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Recently, Telehealth connects patients to vital healthcare services via remote monitoring, wireless communications, videoconferencing, and electronic consults. By increasing access to specialists and physicians, telehealth assists in ensuring patients receive the proper care at the right time and right place. Teleophthalmology is a study of telemedicine that provides services for eye care using digital medical equipment and telecommunication technologies. Multimedia computing with Explainable Artificial Intelligence (XAI) for telehealth has the potential to revolutionize various aspects of our society, but several technical challenges should be resolved before this potential can be realized. Advances in artificial intelligence methods and tools reduce waste and wait times, provide service efficiency and better insights, and increase speed, the level of accuracy, and productivity in medicine and telehealth. Therefore, this study develops an XAI-enabled teleophthalmology for diabetic retinopathy grading and classification (XAITO-DRGC) model. The proposed XAITO-DRGC model utilizes OphthoAI IoMT headsets to enable remote monitoring of diabetic retinopathy (DR) disease. To accomplish this, the XAITO-DRGC model applies median filtering (MF) and contrast enhancement as a pre-processing step. In addition, the XAITO-DRGC model applies U-Net-based image segmentation and SqueezeNet-based feature extractor. Moreover, Archimedes optimization algorithm (AOA) with a bidirectional gated recurrent convolutional unit (BGRCU) is exploited for DR detection and classification. The experimental validation of the XAITO-DRGC method can be …