Unfortunately, OOTP isn't compatible with VoiceOVer, alas. I can use a third-party tool to scan the screen and let me click on text and such, which seems to work surprisingly well. I haven't yet tried some of the more complex management screens but a lot of the basics read fairly well even through the medium of OCR.
Where I run into trouble is places where the game displays something but OCR doesn't pick it up, like a slider. I have a limited ability to move the mouse to arbitrary places on screen to click.
I actually work in accessibility professionally, so am happy to discuss this stuff with anyone interested.
