I used Ubuntu for a few years, but I don't need a screen reader, just bigger fonts, occasional further magnification, and good contrast. Accessibility wise, it was fine. I felt like I had a lot of control over the window manager to make things look and scale the way I wanted/needed them to, which was nice. There were handy keyboard shortcuts for finding the mouse cursor, etc.

I ended up switching to MacOS though, because I wanted the dev environment while still being able to run Adobe software without the need for VMs or multiple operating systems.

Plus I was tired of ALSA breaking every other day.

I use macOS currently but work primarily from the command line
Tdsr is what I use for my screen reader though it has some bugs
Emacs with Emacspeak is what I use as my main editor
If you want to test Linux reasonably safely you could try a vm or get a server through aws or GCC or something and ssh into it through the terminal

I suppose what you can get away with depends somewhat on your use case. Naturally, the safest option is to play around with GNOME/MATE/KDE because of compatibility with Orca.

But as someone who also likes minimalist window managers (dwm and cwm), that isn't very fun. Unfortunately I'm only legally blind, and can still read text so long as I scale it properly, so in terms of screen readers for minimalist wms, I don't have much knowledge.

If we're assuming you'll be without central vision later on, then you'll probably rely on speech synthesis of some sort. Someone else mentioned it already, but emacspeak is a respectable option. I've actually been playing around with TTS engines/frameworks like Fenrir to see if I can come up with an accessible configuration in a minimalist window manager, but I haven't had much time to play around with that.

Best of luck to you!

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I run Linux Mint MATE edition ($1), and it's great. Very accessible, and allows me to run a software company at least. Comes pre-installed with the orca screen reader by default, Firefox, xed text editor, Liber Office and more are all perfectly accessible, etc.

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Two beefs I have with it are you can't really run Orca while botted via USB, making installation quite difficult and requires assistance somewhat. That, and there is no support for Qt based programs. If you open a Qt based program, screen reader simply doesn't work.

Whenever I run Linux, I run Debian, lately I've been using Kali, but that's mostly for school stuff. I'm not completely blind, so the magnification works well enough. I've been meaning to install the elementaryOS (Pantheon) environment, but I just hadn't gotten around to it. I'll update if I get around to it, maybe over the long weekend. I mean, elementry sure looks real pretty, but damn, look don't touch, that thing is in no way truly accessible, at least not when I tried it.

Also, keep in mind there's going to be some sort of big change to the GTK and associated tech, supposedly this up comeing year, so don't get comfortable. I hope we'll be able to hold out to the old tech until something better is made, else we're going to have to stay with GNOME 3, or whatever, until we have to upgrade for sure.