Hi! I'm a sighted player who has been playing continuously since 2007. For in-game messages, I'd recommend having your screen reader listen to the file msglog.txt in your character's folder, in case it's better than what you're got going, though it might be a bit noisy because it starts with a color code, in parentheses, then has a time code between two colons, then in between [] there is a symbol for the type of message, and then between {} there is the world-map location of your character, and then finally there's a | and the message that's displayed on the screen. I don't use a screen-reader, but if I did I'd probably be annoyed by all the part before the |, but you could probably make a script that listens to that file and selects the part of the message that you need. Here's a five line example:
(143270):28id:[#]{06C50374} | You see 2 rocks here.
(143270):28id:[#]{06C50374} | You see a stone here.
(143270):28id:[#]{06C60374} | You see 7 branches here.
(A80000):28id:[!]{06C60374} | There's a fence blocking your way!
(147870):28id:[?]{06C60374} | Climb it?
You can leave a short note for yourself in msglog.txt by pressing v and then hitting enter, and it will record when and where you were when you wrote the note. {06C60374} means that my character is 06C6 east and 0374 south in hexadecimal on the wilderness map (the zoomed out map that you get to by hitting enter). If you make enough of these notes to self and have an easy way of searching through msglog.txt for the string "--" you can find where you were when you wrote something and use the very last line of msglog.txt to know where you are right now. This can help with knowing where you are relative to the house you built or the village where you like to go trading or the river rapids where you like to go fishing. Each zoomed in map tile is 64 steps wide and tall.
Experimenting with look, I think one thing that makes it harder is that if you jiggle the mouse at all, or if your hand touches the trackpad, then it moves the cursor to some unknown place, and then you won't know how many steps away from yourself the cursor is, and if you hit escape and then F3 again, it remembers where the cursor was before -- it doesn't recenter it on your character, so you don't have an easy way to get back to yourself. If you're zoomed in all the way (hit ctrl + a bunch of times to make sure), the screen is 25 tiles wide and 23 tiles tall, and your character is right in the middle: the 13th tile from the left and the 12th tile from the bottom. So if you get lost and you're not sure where the cursor is, hit the 1 key at least 25 times to get to the bottom left of the screen and then hit 9 eleven times to bring the cursor north-east, and then right once to find where your character is standing.
You should also look into urw_ini.txt, a file where you can change some game options. You might want to turn more confirmations on. Also with the standard keyboard controls, it matters which way your character is facing, and the up key takes you forward. There's a tiny arrow over your character and also in the top right of the screen there's a character portrait with an arrow and the word EAST if you're facing east. If your screenreader has trouble detecting which way your character is facing, then try turning traditional movement on. Then the up key will always take you north.
Another thing you might try is turning debug logs on, with the & key. This will cause quite a few files to appear in your urw folder. These are the files I have after moving around a little bit and eating:
debug_all.txt debug_cre.txt debug_movement.txt debug_renderer.txt debug_topics.txt
debug_armour.txt debug_eat.txt debug_msg.txt debug_ter-tiles.txt debug_uflora.txt
debug_asciidata.txt debug_lastentry.txt 'debug_party!.txt' debug_tileloader.txt
Some of these files grow very big very quickly so you'll want to delete them throughout play, maybe as often as every ten minutes, especially debug_all.txt, and debug_cre.txt (which has information about all the creatures in the world but at a very detailed level like some bird flapping around some tiles away that your character can't even see) and it's half in Finnish, but debug_msg.txt might have a better format for you than msglog.txt. And they may have info that helps with your reverse engineering.
There's also an app for your phone that can connect to your game if you enable the controller in urw_ini.txt. There's a free version and a paid version. It's called Unreal World Controller and published by Enormous Elk (same people who make the game), and it's worth a try, though it mostly works as an additional input, you can push a button that says eat instead of typing e, or you can program a series of keypresses into one button, but it sounds like your main problem is finding out what's on the screen and it won't help with that part.