We propose an optical camera communication-based ALOHA-like (OCC-ALOHA) random access algorithm in which the hidden terminal issue is avoided. We use the spatial resolution of the image sensor of the OCC link to enable the access point (AP) to obtain multipacket reception capability. Then, we use the spot estimation algorithm to estimate the number of active terminals, the distance between the AP and terminal, and the emission angle of the terminal light-emitting diode. Based on the above estimation information, the double iteration algorithm is used to calculate the access probability of each terminal to achieve the optimization of the access fairness and system throughput rate. The results show that the throughput rate of the proposed scheme is better than that of carrier sense multiple access with collision avoidance with hidden terminals.