dreama, using the in-pdf zooming feature might help, as I know zoomtext does a shit job at it. However, setting zoomtext to yellow on black might help for some, depending on your level of visual impairment.
Also, one can convert a pdf back to plain text, which will allow you to format it as needed. it's on adobes site somewhere, i'd suggest you google it.
JAWS and other screen readers are not a world closed off if you're deaf- i'm going to assume you read braille, and investing in a decent 20 or 40 cell display could help you a great deal. I find it irreplaceable for long reading tasks. No more wrist-strain from dragging zoomtext around at 10! newer style braille displays can have some confusing navigations, but older styles can and often do only have 6 or 8 braille keys and a few navigation ends- it takes some effort to learn navigation within jaws, that's without a doubt true, and getting used to the display , but once you do - it can be a valuable tool.
hope that helps.
