Macular telangiectasia masqueraders

Macular telangiectasia Type 2 (MacTel 2) is a bilateral retinal disease characterized by progressive neurodegenerative and telangiectatic changes in the macula. Its subtle early presentation and overlap with a variety of retinal conditions often lead to diagnostic uncertainty and delayed intervention. As clinical understanding of MacTel 2 has evolved, advanced imaging modalities such as optical coherence tomography, fundus autofluorescence, fundus fluorescein angiography, and optical coherence tomography angiography have become essential tools for accurate diagnosis and differentiation from mimicking disorders. Key features such as parafoveal telangiectatic vessels, pigment plaques, and ellipsoid zone loss help establish the diagnosis, while multimodal imaging enhances confidence in distinguishing MacTel from its many masqueraders. The recent Food and Drug Administration approval of a long-acting ciliary neurotrophic factor implant has marked a significant advancement in the treatment of MacTel, highlighting the urgent need for timely recognition. In this review, we propose a practical, algorithm-based framework for diagnosing MacTel 2, with an emphasis on key clinical and imaging features and common diagnostic pitfalls. By improving recognition of characteristic patterns and differentiating features, this article aims to support clinicians in making confident, early diagnoses and implementing appropriate management strategies for MacTel 2.