Purpose: The Beijing Eye Public Health Care Project was designed to screen all elderly subjects (age 55-85 years) of the rural region of Greater Beijing. It was developed as a preparatory step for a telemedicine-based public health care system in ophthalmology in China. Design: Population-based public health care project. Participants: Elderly subjects (age 55-85 years) of the rural region of Greater Beijing. Methods: Project participants were visited, interviewed, and examined by 2500 high school graduates trained as ophthalmic technicians. If visual acuity was <0.30, subjects were referred to primary health care centers where ocular photographs were taken. Using telemedicine, the photographs were transmitted to a reading center and causes for visual impairment were diagnosed. Main Outcome Measures: Practicability of a mass screening system in ophthalmology; prevalence of visual impairment and causes for it. Results: Out of 692 323 eligible inhabitants, 562 788 (81.3%) subjects participated. Visual impairment in >= 1 eye was detected in 54 155 (9.62%) subjects, and among them, 30 164 (5.36%) subjects had bilateral visual impairment. Ocular fundus photographs were taken for 37 281 subjects. Cause for visual impairment was cataract in 19 163 (3.41%) of all screened subjects, glaucoma in 1606 (0.29%) subjects, diabetic retinopathy in 905 (0.16%) subjects, other macular diseases in 2700 (0.48%) subjects, pterygium in 1381 (0.25%) subjects, and corneal leukoma in 283 (0.05%) subjects. For 5853 (1.04%) subjects, a diagnosis of premature or mature cataract was made showing the urgent need of cataract surgery. After cataract surgery, visual acuity was >0.30 in 1464 (91.7%) of 1596 postoperatively reexamined subjects. Conclusions: Using a telemedicine approach, the Beijing Eye Public Health Care Project developed, applied and tested an infrastructure for ophthalmic mass screening of >500 000 elderly inhabitants with a response rate of >80%. Beside cataract, retinal diseases including diabetic retinopathy and glaucoma were major causes for visual impairment. Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article. Ophthalmology 2012;119:1167-1174 (C) 2012 by the American Academy of Ophthalmology.