Macular telangiectasia (MacTel) type 2 is a disease that affects your macula, which is in your eye. It's an area in the center of your retina – the light-sensitive tissue at the back of your eye. MacTel is also called perifoveal telangiectasia.
When you have MacTel, you gradually lose your central vision – the sight you need for things like reading and driving. There are several types of MacTel, but MacTel type 2 is the most common.
What Are the Symptoms of Macular Telangiectasia Type 2?
When MacTel type 2 is in its earliest stages, you may not have any symptoms at all. But as the disease gets worse, you'll notice changes in your vision. This may happen slowly, over 10 to 20 years.
Changes in your vision from MacTel will affect your central vision. It doesn't cause total blindness. You typically don't see a change in your peripheral (side) vision.
MacTel type 2 may cause:
- Blurry vision
- Distorted vision where straight lines appear wavy
- A spot (doctors call this a scotoma) of worse vision in the center of your vision
- Trouble seeing detail, or letters, numbers, or parts of words disappearing
- A hard time with tasks such as reading, working, or driving
- Trouble seeing at night or in dim lighting
These symptoms get worse gradually over years.
What Causes Macular Telangiectasia Type 2?
When you have MacTel type 2, blood vessels in your eye dilate (get wider) and leak. This makes your macula swell. You may also grow new blood vessels under your retina. These are abnormal and easily leak, which causes more swelling.
Over time, these changes damage and scar your macula, which makes your retina less able to sense light. This is when you get the most severe vision loss. MacTel type 2 happens in both eyes, but your symptoms may happen at different rates in each eye.
Experts don't yet know what causes MacTel type 2. Your genes may play a part, but scientists haven't identified a specific gene for the condition. The disease may also be related to aging, lifestyle choices, and your environment.
Recent studies show that MacTel type 2 may be a neurodegenerative disease. This means that over time, certain cells are damaged and aren't able to work as well.
Macular Telangiectasia Type 2 Risk Factors
The most common age group to get MacTel type 2 is people in their 40s and 50s. People assigned female at birth (AFAB) and people assigned male at birth (AMAB) are equally at risk of having it.
There are certain things that make you more likely to get this disease. They include:
- Diabetes
- High blood pressure
- Smoking
If someone in your family has MacTel type 2, your risk also goes up.
Getting a Diagnosis
If you're having central vision issues, see an optometrist or ophthalmologist for testing. It's likely they'll refer you to a retina specialist for more accurate testing and diagnosis.
They'll ask about your medical history and your family’s medical history, and they'll give you tests to confirm your diagnosis.
Tests for macular telangiectasia type 2
Your doctor will have multiple tests and tools they can use to get a better look at your eye and assess your vision.
Amsler grid. This is a grid of horizontal and vertical lines in black and white. Your doctor will ask you to look at it and describe what you see. When you have MacTel, it may make the lines look wavy, faded, or broken. Or you may not be able to see parts of the grid at all.
Ophthalmoscope. To see the back of your eye well, your doctor will dilate your pupils with special eye drops. Then they'll use a handheld device with a light called an ophthalmoscope. This allows them to examine your retina and other areas at the back of your eye. They'll look for small, fine crystals in the center of your macula, discoloration of your macula, abnormal blood vessels, pigment clumps, or fat deposits. These can all be signs of MacTel or complications from the disease.
Optical coherence tomography (OCT). This test uses a special device to take cross-sectional pictures of your retina. With these pictures, your ophthalmologist can map and measure the thickness of your retina to see if there is swelling or abnormal blood vessels.
Fluorescein angiography (FA). During this test, your doctor injects a yellowish dye into a vein in your arm. Once the dye reaches the blood vessels in your eyes, your doctor captures images of the area. The dye highlights abnormal sections of your retina.
OCT angiography (OCTA). This test works like FA but doesn't use dye. Your doctor takes close-up images of the blood vessels in and under your retina.
Your Condition Care Team
As you live with, and manage, MacTel type 2, you need several medical professionals on your care team.
Ophthalmologist. These medical doctors specialize in eye diseases and disorders. You may see a general ophthalmologist at the beginning of your MacTel journey.
Retina specialist. These are also ophthalmologists, but they've completed specialized training in diagnosis and treatment of diseases and conditions affecting the retina and vitreous (clear gel that fills the eye). A retina specialist will likely be the main source of your treatment and management of MacTel type 2.
Optometrist. This health care professional may be the first to assess your MacTel symptoms and refer you to a retina specialist. They do eye exams and vision tests, prescribe corrective lenses, detect eye problems, and more. You'll continue to see them for help correcting the vision you still have as your MacTel progresses.
Low vision specialist. As your sight decreases with MacTel, you can see a low vision rehabilitation specialist to help you learn lifestyle changes and give you access to tools that help you live well with low vision.
Questions for your doctor about perifoveal telangiectasia
Take a list of questions with you as you visit your doctor so you can gather all the information you need about your condition and how to manage it.
You can ask:
- What tests will you do to look at my eyes, and what do the tests involve?
- How advanced is my MacTel?
- How do I manage living with MacTel Type 2?
- Can you suggest a vision rehabilitation center in my area?
- How often should I come in for checkups?
- Are there any clinical trials I should know about?
- Will glasses or contact lenses help me see clearer?
- Do you recommend I take injections for my MacTel?
What Are the Treatments for Macular Telangiectasia Type 2?
Sometimes doctors use laser treatments to help seal leaking vessels, but there are risks with this. Some doctors choose to treat MacTel with steroid injections or other medicines, but these don't slow progression of the disease.
In March 2025, the FDA approved the first treatment to slow the progression of MacTel type 2. It's a cell therapy called revakinagene taroretcel-lwey (Encelto). Cell therapy works by replacing damaged or diseased cells with healthy cells.
Your doctor implants a small device into the vitreous (gel) of your eye. This implant releases a protein called ciliary neurotrophic factor that helps protect cells in your retina from damage and destruction. You don't feel the device in your eye.
In clinical trials, researchers found that people using the device had few side effects and that the treatment slowed the loss of cells in the retina. Encelto isn't a cure, but it's the first available treatment for slowing MacTel disease progression.
What to Expect
It's not possible to predict how quickly your MacTel type 2 will get worse. There are five stages of MacTel. The stage you're in is based on what your doctor sees when they look at the back of your eye with special instruments.
Stages 1 through 4 are early stages before you grow new and abnormal blood vessels in your eye. Once you grow new blood vessels, you're in stage 5. But even with this information, your stage doesn't tell you or your doctor how your disease will progress.
With newer technologies, doctors may be able to use other markers to help define disease stage and give doctors more insight into MacTel.
When treatment doesn't work
Although MacTel causes vision loss, it tends to happen slowly. Treatment can only slow progression, so if your doctor does not think Encelto is making a difference, they may decide to take the implant out and focus solely on supporting the vision you do have. You may try:
- Adapting your home to vision loss with improved lighting, safer navigation, and large-print labels
- Preferred retinal locus (PRL), which is a shift in your vision that helps you see things more clearly. A low vision rehabilitation specialist can help train you to do this as effectively as possible.
- Tools and technology that enhance vision, such as magnifiers or smart glasses
What Are the Complications of Macular Telangiectasia Type 2?
One serious complication of MacTel is growth of abnormal blood vessels under your retina. This is called macular neovascularization. If this happens, your doctor may suggest you have injections of anti-VEGF medicines to help treat the blood vessels.
Some people with MacTel Type 2 get macular holes because of the thinning of their retina.
Living With Macular Telangiectasia Type 2
MacTel doesn't have a cure, but there are things you can do to take care of your eyes and protect them.
How can you help manage perifoveal telangiectasia?
Eye healthy habits include:
Regular eye exams. See your eye doctor as often as they recommend so they can notice changes in your vision as soon as possible. If you notice changes between visits, make an extra appointment to be seen.
Control your blood sugar and blood pressure. High blood pressure and diabetes are risk factors for MacTel. Talk to your primary care doctor about ways to control your blood pressure and blood sugar. If you smoke, your doctor can provide resources to help you quit.
Shield your eyes from glare. Wear a hat and sunglasses outside, and try anti-reflective lenses in glasses to reduce glare, increase contrast, and block blue light from the sun or digital devices.
See a low vision specialist. These specialists know tools and tips for living with low vision. They may suggest:
- Electronic or portable magnification devices
- Text-to-voice devices
- Color-coded organizers (such as pill bottles)
- Wearable magnifying devices and telescopes
Caring for Your Mental and Emotional Health
Living with a vision-limiting condition takes a toll on your emotional well-being. Talk to your doctor if you notice changes in your mood. They can point you toward professionals or tools to help.
You can also:
Seek out support. Support groups are a great way to get to know others living with MacTel. Whether they're online or in person, support groups introduce you to people who can offer advice and empathy for what you're going through.
Cultivate connection and joy. Find ways to keep up with the people and activities you enjoy. Isolation increases feelings of sadness, worry, and mental unwellness.
Exercise. Getting regular physical activity improves symptoms of depression and anxiety and boosts mood. Ask your doctor for workout suggestions, and start small if you're not in an exercise habit. Even a short walk around your neighborhood or short session of stretching at home can lift your spirits.
Use professional help. Therapy with a licensed counselor, psychologist, or psychiatrist can help you process and manage feelings and emotions like shock, sadness, and grief that often come with a MacTel diagnosis. They can also help you adjust to lifestyle changes, connect to resources, and find new ways to engage in meaningful activities.
Where to get support
Certain websites, online forums, and support groups can connect people with MacTel or other retinal diseases who have low vision or impending vision loss.
The Macular Telangiectasia – Mactel Group. You can find this group on Facebook. When you join, you'll have access to other people who know what it's like to live with and manage MacTel. You can find advice, support, and empathy.
Eye2Eye. This is a phone-based group that connects people living with visual impairment to peer support. Family members can also find support through the number.
Inspire. This online community connects people living with MacTel and caregivers of people living with MacTel with others around the world in the same position. Search "MacTel" or "Macular Telangiectasia" to find groups and posts about MacTel.
Takeaways
MacTel is an eye disease that affects your macula, the part of your retina responsible for sharp central vision. There's no cure. It causes gradual central vision loss, making it harder to read, drive, or see fine details. But it doesn't lead to total blindness. Symptoms may include blurry or distorted vision, a central blind spot, and a hard time seeing in dim light. The exact cause is unknown. The first FDA-approved treatment recently became available to help slow its progression. Vision tools, lifestyle choices, and emotional support can help you manage life with MacTel.
Macular Telangiectasia Type 2 FAQs
- What is the difference between macular telangiectasia type 1 and type 2?
MacTel type 1 and MacTel type 2 affect the blood vessels in your eyes in different ways. MacTel type 1 causes tiny aneurysms in your eye blood vessels, which leak and cause swelling, typically in only one eye. In MacTel type 2, your eye blood vessels become abnormal and dilate, and may grow new blood vessels that leak. MacTel type 2 happens in both eyes.
- Is macular telangiectasia type 2 hereditary?
Experts don't completely know what causes MacTel, but it does run in some families.
- Can you drive with macular telangiectasia?
You may not have to stop driving right away, but over time, your central vision loss will make driving unsafe. Talk to your eye doctor about whether driving is still safe for you with your MacTel symptoms.
