Vascular attenuation is best described as which finding?

• A. Dilated retinal veins with minimal branching
• B. Retinal hemorrhage along vessels
• C. Thin, attenuated retinal vessels with little branching
• D. Arteriolar attenuation with tortuosity in hypertension

Answer: (C)

Vascular attenuation means narrowing of retinal vessels. The defining description is thin, attenuated retinal vessels with little branching, reflecting chronic narrowing of the arterioles (and sometimes venules) as seen in arteriosclerotic or hypertensive changes. This contrasts with dilated veins (which would imply venous dilation rather than attenuation) and retinal hemorrhages (which are bleeds along the vessels). Arteriolar attenuation can occur with tortuosity, but the hallmark feature is the reduced caliber and sparse branching, not just twisting.