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The adjusted hazard ratio of RVO in the presence of METS was 1.458 (95% confidence interval, 1.440-1.475; 0.001) after adjusting for age, ****, smoking status, alcohol consumption, physical activity, and income. Among all of the criteria for METS diagnosis, elevated blood pressure was the greatest risk for RVO development (adjusted hazard ratio, 1.610; 95% confidence interval, 1.589-1.631; 0.001). METS and each of diagnostic criteria was associated with an increased risk of RVO development. Elevated blood pressure seems to be es