Diabetic retinopathy

A 65-year-old woman comes to the clinic for a routine eye examination. Medical history includes type 2 diabetes diagnosed 15 years ago, as well as hypertension and chronic kidney disease. Medications include insulin, lisinopril, and atorvastatin. Up until 6 months ago, the diabetes had been controlled on metformin and liraglutide, but since then, the patient’s physician switched to monotherapy with insulin, due to increasing capillary blood glucose measurements and hemoglobin A1c. The patient’s temperature is 36.7°C (98.0°F), pulse is 70/min, respirations are 18/min, and blood pressure is 130/85 mmHg. Visual acuity testing shows a score of 20/60 in both eyes. Which of the following is most likely to be found on an ophthalmoscopic examination?