Contemporary research has shown that MacTel is likely a neurodegenerative metabolic disease. MacTel is correlated with hypertension and diabetes mellitus. Although MacTel has been previously regarded as a rare disease, it is in fact probably much more common than previously thought. The subtleness of early symptoms of MacTel may cause mis-diagnosis by optometrists and general ophthalmologists. Terminology MacTel may also be referred to by various names, including (idiopathic) juxtafoveolar telangiectasia, or parafoveal telangiectasis, depending on the source. All refer to the same disease. Signs and symptoms Typical patients present with a mean age of 55–59 years, and a wide range of symptoms from totally asymptomatic to substantially impaired; in most cases however, patients retain functional acuity of 20/200 or better. Metamorphopsia (visual distortions) may be a subjective complaint. Due to the development of paracentral scotoma (blind spots), impaired reading ability may be the first symptom of the disease. Diagnosis Type 2 MacTel commonly occurs in both eyes, and occurs equally in males and females. Histopathology studies have shown a loss of Müller glia markers in the clinically altered area. Diagnosis of MacTel type 2 may be aided by the use of advanced imaging techniques such as fluorescein angiography (which may identify an abnormal capillary pattern), fundus autofluorescence, and OCT. These can help to identify the abnormal vessels, pigment plaques, retinal crystals, foveal atrophy and intraretinal cavities associated with this disorder. Areas of focal RPE hyperplasia (pigment plaques) often develop in the paramacular region as a response to these abnormal vessels. Other signs of macular telangiectasia type 2 include right angle venules, representing an unusual alteration of the vasculature in the paramacular area, with vessels taking an abrupt turn toward the macula as if being dragged. Fluorescein angiography (FA) is helpful in identifying the anomalous vasculature, particularly in the early stages of Type 2 disease. Formerly, FA was essential in making a definitive diagnosis. However, the diagnosis can be established with less invasive imaging techniques such as Ocular Coherence Tomography (OCT) and fundus autofluorescence. Some clinicians argue that FA testing may be unnecessary when a diagnosis is apparent via less invasive means. Macular telangiectasia type 2 is commonly under-diagnosed. The findings may appear very similar to diabetic retinopathy, and many cases have been incorrectly ascribed to diabetic retinopathy or age-related macular degeneration. Recognition of this condition can save an affected patient from unnecessarily undergoing extensive medical testing and/or treatment. MacTel should