Retina World Congress 2026: Diagnosing macular telangiectasia in a field of mimickers

Macular telangiectasia (MacTel) presents diagnostic challenges that can test even experienced clinicians—a point underscored by Jay Chhablani, MD, retina specialist at the UPMC Vision Institute, during a presentation at Retina World Congress 2026 in Fort Lauderdale, Florida, May 14–17.

MacTel is typically bilateral and often presents with subtle clinical findings. A key diagnostic difficulty is its overlap with conditions that can masquerade as the disease, including tamoxifen maculopathy, solar retinopathy, lamellar holes, and age-related macular degeneration (AMD). Chhablani noted that early differentiation is challenging because “in the early stage of the disease, the optical coherence tomography (OCT) findings, the imaging findings, or sometimes the clinical examination also looks pretty much similar.”

Recognizing the mimickers

Clinical history plays an important role in narrowing the differential. Tamoxifen exposure with degenerative cysts may point toward tamoxifen retinopathy, while drusen on examination supports a diagnosis of macular degeneration. Distinguishing MacTel from neovascular AMD was highlighted as particularly critical given the management implications.

OCT findings and multimodal imaging

On OCT, MacTel demonstrates several characteristic features, including minimal inner hyperreflectivity, the ILM drape sign, neurodegenerative cysts and ellipsoid zone loss. Chhablani offered a practical interpretive rule: “if you have a cyst with retinal thinning, it goes in favor of macular telangiectasia, but if you have cyst with retinal thickening, then it goes in favor of CME and associated causes.” When OCT findings raise suspicion, angiography can provide confirmatory evidence.

Multimodal imaging was described as central to diagnosis. Fundus autofluorescence may show loss of central hypoautofluorescence at an early stage, while angiography demonstrates parafoveal hyperfluorescence, predominantly temporal, with late diffuse hyperfluorescence. These patterns help support diagnosis when clinical and OCT findings are equivocal.

Neovascular complications and emerging treatment

A key clinical concern is the identification of neovascular complications. Although MacTel is typically slowly progressive—with patients either asymptomatic or reporting central scotoma or reading difficulty—a sudden change in vision warrants prompt assessment for subretinal neovascularization. Intraretinal hemorrhage and retinal thickening may be present, and anti-VEGF therapy should be initiated without delay, particularly to address type 3 neovascularization.

Chhablani also noted that treatment options are now available where none previously existed. Encapsulated cell therapy (Encelto; Neurotech Pharmaceuticals) has received approval for patients with MacTel. Data for the implant showed that younger patients with lower ellipsoid zone loss tend to have better outcomes, underscoring the value of early diagnosis. As Chhablani put it, the priority is now to “diagnose these patients early and then introduce the treatment options and prevent further photoreceptor loss.”