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Background Despite over 90% of vision impairment (VI) being preventable, in China, a routine screening programme is currently unavailable in primary healthcare. Robust epidemiological evidence is needed to guide national strategies.Method Using Global Burden of Disease 2021 data, we estimated prevalence, years lived with disability (YLDs), and age-standardized rates of VI by cause and severity. Temporal changes were decomposed into contributions from population growth, ageing, and shifts in age-specific prevalence. Estimated annual percentage changes (EAPCs) assessed trends, and Bayesian age–period–cohort models projected burden to 2040.Results In 2021, China had 767.4 million (95% UI 576.6 to 1009.3) VI cases, comprising: 324.4 million (237.7 to 435.4) uncorrected presbyopia, 4.1 million (3.4 to 5.0) moderate VI, 46.7 million (39.4 to 55.3) severe VI and 8.6 million (7.0 to 10.2) blindness. Population ageing emerged as the predominant driver, accounting for 164.25% of the cataract-related burden increase. Women had a higher burden than men (53.79% of cases; 54.87% of YLDs), and the burden peaked at older ages. Uncorrected refractive errors and cataracts were the leading aetiologies, constituting 50.65% of moderate VI and 35.08% of blindness. Projections indicate that by 2040, the age-standardised YLD rate for VI may nearly double from 2021 levels, reaching 596.4 (95% UI 72.0 to 1240.4) per 100 000 population.Conclusions VI is a growing public health challenge in China, driven primarily by ageing. Many cases are preventable, underscoring the need for targeted interventions, particularly among women and older adults.