Ocular Ischemic Syndrome

A 68-year-old man with a long history of smoking, hypertension, and diabetes presents with progressive visual blurring and episodes of amaurosis fugax in the right eye. Fundoscopy reveals attenuated retinal arterioles, dilated but non-tortuous venules, and scattered hemorrhages in the mid-periphery outside the arcades. The structure marked **B** (mid-peripheral dot-blot hemorrhages) is noted. Which of the following clinical findings would BEST distinguish this presentation from central retinal vein occlusion (CRVO)?

A 74-year-old man with severe peripheral arterial disease and poorly controlled hypertension presents with a three-month history of painless visual decline in the right eye. On dilated fundus examination, the structure marked **A** (mid-peripheral dot-blot retinal hemorrhages) is noted along with dilated but non-tortuous retinal veins and narrowed retinal arterioles. Fluorescein angiography shows prolonged arm-to-retina circulation time (>15 seconds) and peripheral capillary non-perfusion. Carotid Doppler confirms complete occlusion of the right internal carotid artery. Which of the following best explains the pathophysiology underlying the hemorrhagic pattern marked **A** in this patient?