If you don't have use of your hands you want that. The whole point of accessibility APIs is allowing arbitrary control of your computer via novel means. One of the big selling points of Dragon Natually Speaking is the ability to tell your computer to do things based on descriptions without a mouse. "open outlook", "click compose", "select subject", "type foo", etc.
And no the solution here is not computer vision with an LLM. Text and buttons rendered on my computer exist in memory somewhere as text and buttons. We should not need to convert them to pixels and back lossily to recover text and buttons. We should just expose things to the accessibility API and not guess.