Macular Telangiectasia (MacTel): Types, Treatment, and Where Integrative Care Fits

In short. Macular telangiectasia (MacTel) is a group of conditions in which the tiny vessels around the centre of the macula change and leak. Type 2 is the common form: it affects both eyes, worsens slowly, and mainly makes reading harder. In March 2025 the FDA approved the first treatment for type 2, an implant that slows the loss of light-sensing cells. Type 1 usually affects one eye and is treated with laser or injections when the macula swells. A sudden change in vision needs prompt care, because new blood vessels can form. Integrative care can sit alongside this plan, but it does not replace it.

What MacTel is. There are two main types of MacTel [1]. Older names you may see are juxtafoveal or parafoveal telangiectasia.

Type 2 is the common form. In the Beaver Dam Eye Study, it was found in 0.1% of people aged 43 to 86 [2]. In a 2026 study of 1.9 million eye clinic patients, 0.06% had the diagnosis, and it was more common in women and over-60s [3].

Type 2 is now seen mainly as a disease of nerve and support cells. Support cells in the retina (Müller cells) and then the light-sensing cells are lost, and the vessel changes follow [4]. People with type 2 have lower blood levels of the amino acid serine and higher levels of toxic fats called deoxysphingolipids [5].

In one study those fats were 84.2% higher and serine was 20.6% lower than in people without MacTel [5]. Diabetes, high blood pressure and obesity are also more common in people with type 2 than in their peers [6].

Symptoms and outlook. Early signs are trouble reading, missing letters or words, small blind spots beside the centre, and bent lines [4]. It moves slowly. Much of what is known comes from the MacTel Project and its natural history study [7].

In the MacTel natural history study of 1,014 eyes, vision fell by about 1 letter a year [7]. Over five years, 15% of eyes lost 15 letters or more [7].

Severe loss is uncommon. In the MacTel registry of 4,449 eyes, 3.8% had vision of 20/200 or worse [8].

How it is diagnosed. An OCT scan shows small hollow spaces in the retina and breaks in the photoreceptor layer, called the ellipsoid zone [9]. Autofluorescence imaging shows loss of the yellow macular pigment. Fluorescein angiography shows leaking vessels, mostly on the ear side of the centre [9].

Type 1 usually affects one eye. Small bulging vessels (aneurysms) leak fluid and fatty deposits into the macula, causing swelling [10]. It is linked with Coats disease, and wide-field imaging can show Coats-like changes at the edge of the retina [10].

Treatments with good evidence

Revakinagene taroretcel-lwey (Encelto) for type 2. The FDA approved Encelto on 5 March 2025 for adults with idiopathic MacTel type 2 [12]. It is a small capsule of cells that release a nerve-protecting protein called CNTF. A retina surgeon places it inside the eye in an operation, one implant per eye [13].

Two phase 3 trials, NTMT-03-A (115 people) and NTMT-03-B (113 people), compared the implant with a sham procedure for 24 months [14]. The main measure was how fast the photoreceptor layer was lost on OCT. Loss was 54.8% slower with the implant in the first trial and 30.6% slower in the second [12, 14].

Results for retinal sensitivity and reading speed were not consistent between the two trials, and eye chart vision did not differ [14]. In a pooled analysis of three trials, reading speed fell by about 5 words per minute with the implant versus 15 with sham [15].

So the implant slows damage. It does not restore vision that has been lost.

The main side effects were a smaller pupil (17% and 14%) and slower adjustment to the dark (17% and 24%) [14]. The label lists surgical risks including infection, retinal tear or detachment, bleeding inside the eye, cataract and the implant working loose [13]. If you take a blood thinner, your doctors will advise on pausing it before surgery [13].

Encelto is approved in the United States. A 2026 review noted it was not yet approved in Europe [4]. Ask your retina specialist whether you are a candidate.

Low-vision rehabilitation. Magnifiers, good lighting and training to use the vision beside the blind spots can make reading easier. The LOVIT II trial studied 323 veterans with macular disease [16]. Adding a low-vision therapist raised reading speed by 21 words per minute more than devices alone [16].

You do not need to wait until vision is poor to ask for a referral.

Treatments with some evidence

Anti-VEGF injections, only when new vessels form. If new vessels grow in type 2, anti-VEGF injections are the usual treatment, as in wet AMD (see wet AMD). In 25 eyes treated with bevacizumab, average vision improved from about 20/91 to 20/62 over a median of two years [17].

Injections have not been shown to help type 2 without new vessels [9]. In a small long-term study, eyes given a year of monthly ranibizumab did no better six years later, and possibly worse [18].

Type 1: laser, injections or steroid implants. Leaking aneurysms can be sealed with laser; in 12 eyes, swelling settled where the aneurysms closed [19]. Anti-VEGF injections and dexamethasone steroid implants are also used. In one series of 10 eyes, 40% had a full response, and steroid implants looked more useful than injections [20].

These are small studies, so your retina specialist will tailor treatment to how much the macula is swollen.

What is not proven

• Acupuncture and herbal medicine. We have not found trials of acupuncture or herbal medicine in MacTel. A single 2026 case report combined acupuncture with injections in type 1, so it cannot show whether acupuncture added anything [21].
• Serine supplements. Low serine is linked to type 2, and in mice serine supplements reversed serine-related retinal changes [22]. Trials in people are under way but not finished (ClinicalTrials.gov NCT04907084) [4]. Please do not take serine on your own while dose and safety in MacTel are still being tested.
• Lutein and zeaxanthin. In type 2, the areas that had lost macular pigment did not take it back up after these supplements [9].
• Anything that asks you to delay injections for new vessels. New vessels can leave scarring at the centre of the macula [8], so delay has a real cost.

Where Netra fits

Netra Eye Institute is an acupuncture and Oriental medicine practice. We do not diagnose or treat MacTel, and we do not replace your retina specialist. Our role is adjunctive:

• We check that the basics are in place with your physician: blood sugar, blood pressure and weight, because diabetes is more common in type 2 [6]. We also check that you have a regular OCT schedule.
• We offer acupuncture and, where appropriate, Chinese herbal medicine within Netra Restoration Therapy (NRT), with the evidence explained before you start. Herbs are reviewed against your diabetes medicines and any blood thinner.
• After an Encelto implant, we do not needle near the eye until your surgeon has cleared it. If your eyes adjust slowly to the dark, we plan visits in daylight.
• We encourage a low-vision referral, share what we see with your eye doctor, and refer you back promptly if your vision changes.

NRT is not a treatment for macular telangiectasia and does not replace the Encelto implant, anti-VEGF injections, laser or low-vision rehabilitation. If you want to talk through whether integrative care makes sense alongside your treatment, request a consultation.

Questions people ask

What is MacTel?

It is short for macular telangiectasia, a disease of the macula, the part of the retina used for reading and faces. In type 2, the common form, cells in the centre of the retina are slowly lost in both eyes [4]. People with MacTel can join research registries; ask your retina specialist.

What are the symptoms of macular telangiectasia?

Trouble reading, missing letters, small blind spots near the centre and bent lines [4]. Most eyes in the MacTel registry still saw better than 20/50 [8].

What is the treatment for macular telangiectasia?

For type 2, the Encelto implant can slow the loss of light-sensing cells [14], and low-vision help makes reading easier [16]. Injections are used only if new vessels form [17]. For type 1, laser, injections or steroid implants treat the swelling [19, 20].

What is macular telangiectasia type 1?

It is the less common type, usually in one eye, with leaking aneurysms that cause swelling and fatty deposits [10]. It is linked with Coats disease, so specialists often check the edge of the retina too [10].

Will I go blind from MacTel?

Severe vision loss is uncommon; fewer than 4 in 100 eyes in the registry had vision of 20/200 or worse [8]. Side vision is not affected by type 2, because the damage stays within a small area around the centre [8].

References

1. Yannuzzi LA, Bardal AM, Freund KB, et al. Idiopathic macular telangiectasia. Arch Ophthalmol. 2006;124(4):450-460.
2. Klein R, Blodi BA, Meuer SM, et al. The prevalence of macular telangiectasia type 2 in the Beaver Dam eye study. Am J Ophthalmol. 2010;150(1):55-62.e2.
3. Younis DA, Chen DX, Chen S, et al. Prevalence and visual acuity characteristics of patients with macular telangiectasia. Ophthalmol Ther. 2026;15(9):2971-2978.
4. Jung M, Bucher F. Type 2 macular telangiectasia: pathogenesis - the interplay between neurodegeneration and metabolic changes [in German]. Klin Monbl Augenheilkd. 2026;243(9):894-900.
5. Gantner ML, Eade K, Wallace M, et al. Serine and lipid metabolism in macular disease and peripheral neuropathy. N Engl J Med. 2019;381(15):1422-1433.
6. Clemons TE, Gillies MC, Chew EY, et al. Medical characteristics of patients with macular telangiectasia type 2 (MacTel Type 2) MacTel project report no. 3. Ophthalmic Epidemiol. 2013;20(2):109-113.
7. Peto T, Heeren TFC, Clemons TE, et al. Correlation of clinical and structural progression with visual acuity loss in macular telangiectasia type 2: MacTel Project Report No. 6. Retina. 2018;38(Suppl 1):S8-S13.
8. Heeren TFC, Chew EY, Clemons T, et al. Macular telangiectasia type 2: visual acuity, disease end stage, and the MacTel area: MacTel Project Report Number 8. Ophthalmology. 2020;127(11):1539-1548.
9. Charbel Issa P, Gillies MC, Chew EY, et al. Macular telangiectasia type 2. Prog Retin Eye Res. 2013;34:49-77.
10. Cirafici P, Musolino M, Saccheggiani M, et al. Multimodal imaging findings and treatment with dexamethasone implant in three cases of idiopathic macular telangiectasia type 1. Case Rep Ophthalmol. 2021;12(1):92-97.
11. Harten J, Raming K, Goerdt L, et al. Macular telangiectasia type 2 (MacTel) - therapeutic options and new developments [in German]. Klin Monbl Augenheilkd. 2026;243(9):911-921.
12. US Food and Drug Administration, Center for Biologics Evaluation and Research. BLA 125798/0 ENCELTO (revakinagene taroretcel-lwey): approval letter and Summary Basis for Regulatory Action, 5 March 2025. fda.gov/media/185733/download; fda.gov/media/185972/download.
13. Neurotech Pharmaceuticals. Neurotech's ENCELTO (revakinagene taroretcel-lwey) approved by the FDA for the treatment of macular telangiectasia type 2 (MacTel). Press release (Business Wire), 6 March 2025.
14. Chew EY, Gillies M, Jaffe GJ, et al. Cell-based ciliary neurotrophic factor therapy for macular telangiectasia type 2. NEJM Evid. 2025;4(8):EVIDoa2400481.
15. Goldberg RA, Manning DC, Yankey J, et al. Pooled analyses of anatomic and visual function data of revakinagene taroretcel-lwey in participants with macular telangiectasia type 2. Ophthalmol Retina. 2026. Published online ahead of print. doi:10.1016/j.oret.2026.07.005.
16. Stelmack JA, Tang XC, Wei Y, et al. Outcomes of the Veterans Affairs Low Vision Intervention Trial II (LOVIT II): a randomized clinical trial. JAMA Ophthalmol. 2017;135(2):96-104.
17. Toygar O, Guess MG, Youssef DS, Miller DM. Long-term outcomes of intravitreal bevacizumab therapy for subretinal neovascularization secondary to idiopathic macular telangiectasia type 2. Retina. 2016;36(11):2150-2157.
18. Kupitz EH, Heeren TF, Holz FG, Charbel Issa P. Poor long-term outcome of anti-vascular endothelial growth factor therapy in nonproliferative macular telangiectasia type 2. Retina. 2015;35(12):2619-2626.
19. Nakai M, Iwami H, Fukuyama H, Gomi F. Visualization of microaneurysms in macular telangiectasia type 1 on optical coherence tomography angiography before and after photocoagulation. Graefes Arch Clin Exp Ophthalmol. 2021;259(6):1513-1520.
20. Carnevali A, Borselli M, Bianchi P, et al. Idiopathic macular telangiectasia type 1: clinical, multimodal imaging features and response to treatment. Graefes Arch Clin Exp Ophthalmol. 2026;264(4):1111-1119.
21. Liu Z, Liu C, Yang S, et al. Macular telangiectasia type 1 treated with integrated traditional Chinese acupuncture and Conbercept: a case report. Front Med (Lausanne). 2026;13:1717145.
22. Lim EW, Fallon RJ, Bates C, et al. Serine and glycine physiology reversibly modulate retinal and peripheral nerve function. Cell Metab. 2024;36(10):2315-2328.e6.