Prevalence of myopia in Chinese children and adolescents: a systematic review and meta-analysis

Background: There is currently a lack of nationally representative assessments of myopia based on gold-standard cycloplegic refraction among Chinese children and adolescents. Therefore, we aimed to systematically review and meta-analyse the prevalence of myopia, diagnosed by cycloplegic refraction (spherical equivalent ≤-0.50 D), among Chinese children and adolescents, and examine its distribution across sexes, age groups, time periods, and geographic regions. Methods: We searched PubMed, Web of Science, Science Direct, CNKI, and Wanfang for population- or school-based studies published between January 2020 and March 2025 that used cycloplegic refraction. We calculated the pooled prevalence and 95% confidence intervals using a meta-analysis, with subgroup analyses by sex, educational stage, time periods, and regions. We assessed publication bias using Egger's and Begg's tests. Results: The overall myopia prevalence among 34 studies with 139 765 participants was 30.1%. Prevalence was higher in females (28.6%) than males (26.0%) and increased markedly with education stage from 4.2% in kindergarten, 28.4% in primary school, 64.1% in junior high, and 81.0% in high school. Temporally, prevalence peaked in 2016 (57.5%). Geographically, the highest provincial prevalence was observed in Taiwan (66.5%), while the lowest was identified in Henan (6.6%). At the regional level, Eastern China had the highest prevalence (40.3%), close to the national average in Northwestern China (31.2%), and the lowest in Central China (6.6%). Conclusions: The pooled prevalence of myopia among Chinese children and adolescents was 30.1%, with a pronounced increase by educational stage. A slightly higher prevalence was observed in females. Geographically, Eastern China had the highest burden, while Central China had the lowest. These findings highlight marked age, sex, and regional disparities, providing evidence for targeted public health interventions. Registration: PROSPERO: CRD420251236626.