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To examine the refractive lens power (RLP) and lens thickness and their associated factors in children from North-Western China. Children from two schools (primary school and junior high school) in the North-Western Chinese province of Qinghai underwent a comprehensive ophthalmic examination including biometry and cycloplegic refractometry. The RLP was calculated using Bennett's equation. The study included 596 (77.9%) individuals (mean age: 11.0 ± 2.8 years; range: 6–16 years) with a mean axial length of 23.65 ± 1.24 mm (range: 20.02–27.96 mm). Mean lens thickness was 3.30 ± 0.16 mm (range: 2.85–3.99 mm) and mean RLP was 24.85 ± 1.98D (range: 19.40–32.97). In univariate analysis, girls as compared to boys had a significantly thicker lens and greater RLP, shorter axial length, smaller corneal curvature radius and shorter corneal curvature radius (all P < 0.001). Both sexes did not differ significantly in refractive error (P = 0.11) and corneal thickness (P = 0.16). RLP was positively associated with refractive error (correlation coefficient r = 0.33; P < 0.001) and lens thickness (r = 0.62; P < 0.001) and negatively with axial length (r = − 0.70; P < 0.001). In univariate analysis, RLP decreased significantly with older age in the age group from age 6–13, while it plateaued thereafter, with no significant difference between boys and girls. In multivariate regression analysis, a higher RLP was associated with younger age (P < 0.001; standard regression coefficient β = − 0.07), female sex (P < 0.001; β = − 0.08), shorter axial length (P < 0.001; β = − 0.48) and higher lens thickness (P < 0.001; β = 0.42). In Chinese children, RLP with a mean of 24.85 ± 1.98D decreases with older age, male sex, longer axial length, and thinner lens thickness. Changes in RLP and axial length elongation are important players in the emmetropization and myopization. [ABSTRACT FROM AUTHOR]