Aqueous zinc-ion batteries (AZIBs) represent a promising next-generation energy storage technology, distinguished by their low cost, high safety, and environmental compatibility. The cathode material plays a decisive role in determining battery performance, and several systems have been explored, including manganese-based oxides, vanadium-based compounds, organic materials, and Prussian blue analogues. Among these, manganese-based oxide cathodes have attracted considerable interest due to their high theoretical capacity and natural abundance. Nevertheless, their practical deployment remains hindered by intrinsic limitations such as low electronic conductivity, slow Zn2+ diffusion kinetics, structural distortion induced by the Jahn–Teller effect, and manganese dissolution. To overcome these challenges and enable commercial applications, substantial research has been directed toward optimizing their properties through various modification approaches. This review systematically outlines the development history, current progress, and key scientific challenges of manganese-based oxide cathodes for AZIBs, while providing an in-depth discussion of their underlying reaction mechanisms. Furthermore, we comprehensively summarize recent strategies for performance enhancement, including ion pre-intercalation/doping, defect engineering, interface modification, and composite design. Finally, this review aims to offer insightful perspectives and inspire future research efforts toward advancing the electrochemical performance of AZIBs.