Lack of accessibility of Canadian university ophthalmology department webpages to the colour vision deficient and visually impaired: the paradox

Authors: Mostafa Bondok¹, Mohamed Bondok, Rishika Selvakumar, Nina Ahuja, Edsel Ing  

Author Disclosures: Mostafa Bondok: None  Mohamed Bondok: None   Rishika Selvakumar: None     Nina Ahuja: None     Edsel Ing: None  

Abstract Body:

Purpose: We reviewed Canadian university ophthalmology department webpages (CUODW) to determine their web content accessibility for visually impaired and colour vision deficient users.   

Study Design:   A cross‐sectional study of CUODW.   

Methods:   The compatibility of fifteen CUODW with the Web Content Accessibility Guidelines version 2.0 (WCAG 2.0) AA international standards for web content accessibility was determined using three automated open‐source accessibility assessment tools: aChecker, Web Accessibility, and WAVE. In addition, foreground (text) and background colour combinations and contrast ratios were assessed by an automated and assisted‐manual approach using WAVE and Colour Contrast Analyzer tools. Results were verified by two independent reviewers. This study was approved by the Michael Garron Hospital Research Ethics Board.   

Results:   The CUODW from all the universities had WCAG 2.0 AA conformance errors. The mean number of errors identified by each tool were: aChecker (18, SD = 15), Web Accessibility (15, SD = 16), and WAVE (12, SD = 14). Violations of WCAG 2.0 success criteria relevant to visually impaired users that utilize assistive technology (i.e., screen readers) include the absence of alternative text (alt text) for images, which would normally allow users to appreciate the content of an image (principle 1.1), and input elements (e.g., a typed data field) that does not inform the visually impaired user of this function through alt text (principles 1.3). The poor use of styling mark‐ups for text (e.g., using   bold elements which can be confused for headings by screen readers) (principle 1.4), and the use of anchor (<a>) elements (hyperlinks) and buttons that lack text to inform users of functionality (principle 2.4) were observed. Other errors include the absence or improper identification of language so that screen readers can dictate translated text appropriately (principle 3.1), and the use of the same element ID more than once in the same document, which may confuse screen readers (principle 4.1). The mean automated contrast errors identified were 6.5 (SD = 5.4). Manual contrast error assessment found a mean of 1.5 errors (SD = 2.1), with 53% of programs containing at least one error. Most CUODW used appropriate colour combinations.   

Conclusions:   The Government of Canada mandated the conformance of all government websites and web applications with the WCAG 2.0 web accessibility guidelines in 2011. We encourage Canadian University Ophthalmology programs to improve their webpages and educational resources to comply with the WCAG 2.0 guidelines, thus improving digital accessibility for the visually impaired.