Purpose: To examine the prevalence of fundus tessellation and its associated factors. Design: Population-based study. Participants: The Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6 +/- 9.8 years (range, 50-93 years). Methods: Participants underwent a comprehensive ophthalmic examination. By using 45 degrees color fundus photographs of the macula and optic disc, fundus tessellation, defined as variation in the visibility of the large choroidal vessels, was differentiated into 3 grades. Main Outcome Measures: Fundus tessellation. Results: Assessment of fundus tessellation was available for 3442 individuals (99.6%) or 6789 eyes (98.6%). In multivariate analysis, a higher degree of fundus tessellation (mean, 0.84 +/- 0.79) was associated with older age (P < 0.001; standardized correlation coefficient beta, 0.14), male sex (P < 0.001; beta, -0.08), lower body mass index (P = 0.04; beta, 0.03), worse best-corrected visual acuity (P < 0.001; beta, 0.05), thinner subfoveal choroidal thickness (P < 0.001; beta, -0.51), longer axial length (P < 0.001; beta, 0.11), larger parapapillary beta zone (P < 0.001; beta, 0.08), lower prevalence of intermediate age-related macular degeneration (AMD) (P = 0.02; beta, -0.04), and lower prevalence of late AMD (P = 0.007; beta, -0.04). If parapapillary beta zone was dropped, higher glaucoma prevalence (P = 0.003) was associated with a higher degree of fundus tessellation. Prevalence of diabetes mellitus and retinal vein occlusions, mean blood pressure, and intraocular pressure were not (P > 0.10) associated with fundus tessellation. In a reverse manner, thinner subfoveal choroidal thickness was associated with a higher degree of fundus tessellation (P < 0.001; beta, -0.49) in the multivariate analysis. Subfoveal choroidal thickness decreased from 322 +/- 90 mm (95% confidence interval [CI], 317-327) in eyes without fundus tessellation to 229 +/- 80 mm in eyes with grade 1, to 122 +/- 52 mm in eyes with grade 2, and to 81 +/- 37 mm in eyes with grade 3 of fundus tessellation. Conclusions: Fundus tessellation is a surrogate for choroidal thinness and may be a clinical sign for a leptochoroid. After adjusting for ocular and systemic parameters, fundus tessellation also is associated with a larger parapapillary beta zone and higher glaucoma prevalence, and a lower prevalence of intermediate and late AMD. Its association with lower visual acuity warrants further investigation. (C) 2015 by the American Academy of Ophthalmology.