Q. A 68-year-old male with a history of diabetes presents to the emergency department with a complaint of severe headache and elevated home blood pressure readings. The patient reports that he has been experiencing worsening headaches over the past several days and that his blood pressure has been consistently elevated despite taking his prescribed medications. The patient's medical history is significant for type 2 diabetes, which he has been managing with oral medications and diet control for the past 10 years. He also reports a history of hypertension, which he has been treated for with medications for the past 5 years. On physical examination, the patient appears uncomfortable and is clutching his head. His blood pressure is measured at 170/110 mm Hg and he reports a headache that is severe and constant. There are no obvious neurological deficits noted. Given the patient's elevated blood pressure and history of diabetes, you perform an ophthalmic examination to assess for diabetic retinopathy. During the fundus exam, you note the presence of numerous small, yellow, well-defined lesions on the retina superior to the fovea (see image). Based on the findings of the fundus exam, you diagnose him with hypertensive retinopathy secondary to uncontrolled hypertension and uncontrolled diabetes. You start the patient on an aggressive treatment plan, including intravenous antihypertensive medications and close monitoring of his blood sugar levels. Which of the following statements most accurately describes the underlying etiology of the lesions found on this patient’s fundoscopic examination?