diff --git a/src/vs/editor/browser/controller/textAreaHandler.ts b/src/vs/editor/browser/controller/textAreaHandler.ts
index e7f16198870..f1661da1fc4 100644
--- a/src/vs/editor/browser/controller/textAreaHandler.ts
+++ b/src/vs/editor/browser/controller/textAreaHandler.ts
@@ -36,6 +36,7 @@ import { ColorId, ITokenPresentation } from 'vs/editor/common/encodedTokenAttrib
 import { Color } from 'vs/base/common/color';
 import { IME } from 'vs/base/common/ime';
 import { IKeybindingService } from 'vs/platform/keybinding/common/keybinding';
+import { IInstantiationService } from 'vs/platform/instantiation/common/instantiation';
 
 export interface IVisibleRangeProvider {
 	visibleRangeForPosition(position: Position): HorizontalPosition | null;
@@ -145,7 +146,8 @@ export class TextAreaHandler extends ViewPart {
 		context: ViewContext,
 		viewController: ViewController,
 		visibleRangeProvider: IVisibleRangeProvider,
-		@IKeybindingService private readonly _keybindingService: IKeybindingService
+		@IKeybindingService private readonly _keybindingService: IKeybindingService,
+		@IInstantiationService private readonly _instantiationService: IInstantiationService
 	) {
 		super(context);
 
@@ -303,7 +305,7 @@ export class TextAreaHandler extends ViewPart {
 		};
 
 		const textAreaWrapper = this._register(new TextAreaWrapper(this.textArea.domNode));
-		this._textAreaInput = this._register(new TextAreaInput(textAreaInputHost, textAreaWrapper, platform.OS, {
+		this._textAreaInput = this._register(this._instantiationService.createInstance(TextAreaInput, textAreaInputHost, textAreaWrapper, platform.OS, {
 			isAndroid: browser.isAndroid,
 			isChrome: browser.isChrome,
 			isFirefox: browser.isFirefox,
@@ -478,7 +480,7 @@ export class TextAreaHandler extends ViewPart {
 	}
 
 	public writeScreenReaderContent(reason: string): void {
-		this._textAreaInput.writeScreenReaderContent(reason);
+		this._textAreaInput.writeNativeTextAreaContent(reason);
 	}
 
 	public override dispose(): void {
@@ -629,7 +631,7 @@ export class TextAreaHandler extends ViewPart {
 		}
 
 		if (e.hasChanged(EditorOption.accessibilitySupport)) {
-			this._textAreaInput.writeScreenReaderContent('strategy changed');
+			this._textAreaInput.writeNativeTextAreaContent('strategy changed');
 		}
 
 		return true;
@@ -639,7 +641,7 @@ export class TextAreaHandler extends ViewPart {
 		this._modelSelections = e.modelSelections.slice(0);
 		// We must update the <textarea> synchronously, otherwise long press IME on macos breaks.
 		// See https://github.com/microsoft/vscode/issues/165821
-		this._textAreaInput.writeScreenReaderContent('selection changed');
+		this._textAreaInput.writeNativeTextAreaContent('selection changed');
 		return true;
 	}
 	public override onDecorationsChanged(e: viewEvents.ViewDecorationsChangedEvent): boolean {
@@ -726,7 +728,7 @@ export class TextAreaHandler extends ViewPart {
 	}
 
 	public render(ctx: RestrictedRenderingContext): void {
-		this._textAreaInput.writeScreenReaderContent('render');
+		this._textAreaInput.writeNativeTextAreaContent('render');
 		this._render();
 	}
 
diff --git a/src/vs/editor/browser/controller/textAreaInput.ts b/src/vs/editor/browser/controller/textAreaInput.ts
index d0a06a18c51..950dd87f220 100644
--- a/src/vs/editor/browser/controller/textAreaInput.ts
+++ b/src/vs/editor/browser/controller/textAreaInput.ts
@@ -11,13 +11,15 @@ import { inputLatency } from 'vs/base/browser/performance';
 import { RunOnceScheduler } from 'vs/base/common/async';
 import { Emitter, Event } from 'vs/base/common/event';
 import { KeyCode } from 'vs/base/common/keyCodes';
-import { Disposable, IDisposable } from 'vs/base/common/lifecycle';
+import { Disposable, IDisposable, MutableDisposable } from 'vs/base/common/lifecycle';
 import { Mimes } from 'vs/base/common/mime';
 import { OperatingSystem } from 'vs/base/common/platform';
 import * as strings from 'vs/base/common/strings';
 import { ITextAreaWrapper, ITypeData, TextAreaState, _debugComposition } from 'vs/editor/browser/controller/textAreaState';
 import { Position } from 'vs/editor/common/core/position';
 import { Selection } from 'vs/editor/common/core/selection';
+import { IAccessibilityService } from 'vs/platform/accessibility/common/accessibility';
+import { ILogService } from 'vs/platform/log/common/log';
 
 export namespace TextAreaSyntethicEvents {
 	export const Tap = '-monaco-textarea-synthetic-tap';
@@ -193,7 +195,8 @@ export class TextAreaInput extends Disposable {
 	// ---
 
 	private readonly _asyncTriggerCut: RunOnceScheduler;
-	private readonly _asyncFocusGainWriteScreenReaderContent: RunOnceScheduler;
+
+	private _asyncFocusGainWriteScreenReaderContent: MutableDisposable<RunOnceScheduler> = this._register(new MutableDisposable());
 
 	private _textAreaState: TextAreaState;
 
@@ -210,16 +213,24 @@ export class TextAreaInput extends Disposable {
 		private readonly _host: ITextAreaInputHost,
 		private readonly _textArea: ICompleteTextAreaWrapper,
 		private readonly _OS: OperatingSystem,
-		private readonly _browser: IBrowser
+		private readonly _browser: IBrowser,
+		@IAccessibilityService private readonly _accessibilityService: IAccessibilityService,
+		@ILogService private readonly _logService: ILogService
 	) {
 		super();
 		this._asyncTriggerCut = this._register(new RunOnceScheduler(() => this._onCut.fire(), 0));
-		this._asyncFocusGainWriteScreenReaderContent = this._register(new RunOnceScheduler(() => this.writeScreenReaderContent('asyncFocusGain'), 0));
-
 		this._textAreaState = TextAreaState.EMPTY;
 		this._selectionChangeListener = null;
-		this.writeScreenReaderContent('ctor');
-
+		if (this._accessibilityService.isScreenReaderOptimized()) {
+			this.writeNativeTextAreaContent('ctor');
+		}
+		this._register(Event.runAndSubscribe(this._accessibilityService.onDidChangeScreenReaderOptimized, () => {
+			if (this._accessibilityService.isScreenReaderOptimized() && !this._asyncFocusGainWriteScreenReaderContent.value) {
+				this._asyncFocusGainWriteScreenReaderContent.value = this._register(new RunOnceScheduler(() => this.writeNativeTextAreaContent('asyncFocusGain'), 0));
+			} else {
+				this._asyncFocusGainWriteScreenReaderContent.clear();
+			}
+		}));
 		this._hasFocus = false;
 		this._currentComposition = null;
 
@@ -431,10 +442,13 @@ export class TextAreaInput extends Disposable {
 
 			this._setHasFocus(true);
 
-			if (this._browser.isSafari && !hadFocus && this._hasFocus) {
+			if (this._accessibilityService.isScreenReaderOptimized() && this._browser.isSafari && !hadFocus && this._hasFocus) {
 				// When "tabbing into" the textarea, immediately after dispatching the 'focus' event,
 				// Safari will always move the selection at offset 0 in the textarea
-				this._asyncFocusGainWriteScreenReaderContent.schedule();
+				if (!this._asyncFocusGainWriteScreenReaderContent.value) {
+					this._asyncFocusGainWriteScreenReaderContent.value = new RunOnceScheduler(() => this.writeNativeTextAreaContent('asyncFocusGain'), 0);
+				}
+				this._asyncFocusGainWriteScreenReaderContent.value.schedule();
 			}
 		}));
 		this._register(this._textArea.onBlur(() => {
@@ -447,7 +461,7 @@ export class TextAreaInput extends Disposable {
 				this._currentComposition = null;
 
 				// Clear the textarea to avoid an unwanted cursor type
-				this.writeScreenReaderContent('blurWithoutCompositionEnd');
+				this.writeNativeTextAreaContent('blurWithoutCompositionEnd');
 
 				// Fire artificial composition end
 				this._onCompositionEnd.fire();
@@ -463,7 +477,7 @@ export class TextAreaInput extends Disposable {
 				this._currentComposition = null;
 
 				// Clear the textarea to avoid an unwanted cursor type
-				this.writeScreenReaderContent('tapWithoutCompositionEnd');
+				this.writeNativeTextAreaContent('tapWithoutCompositionEnd');
 
 				// Fire artificial composition end
 				this._onCompositionEnd.fire();
@@ -602,7 +616,7 @@ export class TextAreaInput extends Disposable {
 		}
 
 		if (this._hasFocus) {
-			this.writeScreenReaderContent('focusgain');
+			this.writeNativeTextAreaContent('focusgain');
 		}
 
 		if (this._hasFocus) {
@@ -621,12 +635,13 @@ export class TextAreaInput extends Disposable {
 		this._textAreaState = textAreaState;
 	}
 
-	public writeScreenReaderContent(reason: string): void {
-		if (this._currentComposition) {
+	public writeNativeTextAreaContent(reason: string): void {
+		if ((!this._accessibilityService.isScreenReaderOptimized() && reason === 'render') || this._currentComposition) {
+			// Do not write to the text on render unless a screen reader is being used #192278
 			// Do not write to the text area when doing composition
 			return;
 		}
-
+		this._logService.trace(`writeTextAreaState(reason: ${reason})`);
 		this._setAndWriteTextAreaState(reason, this._host.getScreenReaderContent());
 	}
 
diff --git a/src/vs/editor/test/browser/controller/imeTester.ts b/src/vs/editor/test/browser/controller/imeTester.ts
index 25cdbd57c75..3aeaed1d9d4 100644
--- a/src/vs/editor/test/browser/controller/imeTester.ts
+++ b/src/vs/editor/test/browser/controller/imeTester.ts
@@ -12,6 +12,8 @@ import * as dom from 'vs/base/browser/dom';
 import * as browser from 'vs/base/browser/browser';
 import * as platform from 'vs/base/common/platform';
 import { mainWindow } from 'vs/base/browser/window';
+import { TestAccessibilityService } from 'vs/platform/accessibility/test/common/testAccessibilityService';
+import { NullLogService } from 'vs/platform/log/common/log';
 
 // To run this test, open imeTester.html
 
@@ -127,7 +129,7 @@ function doCreateTest(description: string, inputStr: string, expectedStr: string
 		isFirefox: browser.isFirefox,
 		isChrome: browser.isChrome,
 		isSafari: browser.isSafari,
-	});
+	}, new TestAccessibilityService(), new NullLogService());
 
 	const output = document.createElement('pre');
 	output.className = 'output';
@@ -146,7 +148,7 @@ function doCreateTest(description: string, inputStr: string, expectedStr: string
 	const updatePosition = (off: number, len: number) => {
 		cursorOffset = off;
 		cursorLength = len;
-		handler.writeScreenReaderContent('selection changed');
+		handler.writeNativeTextAreaContent('selection changed');
 		handler.focusTextArea();
 	};
 
diff --git a/src/vs/editor/test/browser/controller/textAreaInput.test.ts b/src/vs/editor/test/browser/controller/textAreaInput.test.ts
index 6874020e739..19fcf3b1970 100644
--- a/src/vs/editor/test/browser/controller/textAreaInput.test.ts
+++ b/src/vs/editor/test/browser/controller/textAreaInput.test.ts
@@ -12,6 +12,8 @@ import { ClipboardDataToCopy, IBrowser, ICompleteTextAreaWrapper, ITextAreaInput
 import { TextAreaState } from 'vs/editor/browser/controller/textAreaState';
 import { Position } from 'vs/editor/common/core/position';
 import { IRecorded, IRecordedEvent, IRecordedTextareaState } from 'vs/editor/test/browser/controller/imeRecordedTypes';
+import { TestAccessibilityService } from 'vs/platform/accessibility/test/common/testAccessibilityService';
+import { NullLogService } from 'vs/platform/log/common/log';
 
 suite('TextAreaInput', () => {
 
@@ -203,7 +205,7 @@ suite('TextAreaInput', () => {
 
 			public hasFocus(): boolean { return true; }
 		});
-		const input = disposables.add(new TextAreaInput(host, wrapper, recorded.env.OS, recorded.env.browser));
+		const input = disposables.add(new TextAreaInput(host, wrapper, recorded.env.OS, recorded.env.browser, new TestAccessibilityService(), new NullLogService()));
 
 		wrapper._initialize(recorded.initial);
 		input._initializeFromTest();