I am blind and have been a programmer for the last 12 years or so. Currently am a senior architect and work with Sapient Corporation (a cambridge-based consulting company creating both Web-based and thick client based enterprise solutions). I use several screen readers but mostly stick with Jaws for windows and NVDA.

I have mostly worked on the Microsoft platform and visual studio as my environment. I also use tools like the MS Sql enterprise studio and others for DB access, network monitoring etc. I tried to spend some time with emacspeak but since my work was mostly based on the MS platform, never really spent a lot of time there. I have also spent a couple of years working on C++ on linux - mostly used notepad or visual studio on windows for all the coding and then samba to share files with the linux environment. Also used borland C for some experimental stuff. Have recently been playing around with python, which as other people have noted above is particularly unfriendly for a blind user because it is written using indentation as the nesting mechanism. Having said that, NVDA, the most popular open source screen reader is written completely using python and some of the commiters on that project are themself blind. A particularly interesting question I get frequently asked as an architect is how do I deal with diagrams - UML and visio and rational rose etc. Visio is probably the most accessible diagraming tool out there. I was able to write jaws scripts to read rational rose diagrams for me. I've used a tool called T-dub (technical diagram understanding for the blind) developed by some german university for accessing UML 2.0 diagrams. Have used a java-based ugly tool called magic draw for doing model-driven development and was a commiter on the androMDA project and helped develop the .Net code generator from a UML model.

In general, I find that I thrive most in a team environment where I can work on my strengths. For example, while a diagram is extremely useful to communicate/document a design, the actual design process involves a lot of thinking and brainstorming and when the design has been thought out, one of your team mates can help you quickly put together a neatly drawn picture out of it. People incorrectly mis-construe the above to be lack of independence or ability while I see this as pure inter-dependence -- as in I am sure that the team mate alone could never have come up with that design on his/her own and in-turn, if I depend on him to document the design, so be it. Most hurdles I face are tool-based inaccessibility. For example all oracle products have been progressively declining in accessibility over the years (shame on them) and a team environment basically allows me an extra layer of defense against these over and above my screen readers and custom scripts.