Long before he transplanted his first cornea, Aaron Waite, MD, was operating on little critters. Well, not exactly operating, but experimenting.

Growing up in Reno, Nevada, the middle child in a family of nine kids, Waite collected pets the way boys of an earlier generation collected baseball cards or marbles. He had snakes, mice, rats, gerbils, lizards, turtles. “Pretty much anything that was a small animal,” he recalls.

“We never really had any dogs or cats,” he said, “so I probably made up for that by having small animals in my room. I also had fish tanks – freshwater and saltwater. My parents were patient enough so that they let me do all that. They just let me take care of it, which was good experience for me.”

When he was in high school, he wanted to know how one of his rats came to have long hair while the other had no hair.

“I was trying to figure out if it was a dominant or recessive trait – the hairlessness,” he said. “So I bred a hairless rat to a long-haired rat and then bred the offspring to each other and found out that it was an autosomal recessive trait.”

While he acknowledges that breeding rats was not a normal high school activity, it does help explain how Waite came to get an undergraduate degree in zoology at Brigham Young University. How he decided to become an ophthalmologist is another story. 

“It wasn’t until I had the idea of trying to get a PhD (in zoology) and started doing research and found it wasn’t as much fun as I thought it was going to be. I realized that working with people would be a lot more fun.”

Waite now is director of cornea, cataract and refractive surgery at the Hamilton Eye Institute at the University of Tennessee Health Science Center (UTHSC), and is a leading proponent of the relatively new corneal transplant procedure DMEK – Descemet Membrane Endothelial Keratoplasty. 

The modern era of corneal transplantation dates roughly to the late ’90s with the introduction of partial corneal transplantation techniques. This led to DALK (Deep Anterior Lamellar Keratoplasty), which replaces the front of the cornea, and DSAEK (Descemet Stripping Automated Endothelial Keratoplasty), which replaces the back of the cornea.

“By 2007, DSAEK became the standard for treating disease of the inside layer of the cornea,” Waite said. “That’s when I started a residency (at UTHSC). DMEK has come into vogue more recently because it is the thinnest corneal graft that can be placed

inside the eye.  It leads to a faster recovery, with better visual results, and lower risk of rejection.  Because the incision is so small, no sutures are required.

“It has been phenomenal to have a suture-less corneal transplant technique that can be offered to patients. It really can make a big difference.”

Waite explained that Fuchs’ dystrophy is one of the most common conditions that ultimately lead to corneal transplant.

“There’s a defect in the inner layer of the cornea so there’s not enough cells to keep the cornea clear,” he said. “So I make a small incision at the edge of the cornea and take out those cells that aren’t working and put new cells in from a deceased donor.”

The DMEK procedure, Waite said, is becoming more common in the United States. 

“But it’s not as common as DSAEK because the technique is new and is a little bit tricky to perform,” he said. “As soon as a surgeon learns the technique, it’s something that’s definitely repeatable and doable. So we’re in an early phase of the technique right now, and we’re trying to help other surgeons learn how to do it.

“It’s not something we want to exclusively do here. We want everyone who’s doing corneal surgery to do this because it works so well.”

Waite cited the case of a patient referred from Jackson, Tennessee, whose swelling was so severe she couldn’t see the biggest letters on the eye chart with either eye. After the procedure on one eye, “she was probably seeing 20/30, so she would be able to pass the driver’s test. Then we did the same thing on her other eye and had a great result on that side as well. 

“So it’s kind of a life-changing event for these patients where they’re unable to really function. She was getting around in a wheelchair beforehand and then able to see almost perfectly after the surgery.”

Coming out of med school and residency at the University of Utah, Waite matched at UTHSC. He went back to the West for additional training at the University of Colorado in Denver, followed by private practice at Las Vegas.

He’s clearly a Western guy, but Waite broke the pattern again by returning to Memphis 2½ years ago to work at HEI and UTHSC.

“What’s nice here in Memphis is that you can have a big yard, you have seasons and a lot of good people,” he said.

During his spare time, Waite enjoys spending it with his wife, Carolyn, and five children. He also enjoys playing the piano. When he was based in Las Vegas, he played at a country club, providing background music during dinner.

“I can play,” he said. “I think I would be better if I spent more time at it. But I’m too busy with other things.”

RELATED LINKS:

Hamilton Eye Institute, www.hamiltoneyeinstitute.org, www.uthsc.edu/eye/