Background Specialized terminology employed by ophthalmologists creates a comprehension barrier for non-ophthalmology providers, compromising interdisciplinary communication and patient care. Current solutions such as manual note simplification are impractical or inadequate. Large language models (LLMs) present a potential low-burden approach to translating ophthalmology documentation into accessible language. Methods This prospective, randomized trial evaluated the addition of LLM-generated plain language summaries (PLSs) to standard ophthalmology notes (SONs). Participants included non-ophthalmology providers and ophthalmologists. The study assessed: (1) non-ophthalmology providers' comprehension and satisfaction with either the SON (control) or SON+PLS (intervention), (2) ophthalmologists' evaluation of PLS accuracy, safety, and time burden, and (3) objective semantic and linguistic quality of PLSs. Results 85% of non-ophthalmology providers (n=362, 33% response rate) preferred the PLS to SON. Non-ophthalmology providers reported enhanced diagnostic understanding (p=0.012), increased note detail satisfaction (p<0.001), and improved explanation clarity (p<0.001) for notes containing a PLS. The addition of a PLS narrowed comprehension gaps between providers who were comfortable and uncomfortable with ophthalmology terminology at baseline (intergroup difference p<0.001 to p>0.05). PLS semantic analysis demonstrated high meaning preservation (BERTScore mean F1 score: 0.85) with greater readability (Flesch Reading Ease: 51.8 vs. 43.6, Flesch-Kincaid Grade Level: 10.7 vs. 11.9). Ophthalmologists (n=489, 84% response rate) reported high PLS accuracy (90% "a great deal") with minimal review time burden (94.9% ≤ 1 minute). PLS error rate on initial ophthalmologist review and editing was 26%, and 15% on independent ophthalmologist over-read of edited PLSs. 84.9% of identified errors were deemed low risk for patient harm and 0% had a risk of severe harm/death. Conclusions LLM-generated plain language summaries enhance accessibility and utility of ophthalmology notes for non-ophthalmology providers while maintaining high semantic fidelity and improving readability. PLS error rates underscore the need for careful implementation and ongoing safety monitoring in clinical practice.

The authors have declared no competing interest.

This study was funded by the Heed Ophthalmic Foundation

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