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Old displays were manufactured with pixels that were close to 96ppi. Around 2000 it became possible to manufacture displays with much smaller pixels ppi resolution of 200ppi 300ppi and even 365 ppi could be manufactured. Display manufactures still made desktop displays with low 100ppi resolution. Where you could get a laptop with a 15" high resolution 4k Display you could not buy a 15" desktop 4k display you could buy a 32' low resolution 4K Display for your desk top. IBM has long since discontinued marketing their 22" 16:10 4K Display 204ppi 3840x2400 pixel display. I now use a Dell 24" 4k Display with a 185ppi resolution. Old icons and test are usable but on the small side.
How is your Photoshop Brush cursor option set?
With that setting if your brush hardness is set to a low percent and you have a pressure sensitive pen when you press hard the paint will exceed the brush cursor size. Try using the setting I posted. Full Size Brush tip... Set hardness to 100%.
That was my original thought as well, but unfortunately, my brush is already at 100% hardness. And I'm not using a tablet, just a mouse. Going to Full Size Brush Tip doesn't help either.
I think it has something to do with the work around for the high resolution monitor. When I remove that .manifest file (and go back to tiny icons) the brush size and preview circle size are identical. So clearly something about the work around is causing me issues!
Very much appreciate your thoughts! At least I know my first steps in troubleshooting were logical!