At my work, they're grappling with the same problem. They have a number of blind people working the phones, and their workstations have all sorts of expensive specialised hardware to help them work. The problem is, as more apps move from older green screen technology (yep, there's still lots) to newer wiz-bang web applications, those web-apps have to be created with accessibility in mind.
They use JAWS (a commercial product from Freedom Scientific) to make internal applications accessible. As for why there's not much work on the open source front, I guess it's one of those things where a competent developer hasn't had the urge to work on it.
But I agree that making computers accessible at a reasonable price (or free) is very important, especially given as a huge chunk of society is getting to the age where this stuff will be needed a lot.