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The prevalence of macular telangiectasia type 2 (MacTel-2) is often underestimated. However, recent studies indicate that it could be as high as 0.1% in individuals aged ≥40 years. MacTel-2 typically presents with subtle clinical signs such as right-angled venules, intraretinal crystalline deposits and minimal pigmentary changes. Although the presence of large pigment clumps is uncommon, they can significantly affect visual function as the disease progresses.We present two cases of bilateral large pigment clumps secondary to parafoveal telangiectasia and discuss their clinical and diagnostic features.