versions": []
}