All the following changes are caused in the retina by benign hypertension except –

The major objection to Keith-Wagener classification is that, it does not clearly distinguish between the retinal changes of benign and malignant hypertension. So, by looking keith - wagener classification, you can not differentiate the retinal lesions of benign and malignant hypertension. For example, soft exudates (cotton wool spots are characteristic of malignant hypertension and hard exudates are usually seen in elderly patients with benign hypertension; however, both are included in keith-wagner's grade III. Therefore, Fishberg and oppenheimer proposed a classification which draws a distinction between retinal lesions of benign hypertension (i.e., retinal arteriosclerosis with arteriosclerotic retinopathy) and retinal lesions of malignant hypertension ( hypertensive neuroretinopathy). Retinal arteriosclerosis with arteriosclerotic retinopathy (Benign hypertension) Arteriolar narrowing (diffuse) Focal arteriolar narrowing Arteriovenous crossing changes Broadening of light reflex (copper wire or silver wiring) Perivasculitis Solitary round hemorrhage Hard exudates Central or branch venous occlusion Hypertensive uenroretinopathy (Malignant hypertension) Generalized arteriolar narrowing Striate (flame-shaped) hemorrhage Cotton - wool spots (soft exudates) Bilateral papilledema Macular star