Objective: To investigate the prevalence and distribution characteristics of fundus diseases among the elderly population aged 60 and above in Mangxin Town, Yengisar County, Kashgar Prefecture, Xinjiang, and to analyze the epidemiological status of fundus diseases in this region, thereby providing a scientific basis and data support for the development of fundus disease prevention and control strategies and the construction of a primary eye health service system in high-altitude areas of Western China. Methods: A cross-sectional study was conducted from May to June 2024 among the permanent residents aged 60 and above in Mangxin Town. Inclusion criteria were age ≥ 60 years, local residence for ≥ 6 months, and voluntary participation with signed informed consent. Data were collected through standardized ophthalmological examinations (including visual acuity testing, intraocular pressure measurement, slit-lamp microscopy, and fundus photography), structured questionnaire surveys, vital sign measurements, and laboratory tests. Diagnoses of fundus diseases were strictly based on domestic and international diagnostic criteria. Statistical analysis was performed using SPSS 24.0 to calculate the prevalence rates of various fundus diseases and their 95% confidence intervals. Results: A total of 1,310 elderly individuals were included, with a response rate of 76.76%. Among them, 669 (51.1%) were male and 641 (48.9%) were female, with a mean age of 68.4 ± 6.6 years. The overall prevalence of fundus diseases was 16.1% (95% CI: 14.2–18.0). The prevalence rates of specific fundus diseases were as follows: age-related macular degeneration, 5.9% (77 cases); optic atrophy, 2.8% (36 cases); epiretinal membrane, 2.3% (30 cases); diabetic retinopathy, 1.8% (23 cases); other macular diseases, 1.07% (14 cases); and hypertensive retinopathy, 0.99% (13 cases). Other fundus diseases, including high myopia-related fundus changes, retinitis pigmentosa, macular hole, vasculitis, and retinal hemorrhage, each had a prevalence of less than 0.38%. Among diabetic patients, the prevalence of diabetic retinopathy was 20.8%, which is consistent with previous domestic and international studies. Conclusions: The prevalence of fundus diseases among the elderly in Mangxin Town, Xinjiang, is relatively high, with age-related macular degeneration being the most common type. This study fills a gap in the epidemiological data on fundus diseases in high-altitude regions of Western China. The findings highlight the need to establish a targeted stratified screening and prevention system, strengthen fundus health management in the elderly, and promote a screening model combining portable fundus photography with telemedicine to improve the accessibility and quality of primary eye health services.