Purpose To determine peripapillary atrophy in elderly Chinese in an urban and rural regions of Beijing. Methods The Beijing Eye Study a population-based, cross-sectional cohort study, included 4439 subjects out of 5324 subjects who were asked to participate (response rate 83.4%). Mean age was 56.2 +/- 10.6 years (range, 40-101 years). Colour optic disc photographs (30 degrees) were morphometrically examined. Peripapillary atrophy was divided into alpha zone and beta zone. Results Optic disc photographs were available for 4027 (90.7%) subjects. Alpha zone and beta zone, respectively, were present in 2867 (71.2%) subjects and 802 (19.9%) subjects, respectively, measuring 0.52 +/- 0.64 mm(2) and measuring 0.46 +/- 1.82 mm(2). Both zones were significantly widest and found significantly (P<0.001) most often in the temporal peripapillary region, followed by the temporal inferior region, the temporal superior region, and finally the nasal region. Size of both zones was significantly correlated with optic disc size (P<0.001), age (P<0.001), and myopic refractive error (P<0.001). Both zones increased significantly with decreasing uncorrected visual acuity (P<0.001) and decreasing best-corrected visual acuity (P<0.001). They did not vary significantly (P=0.10; and P=0.78) between male and female subjects. In multivariate analysis, the relationships between both zones and age, myopic refractive error, disc size, and uncorrected and best-corrected visual acuity remained statistically significant (P<0.001). Conclusions Alpha zone and beta zone of peripapillary atrophy, respectively, occur in about 70 and 20%, respectively, of elderly Chinese. As peripapillary atrophy changes in glaucomatous optic neuropathy, these normative data may be helpful for glaucoma detection.