[mwcampbell]

Out of curiosity, what operating system and screen reader(s) are you using?

As a partially sighted developer, I generally use a screen reader for web browsing and email, but read the screen visually for my actual programming work. So I don't have significant first-hand experience with the accessibility (or lack thereof) of development tools. But some of my totally blind programmer friends have expressed some frustration with the accessibility of some tools, especially web applications. They generally use Windows with NVDA (http://www.nvaccess.org/). At least with NVDA, you can write add-ons (in Python) to help with specific applications and tasks.