Purpose: To assess longitudinal changes in parapapillary atrophy in the adult population of Greater Beijing. Methods: The population-based Beijing Eye Study 2006 included 3251 subjects who had participated in the Beijing Eye Study 2001 and returned for re-examination. The mean age was 60.4 +/- 10.1 years. Using optic disc photographs, we measured parapapillary atrophy which was divided into alpha zone and beta zone. Results: Overall progression rate of alpha zone was seen in 0.6 +/- 0.1% (95% confidence interval (CI): 0.3,0.9) of the subjects and of beta zone in 8.2 +/- 0.5% (95% CI: 7.2,9.1) of the subjects. In binary regression analysis, rate of progression of alpha zone was significantly associated higher age (P = 0.04) and the co-progression of zone Beta (P<0.001). Rate of progression of beta zone was significantly associated with higher age (P< 0.001; odds ratio (OR): 1.11; 95% CI: 1.10,1.14), higher intraocular pressure (P<0.001; OR: 1.10; 95% CI: 1.05,1.14), higher myopic refractive error (P<0.001; OR: 0.71; 95% CI: 0.67,0.75), rural region of habitation (P = 0.002; OR: 0.58; 95% CI: 0.41,0.82), presence of glaucomatous optic nerve damage (P<0.001; OR: 2.89; 95% CI: 1.62,5.14), co-progression of alpha zone (P<0.001; OR: 7.13; 95% CI: 2.43,20.9), absence of arterial hypertension (P = 0.03; OR: 0.70; 95% CI: 0.51,0.96), and thicker central corneal thickness (P = 0.02; OR: 1.01; 95% CI: 1.00,1.01). Subjects with a non-glaucomatous optic nerve damage (n = 22) as compared to the remaining subjects did not vary in the progression rate of alpha zone (0.0% versus 0.6 +/- 0.1%; P = 1.0) and beta zone (8.2 +/- 0.5% versus 6.3 +/- 0.6%; P = 1.0). Conclusions: In adult Chinese in Greater Beijing, the 5-year progression rate of beta zone of parapapillary atrophy (seen in 8.2 +/- 0.5% of subjects) was significantly correlated with higher age, rural region of habitation, absence of arterial hypertension, higher intraocular pressure, higher myopic refractive error, thicker central corneal thickness, and presence of glaucoma. It was not associated with non-glaucomatous optic nerve damage.