Telemedicine technology is increasingly being incorporated into mainstream ophthalmology. Remote fundus imaging is most frequently used in the context of screening for treatable retinal diseases, and robust ocular telehealth programs with mature reading centers now exist to identify vision-threatening diseases in patients with diabetes. Similar advances are being made using telemedicine technology to evaluate for other conditions, including age-related macular degeneration and glaucoma. In particular, a number of successful programs are in place in the United States and elsewhere to screen for retinopathy of prematurity (ROP) with remote retinal imaging. The increasing implementation of telemedicine programs in ophthalmology is being fueled by unmet clinical needs, such as the poor compliance rate for diabetic retinopathy screening and the insufficient number of qualified ophthalmologists willing to screen infants at risk for ROP. While implementation of teleophthalmology continues to expand, significant challenges and unresolved questions remain.