Scientific Domain Knowledge Improves Vision-Language Fundus Models

The advancement of general medical Multimodal Large Language Models (MLLMs) has shown great potential for building conversational assistants to support clinical diagnosis. However, their adaptation to highly specialized domains such as ophthalmology remains underexplored, primarily due to the scarcity of large-scale, domain-specific instruction-tuning data. Existing ophthalmic datasets for conversational agents are often limited in scale and largely rely on images from established public benchmarks, limiting the scalability of ophthalmic MLLMs and their ability to capture real-world clinical complexity. To address this gap, we propose $\textbf{OphIn-Engine}$, an ophthalmology-specific instruction data curation pipeline that constructs high-quality instruction data from open-access ophthalmology web-scale videos. The pipeline integrates multimodal transcription for extracting image-transcript pairs, visual cue separation and scoring for identifying clinically relevant visual descriptions, and instruction synthesis with quality control for generating accurate and diverse clinical dialogues. Using this engine, we introduce $\textbf{OphIn-500K}$, a large-scale multimodal ophthalmology instruction-tuning dataset containing over 500,000 instruction instances and more than 151,000 unique images from over 29,000 video clips, formatted as visual question answering (VQA), multi-turn conversational interactions, and chain-of-thought (CoT) reasoning. Built upon this dataset, we further develop $\textbf{OphIn-VL}$, an ophthalmology-specific MLLM with advanced visual understanding and conversational capabilities. Comprehensive experiments and case studies demonstrate that OphIn-VL achieves superior performance compared with state-of-the-art general medical and domain-specific MLLMs.

We present OpenMedQ, a medical vision-language model pretrained on the broadest fully-open medical mix to date: 14 datasets totaling ~3.35M pretraining samples spanning pathology, radiology, microscopy, and text-only clinical QA. OpenMedQ reaches state-of-the-art BLEU-1 on PathVQA (75.9), beating Med-PaLM M variants up to 562B parameters (~80x larger), and matches the best reported VQA-MED BLEU-1 (64.5). Its vision encoder, transferred to 8 unseen medical classification benchmarks under an identical downstream recipe, obtains the highest average macro-F1 (0.757) among BiomedCLIP (0.745), PMC-CLIP (0.745), PubMedCLIP (0.746), and a from-scratch baseline (0.616). We release our code and an interactive demo is publicly available as a reproducible baseline for the community.

While Large Vision-Language Models (VLMs) demonstrate remarkable generic capabilities, their clinical reasoning in specialized domains like ocular surface diseases (OSDs) is severely hindered by a paucity of high-fidelity, multimodal instruction-tuning data. To dismantle this data bottleneck, we introduce IRIS, an Intelligent Recognition and Interaction System tailored for fine-grained OSD understanding via external eye photography. First, we curate IRIS-120K, the largest and most comprehensive OSD visual question-answering (VQA) dataset to date. Crucially, to overcome the semantic shallowness of conventional image-caption pairs, we propose a synergistic data generation paradigm to explicitly inject clinical priors. Our data engine operates via a dual-branch framework: 1) a Topic Finding Tree (TFT) that hierarchically anchors visual features to precise anatomical and pathological concepts, enforcing rigorous medical deduction logic; and 2) a Scene-driven strategy that synthesizes role-adaptive clinical dialogues to ensure pragmatic generalization. By explicitly aligning a compact 4B-parameter VLM on this structurally enriched corpus, IRIS achieves state-of-the-art performance, comprehensively outperforming both generalist and specialized medical VLMs with up to 34B parameters. Our findings underscore that structured knowledge injection profoundly prevails over sheer parameter scaling, unlocking the potential for resource-efficient, expert-level AI deployment on mobile edge devices for scalable OSD screening. Code, datasets, and model weights will be publicly released by this repo.