Optical Coherence Tomography Angiography (OCT-A) is an evolving retinal imaging modality for vascular diseases. By avoiding the intravenous fluorescein dye and its associated complications, OCT-A better identifies abnormal vasculature in the retinal and choroidal layers without any interference from fluorescein leakage. This is particularly useful for visualization of pathology in macular telangiectasia. Classified as non-proliferative and proliferative, macular telangiectasia can eventually progress to subretinal neovascularization. In this article, we review its pathology at different stages and corresponding OCT-A findings in different retinal layers: from the superficial and deep retinal capillary plexus, through the retinal pigment epithelium, and down to the choriocapillaris layers.