@pixelate if my vision where to become impaired i would likely use the distro made by Klaus Knopper for his wife. Beyond that Orca has done a great job and monitors in the larger sizes have dropped in price.

Better OCR to speech would be handy. Though i have heard there are some projects using large language modles that help. Whisper has replaced Dragon Natualy Speaking for me when it comes to Speech to Text. Google Doc's speech to text has been decent enough too.