KDE also uses orca.

For higher quality Text-to-Speech, install Pied (Flatpak or Snap), which offers a GUI for installing and configuring Piper TTS voices.

Not sure what someone with only 2% total vision would even be able to see, but whatever they would use on Windows has analogous tools on every DE in Linux. Just ask them what they currently use: magnification, high contrast, screen reader...etc, then set those up for them. Also make sure to get whatever hotkeys they use in their workflow as people with visual impairments rely heavily on them.

MoHonestly, it has improved over the years.

Most distros now have dark mode installs with higher contrast. But adjustable font size and any form of text to speech during install seems missing.

Text to speech is available on most DE's but very like windows. It is still very unintuitive for low vision rather than 0 vision use. Unfortunately, developers with no vision issues still fail to recognise speed matters in real life. And folks with limited vision tend to need the ability to only use text to speech on set text. IE the ability to enlarge most text and just speak on text we choose. Android is very good at that now. But desktop OSes still make visual impaired difficult to compete time wise with non-disabled users.

I have found it impossible to adjust menu font sizes on the vast majority of DE's using a start like menu. Not to mention how bad the majority of more modern (fasionable) DE and application interface trends are for people needing to remember locations.

Fortunately, most Linux DE's do have the ability to quickly magnify sections of the screen using alt and mouse scroll.

As for some applications, insistence on gray text on white or lighter gray backgrounds. Why the hell is this so darn common now. Even folks with good vision find it awful.

Seriously take the OS 3d slicing software available. Every time I install one. I takes most of a day to find out how to make anything even slightly visible. Their is absolutely no reason for it.