Greetings jbrowning,
I apologize for "hijacking" the thread...
If I may chip in my two cents worth, I may be in worse shape than you are and I have no problems manually focusing my 645 (so far). I had my cataract replacement surgery in my right eye done two years ago and after the surgery, the Doctor said "now you have 20/20 vision in your right eye". That may be true, but the replacement cataract lens is nowhere near as good as your natural yellowish sac of protein. Bright lights are troublesome, early dawn and late dusk vision has become more limited. If I was to describe my right eye as a camera lens, take an f-stop or two from either end of the said lens' aperture would be (I think) an apt comparison. But I am thankful that it is only cataract, not anything truly serious.
I think I can continue to manually focus the 645 accurately if I stick to prime lenses no slower than f2.8, with f4.0 and slower I will probably limit myself to shooting only under bright lighting conditions. Eventually I will buy an Beattie Intenscreen replacement focusing screen, which reportedly gains about 1 or more f-stop in screen brightness. Granted, I probably will have trouble focusing in very low light situations, but the days of staying up all night so I can shoot at the earliest light possible is long, long past. If you have an angle finder with 2x or higher magnification, you can use it as a focusing aid, similar to using a 6x-10x loupe against the ground glass on the large format cameras as a focusing aid.
I believe if I use every trick in the book to enhance focusing, I can manually focus my 645 for long time to come. Having said that, I will get the 645n at the earliest opportune moment.
Thanks,