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
Narrowing of arterioles
Exudates
Cotton wool spots
Retinal hemorrhage