Hi Steve,
Well, as I am both a game player and a software developer I'd say I am
definitely in a position to help you and your friend here. If you have
any questions you would like to ask me specifically I'm certain I may
be a big help. Anyway, here are the questions and answers to the
questions you asked.

Question:
1. What is the best combination for accessibility within a visual
environment. E.g,
Java (graphics) and self-voicing? Flash (graphics) and self-voicing?
Java (graphics)
and a client TTS based program? etc...

Answer:
All of these questions are asking about specific programming languages
such as Java and Flash. Either one could work for a game if the
developer knows how to add accessibility to the program. However, I
will say that Java can be problematic as not all screen readers
support swing, and there for if the developer uses Java there should
definitely be some way to self-voice the game that way the screen
reader is not an issue for the gamer. Fortunately, you can use
prerecorded speech files that get played back as needed as I do with
my games, or the Java developer could use something like FreTTS for
speech output. It isn't the best quality speech system, but it does
work.

Question:
2. Would 1 approach be more difficult than another? E.g, screenreader
over self-voicing?

Answer:
Not really. However, as a developer and a gamer I prefer the program
self-voice itself rather than depending on a screen reader. The reason
I say this even though some screen readers like Jaws and Window-Eyes
can directly be supported through their individual APIs not all screen
readers have this ability and there for your screen reader support
would be limited to whatever screen reader/screen readers you decided
to support. If you use a language like Java accessibility is dependant
on if the screen reader supports the Java access bridge. Jaws and NVDA
do, but Window-Eyes does not. Therefore once again your accessibility
is very hit and miss using a screen reader. The only way to make sure
everyone can play it is to make the game itself provide the speech
output via tts engine or by using prerecorded speech as needed.

Question:
3. Are there any examples of such a graphical game which offer a good
gaming experience
to both the blind and sighted, which incorporate audio accessibility?

Answer:
A few. However, this is something that has largely not been done since
most accessible game developers don't care about graphics thus don't
include them. One game I know of that has graphics and is accessible
is Teraformers. That's one of the only examples I can think of in
terms of an action game that does this. There are other games such as
those created by 7128.com that have graphics and speech output, but
those are mostly turn based games where you answer questions such as
in the Inspector Cindy games, or word puzzles. Not exactly what you
are looking for here as they are rather simple examples of how
accessibility can be applied to a graphical game. there are also the
All In Play card games that are accessible to blind and sighted alike,
but once again it is  a rather simple example of a graphics based game
being made accessible to the blind. I'm not sure you can find anything
complex where graphics and accessibility were designed into the same
game.

HTH

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