Peripapillary hyper-reflective ovoid mass-like structure(PHOMS)is a new finding in 2018, which is based on the enhanced-depth imaging optical coherence tomography(EDI-OCT). A PHOMS is peripapillary in location, situated just above the lip of Bruch membrane open(BMO), and it is an ovoid, mass-like homogeneous structure similar to the hyper-reflectiveretinal nerve fiber layer. Although previously assumed to represent a form of buried optic disc drusen(ODD), the prevailing view is that PHOMS is the bulge of the axons of optic nerve fibers and a marker of axoplasmic stasis in the optic nerve fibers. This article describes the reasons for the concept of PHOMS, identifies its relationship with ODD, and discusses the possible histopathological mechanisms. In addition, we detail the differences between PHOMS on fundus multimodal images and other imaging features and explore the clinical manifestations and possible pathophysiological mechanisms of PHOMS in different diseases, which are important for a better understanding of neuro-ophthalmic related diseases such as myopic optic neuropathy and optic neuritis. Furthermore, we propose possible future research directions for PHOMS to gain new insights into PHOMS and its related diseases.