Background <p>To investigate the relationship between changes in macular curvature and axial elongation in school children.</p> Methods <p>This prospective cohort study involved 75 right eyes of elementary school students for six years (from 8 to 9 to 14–15 years). In the first and last year, all participants underwent optical axial length measurement and color fundus photographs. Optical coherence tomographic vertical cross-sectional images of the macula were taken and used for the analysis. The macular curvature was plotted as the retinal pigment epithelium and fitted to a second-degree polynomial equation using ImageJ software to calculate the macular curvature. Wilcoxon’s signed rank test was used to compare macular curvature and axial length. The association between axial elongation and macular curvature was investigated using Spearman’s correlation.</p> Results <p>The mean axial length in the last year (24.82&#xa0;mm) was significantly greater than that in the first year (23.34&#xa0;mm). Likewise, the mean macular curvature was significantly greater in the last year (0.041) than in the first year (0.014). Macular curvature in the first year was significantly negatively correlated with axial elongation over 6 years (<i>r</i>=-0.28, <i>p</i> = 0.014). The change in macular curvature was significantly positively correlated with axial elongation (<i>r</i> = 0.28, <i>p</i> = 0.017).</p> Conclusions <p>During the period from 8 to 9 years to 14–15 years of age, the macular curvature increased, and eyes with smaller macular curvature at 8–9 years tended to have greater axial elongation. Macular curvature can be a predictor of axial elongation during this period.</p>