Abstract
Background: Artificial intelligence (AI) can improve efficiency, documentation, and diagnostic quality in ophthalmology. This study examined clinical AI adoption, institutional readiness, perceived utility, trust, ethical concerns, and educational needs among Swiss ophthalmologists and residents. Methods: In May 2025, an anonymous online survey was distributed to board-certified ophthalmologists and residents across Switzerland. The structured questionnaire addressed clinical AI use, institutional infrastructure, perceptions of diagnostic utility, trust, ethical-legal concerns, and educational preparedness. Responses were recorded on five-point Likert scales. Results: Of 106 respondents (mean age 42.4 ± 11.4 years, 48.1% female), 20.8% reported current clinical AI use. Willingness to use AI exceeded 65% across all 10 diagnostic scenarios, but active use remained ≤12.1%. Institutional readiness was low: 6.6% reported AI-related guidelines, 26.4% had access to an institutional AI contact person, and 28.3% received supervisor support (more often among residents). While 80% agreed that AI can support diagnostics, only 12.1% trusted AI recommendations as much as those from colleagues; 87.9% critically reviewed the results, and 93.9% endorsed the use of AI in an assistive but not independently decision-making role. Ethical-legal concerns included unresolved liability (74.8%), informed consent (66.7%), and data protection adequacy (49.5%). Structured AI education was supported by 77.8%, yet only 15.1% felt prepared, and two-thirds (66.7%) indicated they would use AI more with better training. Conclusions: Ophthalmologists and residents in Switzerland express strong interest in the clinical use of AI and recognize its diagnostic potential. Major barriers include insufficient institutional structures, lack of regulatory clarity, and inadequate educational preparation. Addressing these deficits will be essential for responsible AI integration into ophthalmologic practice.