A cross-sectional study assessed the knowledge, attitudes, and practices (KAP) of 433 adult myopic patients toward refractive surgery and postoperative medication at the Affiliated Hospital of Panzhihua University between July and November 2024. Among the participants, 53.3% were female, 49.9% had a spherical equivalent refractive error of -3.00 to -6.00 diopters in both eyes, and 35.6% spent daily on screen for 6 to 12 hours. The mean scores for knowledge were 10.60 (range 0–18), attitudes 38.61 (range 11–55), and practice 18.81 (range 6–30). Knowledge, attitudes and practice showed significant positive correlations (p < 0.001). Multivariate analysis showed that higher knowledge significantly increased positive attitude (OR = 1.200, 95% CI: [1.133–1.272], p < 0.001) and behavioral engagement (OR = 1.255, 95% CI: [1.177–1.339], p < 0.001). Structural equation modeling confirmed the direct effect of knowledge on attitude (β = 0.546, p < 0.001) and practice (β = 0.246, p < 0.001), as well as attitude on practice (β = 0.468, p < 0.001) and the indirect effect of knowledge through attitude (β = 0.256, p < 0.001). Patients had insufficient knowledge and suboptimal practices despite positive attitudes, highlighting the need for educational strategies to improve adherence and postoperative visual quality.