On optical coherence tomography (OCT) scans of the optic nerve head, peripapillary hyperreflective ovoid mass-like structures (PHOMS) are sometimes seen as a sign of axonal distension. The phenomenon has been reported more frequently in myopic subjects. We investigated PHOMS-prevalence in a myopic pediatric cohort, associated risk factors, and PHOMS development over 18 months during low-dose atropine treatment.