The prevalence of pediatric myopia continues to increase worldwide, with East Asia bearing a particularly high burden of early-onset and progressive disease. In Japan, systematic school-based vision screening enables early detection, creating a clinical environment in which myopia control is an integral part of pediatric eye care. This review summarizes the current strategies, clinical evidence, and distinctive characteristics of myopia control in Japan with a primary focus on optical interventions. In Japan, myopia control is implemented within a structured framework that integrates pharmacological, optical, and lifestyle approaches. Optical strategies play a central role in clinical practice. Orthokeratology (Ortho-K) has been widely adopted and supported by national clinical practice guidelines that emphasize safety, patient education, hygiene management, and long-term follow-up. Soft contact lenses (SCLs) for myopia control have gained increasing attention, particularly dual-focus designs supported by robust international evidence, along with emerging optical concepts such as extended depth-of-focus lenses. Although regulatory approval for myopia control remains limited, Japanese clinical practice has adopted a cautious stepwise approach that balances international evidence with local clinical experience and ethical considerations. Limited published data from Japan indicate that Ortho-K and various SCLs designs have been investigated in the pediatric population. Overall, myopia control in Japan is characterized by evidence-based practices, regulatory awareness, and an emphasis on safety and education. This experience provides insights into how Ortho-K and SCLs may be integrated into routine clinical care, and highlights the importance of continued research, guideline development, and international collaboration.