AIM: To evaluate the prevalence of myopia and identify its associated risk factors among children and adolescents in Xi’an, China. METHODS: In a school-based cross-sectional design, students ranging from kindergarten to high school across Xi’an were enrolled. Ophthalmic examinations were performed to assess refractive status via non-cycloplegic refraction. Myopia was defined as SE≤-0.5 D, with stratification into mild (SE: ≤-0.5 to >-3.0 D), moderate (SE: ≤-3.0 to >-6.0 D), and high myopia (SE≤-6.0 D). Data on potential risk factors such as age, gender, and educational level were obtained through structured questionnaires. RESULTS: The study included 156 416 participants, with 81 389 boys (52.0%) and 75 027 girls (48.0%). The prevalence rates of myopia were 65.67% for boys and 68.83% for girls. Data collection occurred over two consecutive years, 2021 and 2022, with 78 849 and 77 567 participants, respectively. The prevalence of myopia was 67.65% in 2021 and decreased slightly to 66.71% in 2022. The high myopia rates were 3.85% and 3.43% for these years, respectively. Analysis revealed significant risk factors including gender, age, and educational level, with a distinct positive correlation between increased educational level and higher myopia prevalence. Notably, both genders exhibited a significant decrease in moderate myopia over the study period, with reductions of 1.7% and 1.2%. CONCLUSION: This comprehensive study underscores the substantial prevalence of myopia among school-aged children and adolescents in Xi’an, marking it as a significant public health concern. The correlation with higher educational levels suggests the need for targeted interventions aimed at myopia prevention and management. These findings contribute critically to the body of knowledge necessary for formulating effective public health strategies in Xi’an and potentially other similar regions.