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Background Gender disparities in vision impairment (VI) among Chinese children and adolescents persist over time. Assessment and prediction of secular trends and the disease burden associated with this disparity can optimise vision health practices.Methods We analysed data from the 2005, 2010, 2014 and 2019 Chinese National Surveys on Students Constitution and Health (CNSSCH), which included 874 640 students aged 7–18 years. Regional environmental factors comprised the Price Constant Index (PCI), health worker density, greenery coverage, intensity of light at night, annual patent grants of three kinds, population density, climate and air quality. Trends in VI burden were assessed and predicted using Chinese standard population and WHO population estimates. Mixed-effects models were employed to evaluate sex-based disparities in regional environmental factors and VI prevalence.Results Male VI patients have surpassed females, with the gender disparity increasing from −8797.9 thousand in 2005 to 5941.9 thousand in 2030. The PCI ( β=0, p=0), greenery coverage (β=0, p=0), intensity of light at night (β=0, p=0) and annual patent grants of three kinds (β=0, p<0) were positively associated with VI prevalence. Stronger associations were observed between VI in male and both PCI (male: β=0, p=0.; female: β=0, p=0) and annual patent grants of three kinds (male: β=0, p<0; female: β=0, p<0).Conclusions In China, VI is more prevalent in females, yet the absolute number of patients is larger in males, with this disparity progressively increasing. Males demonstrate heightened susceptibility to regional environmental factors. These findings support incorporating sex-specific prevention measures into current vision protection policies.