We have developed a system for tele-ophthalmology that uses low bandwidth data transmission via the Internet. The online system has been tested in two different trials, with specialist advice provided from Perth. The first trial concerned referrals from Indonesia. Approximately 250 consultations were provided in the first two years. The referral rate rose to an average of 10 consultations per month. 25% of patients avoided intended air travel to Australia, 20% were operated on locally in Indonesia and the other 55% travelled to Australia where they were given advice about the surgery required, cost and length of stay. In the second trial, referrals were received from a regional hospital in Western Australia. Approximately 200 consultations were provided. About 4% of the patients were transferred to Perth for treatment, 38% of the patients needed follow-up, 8% were treated by local medical officers according to specialist advice, and the rest were cleared of any disease. Problems of reimbursement and doctors' indemnity will need to be overcome if the online service is to become sustainable.