To identify factors associated with early age-related macular degeneration (AMD) in a rural Chinese population, with emphasis on retinal vessel caliber. The study population comprised the 6,830 participants of the Handan Eye Study. All participants underwent digital retinal photography of both eyes. Trained graders assessed the presence of AMD lesions. Arteriolar and venular diameters were measured with a specific computer-assisted program and were summarized as the central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE). The data for the 199 individuals with evaluable retinal photographs and early AMD and 400 age-matched individuals randomly selected from the group without AMD were analyzed. After adjusting for participants' age, sex, smoking status, hypertension, diabetes, BMI, and CRVE, the multivariate adjusted model showed that a higher CRAE was significantly associated with early AMD (OR = 1.34; 95% CI: 1.05-1.71; p = 0.020) and the presence of soft distinct drusen (OR = 1.32 (95% CI: 1.02-1.71, p = 0.037). There were no significant associations between CRVE and early AMD. Dilated retinal arteriolar caliber is associated with early AMD and soft distinct drusen in this population. We found no significant associations between CRAE and other characteristics of the retina related to AMD or between retinal venal caliber and early AMD. More research is needed to determine whether the difference between these results and those previously published stem from the rural living conditions of the participants or other factors.