Current multimodal LLMs encode images as static visual prefixes and rely on text-based reasoning, lacking goal-driven and adaptive visual access. Inspired by human visual perception—where attention is selectively and sequentially shifted from the most informative regions to secondary cues—we propose Structural Sequential Visual CoT **(SSV-CoT)**. First, a question-relevant saliency map identifies and organizes key visual regions, explicitly modeling the spatial distribution of visual importance. Second, reasoning is performed following this discriminative order, inducing a curriculum-like semantic progression from primary to secondary cues. This method is trained end-to-end, using text cot and answer supervision, without relying on region-level annotations or specialized external tools. Experiments on diverse visual reasoning benchmarks show gains, validating structured and sequential visual cognition.

Vision-language models (VLMs) achieve promising results in medical reasoning but struggle with hallucinations, vague descriptions, Inconsistent logic and poor localization. To address this, we propose a agent framework named Medical Visual Reasoning Agent (Med-VRAgent). The approach is based on Visual Guidance and Self-Reward paradigms and Monte Carlo Tree Search (MCTS). By combining the Visual Guidance with tree search, Med-VRAgent improves the medical visual reasoning capabilities of VLMs. We use the trajectories collected by Med-RAgent as feedback to further improve the performance by fine-tuning the VLMs with the proximal policy optimization (PPO) objective. Experiments on multiple medical VQA benchmarks demonstrate that our method outperforms existing approaches.