To evaluate the prevalence of myopic maculopathy among participants aged 50 years and older in rural southern China.Population-based, cross-sectional study. Subjects were recruited using cluster sampling from Yangxi County, Guangdong Province, China from August to November in 2014. Non-cycloplegic autorefraction and fundus photography were performed on all of the participants. Myopic maculopathy was graded based on fundus photographs using the International Classification of Myopic Maculopathy.Among 5825 individuals who participated (90.7% response rate), a total of 4469 participants with gradable fundus photographs for myopic maculopathy and automated refractive data were included in this study. The mean age of these participants was 65.50±9.70 years. The crude prevalence of myopic maculopathy was 1.4% (62/4469; 95% confidence interval [CI] 1.0% to 1.8 %) and age-standardised prevalence was 1.2% (95% CI 1.1% to 1.2%). Diffuse chorioretinal atrophy, patchy chorioretinal atrophy, macular atrophy, lacquer cracks and staphyloma were observed in 43 (1.0%), 3 (0.1%), 1 (0.1%), 15 (0.3%) and 8 eyes (0.2%), respectively. Myopic maculopathy was more common in eyes of older participants (OR 1.07; 95% CI 1.03 to 1.11) and more myopic spherical equivalence (OR 1.69; 95% CI 1.57 to 1.84).The prevalence of myopic maculopathy was low among the rural southern Chinese population. Diffuse chorioretinal atrophy was the most common retinal finding among Chinese myopes.© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.