Background/Objectives: Discharge letters are essential for continuity of care but are often time-consuming to prepare and variable in quality. Large language models (LLMs) may help standardize and support this process, yet evidence in ophthalmology remains limited. This study compared the quality of resident-written and GPT-5.2-generated ophthalmology discharge letters derived from the same de-identified clinical data. Methods: This retrospective blinded study was conducted at a tertiary hospital in Croatia. For 146 consecutive inpatient discharges, original resident-written letters were paired with GPT-5.2-generated letters created using a standardized prompt; 142 complete pairs were available for the primary analysis. Three board-certified ophthalmologists evaluated anonymized letters using a structured assessment of accuracy, completeness, clarity/structure, tone/professional phrasing, conciseness, global quality, errors, omissions, and key content elements. Results: In the primary paired analysis, GPT-5.2-generated letters performed similarly to resident-written letters across accuracy, completeness, clarity/structure, errors, omissions, and overall quality. GPT-5.2-generated letters received higher ratings for tone/professional phrasing, whereas resident-written letters were rated as more concise, although inter-rater agreement was poor on these stylistic domains (at or below chance for conciseness) and these findings should therefore be interpreted as exploratory. Resident-written letters more often documented operations, while GPT-5.2-generated letters more consistently included findings. Reviewer-adjusted sensitivity analyses were less favorable to GPT-5.2 for several domains. Conclusions: GPT-5.2-generated ophthalmology discharge letters showed similar performance to resident-written letters in several evaluated domains in the primary paired analysis, but differences in specific content elements and less favorable sensitivity analyses indicate that clinician oversight remains necessary to ensure accuracy, procedural completeness, and clinical usability.

Accurate documentation is critical in ophthalmology, yet clinical notes often contain subtle errors that can affect decision-making. This study prospectively compared contemporary large language models (LLMs) for detecting clinically salient errors in emergency ophthalmology encounter notes and generating actionable corrections. 129 de-identified notes, each seeded with a predefined target error, were independently audited by four LLMs (o3 (OpenAI, closed-source), DeepSeek-v3-r1 (Deepseek, open-source), MedGemma-27B (Google, open-source), and GPT-4o (OpenAI, closed-source)) using a standardized prompt. Two masked ophthalmologists graded error localization, relevance of additional issues, and overall recommendation quality, with within-case analyses applying appropriate nonparametric tests. Performance varied significantly across models (Cochran’s Q = 71.13, p = 2.44 × 10⁻¹⁵). o3 achieved the highest error localization accuracy at 95.7% (95% CI, 89.5–98.8), followed by DeepSeek-v3-r1 (90.3%), MedGemma-27b (80.9%), and GPT-4o (53.2%). Ordinal outcomes similarly favored o3 and DeepSeek-v3-r1 (both p < 10⁻⁹ vs. GPT-4o), with mean recommendation quality scores of 3.35, 3.05, 2.54, and 2.11, respectively. These findings demonstrate that LLMs can serve as accurate “second-eyes” for ophthalmology documentation. A proprietary model led on all metrics, while a strong open-source alternative approached its performance, offering potential for privacy-preserving on-premise deployment. Clinical translation will require oversight, workflow integration, and careful attention to ethical considerations.