# Constructing Ophthalmic MLLM for Positioning-diagnosis Collaboration Through Clinical Cognitive Chain Reasoning

arXiv: https://arxiv.org/abs/2507.17539 · HTML: https://mlsanity.com/paper/2507.17539/

## Key facts

- Cited by 6 papers in the map (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 18 of its 39 references that are in the map.
- First posted on arXiv 23 Jul 2025.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)
- Multimodal LLMs / vision-language models / [Medical vision-language models](https://mlsanity.com/mllm/medical-vision-language-models/)

## Builds on (most cited first, 18 of 18)

- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [DeepSeek-R1: Incentivizing Reasoning Capability in LLMs via Reinforcement Learning](https://mlsanity.com/paper/2501.12948/) (2025)
- [Qwen2.5-VL Technical Report](https://mlsanity.com/paper/2502.13923/) (2025)
- [Qwen2-VL: Enhancing Vision-Language Model's Perception of the World at Any Resolution](https://mlsanity.com/paper/2409.12191/) (2024)
- [MiniGPT-4: Enhancing Vision-Language Understanding with Advanced Large Language Models](https://mlsanity.com/paper/2304.10592/) (2023)
- [Qwen-VL: A Versatile Vision-Language Model for Understanding, Localization, Text Reading, and Beyond](https://mlsanity.com/paper/2308.12966/) (2023)
- [Expanding Performance Boundaries of Open-Source Multimodal Models with Model, Data, and Test-Time Scaling](https://mlsanity.com/paper/2412.05271/) (2024)
- [Gemini: A Family of Highly Capable Multimodal Models](https://mlsanity.com/paper/2312.11805/) (2023)
- [GMAI-MMBench: A Comprehensive Multimodal Evaluation Benchmark Towards General Medical AI](https://mlsanity.com/paper/2408.03361/) (2024)
- [BioMedLM: A 2.7B Parameter Language Model Trained On Biomedical Text](https://mlsanity.com/paper/2403.18421/) (2024)
- [MedTrinity-25M: A Large-scale Multimodal Dataset with Multigranular Annotations for Medicine](https://mlsanity.com/paper/2408.02900/) (2024)
- [GSCo: Towards Generalizable AI in Medicine via Generalist-Specialist Collaboration](https://mlsanity.com/paper/2404.15127/) (2024)
- [Interpretable Bilingual Multimodal Large Language Model for Diverse Biomedical Tasks](https://mlsanity.com/paper/2410.18387/) (2024)
- [GMAI-VL & GMAI-VL-5.5M: A Large Vision-Language Model and A Comprehensive Multimodal Dataset Towards General Medical AI](https://mlsanity.com/paper/2411.14522/) (2024)
- [VisionUnite: A Vision-Language Foundation Model for Ophthalmology Enhanced with Clinical Knowledge](https://mlsanity.com/paper/2408.02865/) (2024)
- [EyeCLIP: A visual-language foundation model for multi-modal ophthalmic image analysis](https://mlsanity.com/paper/2409.06644/) (2024)
- [Enhancing Diagnostic Accuracy in Rare and Common Fundus Diseases with a Knowledge-Rich Vision-Language Model](https://mlsanity.com/paper/2406.09317/) (2024)
- [ViLReF: An Expert Knowledge Enabled Vision-Language Retinal Foundation Model](https://mlsanity.com/paper/2408.10894/) (2024)

## Built on by (most cited first, 6 of 6)

- [A Survey of Scientific Large Language Models: From Data Foundations to Agent Frontiers](https://mlsanity.com/paper/2508.21148/) (2025)
- [Ophiuchus: Incentivizing Tool-augmented "Think with Images" for Joint Medical Segmentation, Understanding and Reasoning](https://mlsanity.com/paper/2512.14157/) (2025)
- [Bridging the Gap in Ophthalmic AI: MM-Retinal-Reason Dataset and OphthaReason Model toward Dynamic Multimodal Reasoning](https://mlsanity.com/paper/2508.16129/) (2025)
- [MEDVISTAGYM: A Scalable Training Environment for Thinking with Medical Images via Tool-Integrated Reinforcement Learning](https://mlsanity.com/paper/2601.07107/) (2026)
- [OphIn-500K: Curating Web-Scale Visual Instructions for Scaling Ophthalmic Multimodal Large Language Models](https://mlsanity.com/paper/2605.27916/) (2026)
- [RetiBridge: Bridging Quantitative Retinal Biomarkers and Qualitative Diagnosis with a Knowledge-Guided Multimodal Large Language Model](https://mlsanity.com/paper/2510.04281/) (2025)

## Abstract (arXiv)

Multimodal large language models (MLLMs) demonstrate significant potential in the field of medical diagnosis. However, they face critical challenges in specialized domains such as ophthalmology, particularly the fragmentation of annotation granularity and inconsistencies in clinical reasoning logic, which hinder precise cross-modal understanding. This paper introduces FundusExpert, an ophthalmology-specific MLLM with integrated positioning-diagnosis reasoning capabilities, along with FundusGen, a dataset constructed through the intelligent Fundus-Engine system. Fundus-Engine automates localization and leverages MLLM-based semantic expansion to integrate global disease classification, local object detection, and fine-grained feature analysis within a single fundus image. Additionally, by constructing a clinically aligned cognitive chain, it guides the model to generate interpretable reasoning paths. FundusExpert, fine-tuned with instruction data from FundusGen, achieves the best performance in ophthalmic question-answering tasks, surpassing the average accuracy of the 40B MedRegA by 26.6%. It also excels in zero-shot report generation tasks, achieving a clinical consistency of 77.0%, significantly outperforming GPT-4o's 47.6%. Furthermore, we reveal a scaling law between data quality and model capability (L propto N0.068), demonstrating that the cognitive alignment annotations in FundusGen enhance data utilization efficiency. By integrating region-level localization with diagnostic reasoning chains, our work develops a scalable, clinically-aligned MLLM and explores a pathway toward bridging the visual-language gap in specific MLLMs. Our project can be found at https://github.com/MeteorElf/FundusExpert.