Common symptoms of MacTel:

• Mildly ectatic capillaries affect primarily the deeper capillary network, though telangiectatic vessels have been observed in inner and outer retinal circulation.
• Blunted, slightly dilated venules are often associated with ectatic capillaries and, in later disease stages, with retinal pigment plaques. These vessels don’t appear to narrow as they approach the foveola, rather, they suddenly seem to dive at right angles into the deeper retinal layers.
• Foveal atrophy. This may appear as small foveal non-prominent cysts, or a pseudo-lamellar macular hole, or as slightly altered foveal reflectivity. Atrophy can be missed on fundus images. Atrophy of the outer retinal photoreceptor layer is the endpoint of MacTel, and results in localized loss of visual function.
• Abnormal distribution of macular pigment. Macular pigment deposition is normally concentrated in the fovea. In MacTel eyes, there is a loss of macular pigment from the central retina. Instead, MacTel eyes show a ring of pigments about 12 degrees in diameter, much larger than the normal 1-2 degrees in diameter. This can be visualized with autofluorescence imaging. Studies found that dietary supplementation with lutein and zeaxanthin enhanced the existing ring of macular pigments, but does not restore normal macular pigment distribution.
• Retinal pigment plaques (pigment-hyperplasia) seem to originate from small foci of RPE hyperplasia that migrate into the neurosensory retina. Photoreceptor atrophy precedes, and may cause, the presence of retinal pigment plaques. Retinal pigment plaques may be surrounded by RPE atrophy.