History of herpes simplex virus keratitis

“Cornea. (1) Corneal dystrophy or degeneration of any type, including, but not limited to, keratoconus of any degree. (2) History of any incisional corneal surgery including, but not limited to, partial or full thickness corneal transplant, radial keratotomy, astigmatic keratotomy, or corneal implants (e.g., Intacs). (3) Corneal refractive surgery performed with an excimer or femtosecond laser, including, but not limited to, photorefractive keratectomy, laser epithelial keratomileusis, laser-assisted in situ keratomileusis, and small incision lenticule extraction, if any of the following conditions are met: (a) Pre-surgical refractive error in either eye exceeded a spherical equivalent of +8.00 or -8.00 diopters. (b) Pre-surgical astigmatism exceeded 3.00 diopters. (c) Within 180 days of accession medical examination. (d) Complications, ongoing medications, ophthalmic solutions, or any other therapeutic interventions required beyond 180 days of procedure. (e) Post-surgical refraction in each eye is not stable. 1. For refractive surgery procedures within the last 36 months, stability is demonstrated by at least two separate post-operative refractions performed at least 1 month apart that demonstrate no more than +/- 0.50 diopters difference in sphere or no more than +/- 0.50 diopters in cylinder. 2. For refractive surgery procedures more than 36 months ago, stability is demonstrated by at least two separate post-operative refractions that demonstrate no more than +/- 1.00 diopters difference in sphere or no more than +/- 1.00 diopters in cylinder. (4) Current or recurrent keratitis. (5) History of herpes simplex virus keratitis. (6) Current corneal neovascularization, unspecified, or corneal opacification from any cause that is progressive or reduces vision. (7) Any history of uveitis or iridocyclitis.”

“Conjunctiva. (1) Current acute or chronic conjunctivitis excluding seasonal allergic conjunctivitis. (2) Current pterygium if condition encroaches on the cornea in excess of 3 millimeters (mm), is symptomatic, interferes with vision, or is progressive. (3) History of pterygium recurrence after any prior surgical removal.”

“Retina. Any history of any abnormality of the retina, choroid, or vitreous.”

“Optic Nerve. (1) Any history of optic nerve disease, including but not limited to optic nerve inflammation, optic nerve swelling, or optic nerve atrophy. (2) Any optic nerve anomaly.”

“Lens. (1) Current aphakia, history of lens implant to include implantable collamer lens, or any history of dislocation of a lens. (2) Any history of opacities of the lens, including cataract.”