As someone with progressive retinal tearing who's used the linux desktop for 20 years I'm terrified. The forcing of the various incompatible waylands by the big linux corps has meant the end of support for screen readers. The only wayland compositor that supports screen readers in linux is GNOME's mutter and they literally only added that support last year (after 15 years of waylands) and instead of supporting standard at-spi and existing protocols that Orca and the like use GNOME decided to come up with two new in-house GNOME proprietary protocols (which themselves don't send the full window tree or anything on request but instead push only info about single windows, etc, etc) for doing it. No other wayland compositor supports screen readers. And without any standardization no developers will ever support screenreaders on waylands. Basically only GNOME's userspace will sort of support it. There's no hope for non-X11 based screen readers and all the megacorps are say they're dropping X11 support.
The only options I have are to use and maintain old X11 linux distros myself. But eventually things like CA TLS and browsers just won't be feasible for me to backport and compile myself. Eventually I'm going to have to switch to using Windows. It's a sad, sad state of things.
And regarding AI based text to speech: almost all of it kind of sucks for screen readers. Particularly the random garbled ai-noises that happen between and at the end of utterances, inaccurate readings, etc in many models. Not to mention requiring the use of a GPU and lots of system resources. The old Festival 1.96 Nitech HTS voices on (core2duo) CPU from the early 2000 are incomparibly faster, more accurate, and sound decent enough to understand.