Abstract: Ophthalmic clinical decision support requires fast, accurate, and privacy-preserving inference, yet autoregressive large language models (LLMs) incur substantial latency and computational overhead for decisions among predefined actions. We therefore investigate a decision-oriented alternative to generative reasoning. Specifically, we first introduce RetiJev-Data, a source-grounded ophthalmology corpus comprising 78,158 clinical-decision and diagnosis questions derived from articles in PubMed Central and a MeSH vocabulary covering 531 eye diseases, and 50,074 guideline-grading questions spanning 11 grading systems, along with a 24,662-question evaluation benchmark. Based on this, we develop RetiJev, a family of 0.8B-9B decision models that directly score candidate answers without autoregressive decoding. Across all model sizes, RetiJev outperforms both a 27B LLM and the commercial Jev 1.13 decision model on guideline grading by 10.4-23.0 points. RetiJev-9B further achieves the highest accuracy on clinical decisions, improving over both baselines by 5.4-6.5 points while matching them on diagnosis. It answers a case in 158 ms on one GPU, 3.5x faster than LLM generation and 470x faster than reasoning. Models are released at https://github.com/Awenbocc/RetiJev.