Purpose: To assess the prevalence of pseudoexfoliation (PEX) and its associations in a population-based setting.Design: Population-based, cross-sectional study. Methods:The Central India Eye and Medical Study included 4711 individuals. All study participants underwent a detailed ophthalmological examination. After medical pupil dilation, PEX was assessed by an experienced ophthalmologist using slitlamp based biomicroscopy.Results: Slit lamp examination results were available for 4646 (98.6%) study participants with a mean age of 49.3613.3 years (range: 30-100 years). PEX was detected in 87 eyes (prevalence: 0.9560.10% (95%CI: 0.75, 1.15) of 69 subjects (prevalence: 1.4960.18% (95%CI: 1.14, 1.83). PEX prevalence increased significantly (P,0.001) from 0% in the age group of 30-39 years, to 2.8560.56% in the age group of 60-69 years, to 6.6061.21% in the age group of 70-79 years, and to 12.364.11% in the age group of 80+ years. In multivariate analysis, PEX prevalence was associated with higher age (P,0.001; regression coefficient B:0.11; odds ratio (OR): 1.11 (95%CI: 1.09, 1.13)), lower body mass index (P = 0.001; B: 20.12; OR: 0.88 (95CI: 0.82, 0.95)) and higher diastolic blood pressure (P = 0.002; B: 0.02; OR: 1.03 (95%CI: 1.01, 1.04)). In the multivariate analysis, PEX was not associated with retinal nerve fiber layer cross section area (P = 0.76) and presence of openangle glaucoma (P = 0.15). Conclusions:In a rural Central Indian population aged 30+ years, PEX prevalence (mean: 1.4960.18%) was significantly associated with older age, lower body mass index and higher diastolic blood pressure. It was not significantly associated with optic nerve head measurements, refractive error, any ocular biometric parameter, nuclear cataract, early age-related macular degeneration and retinal vein occlusion, diabetes mellitus, smoking, and dyslipidemia.