We conducted a single-center, retrospective observational study to evaluate large language models (ChatGPT 4o, GPT-5, DeepSeek) for automated interpretation of de-identified IOLMaster 700 reports provided as raster images. Models produced structured biometric extraction, toric IOL recommendation, and refractive predictions (sphere, cylinder, axis). Primary outcomes included parameter-level agreement and refractive error metrics; secondary outcomes included decision-support performance for toric IOL selection and agreement on ordered T-codes. No clinical intervention was performed.

This study compares three large language models accessed in their native configurations, without fine-tuning or external tools. For each examination, the original IOLMaster 700 report image was supplied without manual annotation or pre-processing. A standardized instruction required: (i) structured extraction of AL, ACD, LT, WTW, K1/K2 and axes, ΔK, TK1/TK2 and axes, and ΔTK; (ii) binary toric candidacy and T-code according to institutional ALCON mapping; and (iii) refractive recommendations (sphere, cylinder, implantation axis). Each model generated three independent outputs per case. De-identification and IRB oversight (waiver of consent) were implemented according to institutional policy. The unit of enrollment is participants (n=54), with outcomes analyzed per eye (162 eyes) and per model generation where applicable.

Inclusion Criteria:

-postoperative corrected distance visual acuity (CDVA) of 0.10 logMAR or better -an absolute IOL rotational stability of less than 10∘ at the 1-month follow-up examination

Exclusion Criteria:

• incomplete biometric data on the examination report;
• a history of previous ocular surgery or ocular trauma
• the occurrence of intraoperative complications, such as an anterior capsular tear or posterior capsular rupture
• the development of significant postoperative complications, including but not limited to severe intraocular infection or inadequate pupillary dilation.

cataract patients who had undergone phacoemulsification and implantation of an AcrySof IQ Toric monofocal intraocular lens