Background The global rise in myopia, particularly in Asia, presents significant public health challenges. Analyzing trends and forecasting impacts are critical for developing strategies to mitigate this burden. Methods We conducted the largest study to date on myopia and high myopia prevalence in Chinese children and adolescents aged 7-18 years, analyzing data from 5,095,256 individuals across 119 studies from 1998 to 2022. Data variability between cycloplegia and non-cycloplegia measurements was addressed using a distance-based model averaging calibration. Aggregated prevalence and age-specific urban-rural trends were estimated using thin plate spline regression, with projections to 2050 derived from time series modeling. Findings Myopia prevalence plateaued in 2006 in urban areas and in 2013 in rural areas, with the urban-rural prevalence gap narrowing since 2015 (urban/rural ratio below 1.3 for all ages). By 2050, myopia prevalence is projected to stabilize at 27.1% (95% CI: 10.0-44.4%) for ages 7-9 and 81.5% (74.7-88.3%) for ages 16-18 in urban areas, and at 20.1% (8.6-31.7%) and 74.1% (63.2-84.8%), respectively, in rural areas. High myopia prevalence among adolescents aged 16-18 is expected to rise from 7.3% in 2001 to 22.1% by 2050. Prevalence correlated significantly with the Human Development Index (P < 0.001). Interpretation Despite stabilization in overall myopia prevalence, the continued rise in high myopia underscores the need for targeted control measures. Projections emphasize the importance of addressing regional disparities and prioritizing public health interventions. Copyright (c) 2025 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).