Objective: To investigate gender differences regarding changes of myopia rates among Han Chinese students aged 7-18 years in China, and to provide a scientific basis for precise myopia prevention and control. Methods: The visual acuity data of 871 112 students aged 7-18 years from four national student physical fitness and health surveys in 2005, 2010, 2014 and 2019 were selected to analyze gender differences in myopia rates and myopia rates among male and female students in each age group. Results: The overall myopia rate of students aged 7-18 years in China increased from 2005 to 2019( χ 2=7 265.06, P <0.01), and the myopia rate increased from 47.9%(2005) to 60.1% (2019). Gender differences in myopia rates among students trended to decrease( χ 2=72.24, P <0.01), and showed an inverted "U shaped" distribution from south to north, decreasing first and then increasing. Conclusion The problem of myopia in children and adolescents cannot be ignored, and the difference in myopia rates between male and female students should be taken into account, precise prevention and control of myopia accurately according to gender.