In the first few minutes of the game, Snake's vision slowly un-blurs as a nurse enters the room to check on him. The player will briefly see her trimming some flowers. These flowers are the "Star of Bethlehem" lilies that appeared during the final boss battle of Metal Gear Solid 3: Snake Eater, in which Naked Snake eliminated The Boss in a field of said lilies.
In addition to his voice work, Kiefer Sutherland also provided the facial motion capture work for the lead character.
Hideo Kojima wanted to open the game to David Bowie's "Diamond Dogs" playing, but the rest of his team were against the idea.
The first Metal Gear game with an open world gameplay structure.
Throughout the game, there are several references to the classic revenge novel, Moby Dick. In the prologue for Metal Gear Solid V, 'Awakening', a character says "O.K. Ahab, time to go". A bandaged man who watched over Snake when he was in a coma says, "You can call me Ishmael". Later on in the prologue, Snake realizes that he has a hook hand and a large whale emerges from an explosion. In Moby Dick, the main character is a man named Ahab, who has a wooden leg and is hunting the whale that dismembered him. The first line of the novel is "You can call me Ishmael". One of Metal Gear Solid V's main themes is revenge, just like revenge is Moby Dick's most prominent theme.