In the scleral hypoxia pathway involved in myopia, Hypoxia-Inducible Factor-1α (HIF-1α) plays a critical role: hypoxic conditions increase HIF-1α expression, activating and upregulating factors such as P-eIF-2α and p-mTOR, resulting in fibroblast differentiation, an increased ratio of myofibroblasts to fibroblasts, ECM remodeling, reduced collagen production, and eventually axial myopia (Wu et al., 2018; Zhao F. et al., 2020). The gene discussed is HIF1A; the disease is myopia.