Excellent article.

I've done accessibility testing for a firm before, and in general it goes like this:

"Here's a JAWS license. Take a week, make sure the tabbing works okay. Don't sweat it, it's low priority."

The thing that kills me is that for a while in my life, I was legally blind. I'm not now, but I was. I'd not had much experience with screen readers, but it was "eye-opening" in the sense of having to learn how to build a mental model of a screen without "cheating" by looking at it.

It really is infuriating. Here's an example.

Imagine a screen with three columns, each filled with a series of questions to be answered; some text, some radio button, some checkbox. Each column's state can have an effect on whether another column's state is submittable or not.

Now let's run some tests at various visual/auditory fidelities:

Full visual: works just fine. All fields and values can be read, screen reader isn't necessary/tends to be distracting. Error text tends to be crossreferencable based on visual cues.

Partial vision: (I simulated visual degradation via forcing myself to read through a badly focused set of optics, my TLAR (That Looks About Right) set point for testing being when the image was distorted enough that text was no longer decipherable, basic shading/shapes were about the best visual information I was getting, and field focus information was only gleanable from text fields by holding down a key to dump in enough junk text to change the perceived shading.)

Now's where you start to have to build your mental model from the screen reader. This is where someone who hasn't had to master screen reading starts running into pain and flailing about.

Your brain tries to hang onto those text fields or exploit every trick it can to try to utilize the visual cues you'd tested with before. I actually had to force myself to let my aural processing take over. The first thing you realize is that everything requires a good deal more attention. You're much more dependent on tab order, and remembering where your interface "focus" is in relation to the information on the screen. Most error messages become nigh impossible to make heads or tails of without significant domain knowledge, because screen readers can't communicate visual trickery at all. If you're generous, you can assume a visually impaired person can pick out formatting tricks, but I tend to be more conservative and assume it's broken even for them.

Full visual impairment:
TLAR set point: What Screen? There is only Tab, and the voice in my head.

In a lot of ways, using a screen reader is easier when you can just ignore visual stimuli altogether. Unfortunately, the specter of visually biased UI design still predominates the experience. You need to get to that question in Column 2 that can invalidate an answer in Column 1? Enjoy the tab spam. Or enjoy having to get intimately familiar with the decided upon presentation structure of the page if it's accessible to the screen reader. After a while though (and I don't know of this can be counted upon for those visually impaired or blind from birth), your brain will start to kind of generate a logical structure from the sound, and I found myself increasing the reading speed to just barely incomprehensible after some use, and found that I was able to make some sense, and speed out of the setup. The quick near incomprehensible overreads of the screen defined the structure, and a slower, more understandable read for specific content. Error parsing and crossreferencing was still a nightmare though.

Overall, the tech world doesn't care for impaired user's except for the bare minimum required to still be eligible for Government contracts, and the bar for that is painfully low in terms of pleasant or intuitive experience for the user. As a programmer, I can see how some programmer's worst nightmare is going blind. No reading design docs, every architect diagram is suddenly locked away from you, and that screen that used to tell or show you anything you wanted is just so much plastic and silicon.

I can guarantee that even the best Accesibility implementation out there is not delivering the usability the User is paying for. Time/money/practicality is only a cop out in the grand scheme of things dictated by a society that prioritizes the profitability of an endeavor over delivery of a thorough high quality solution for everyone involved.

Accessibility is the Neglected Tropical Disease of the software world, and I see no signs of change to that state of affairs. The population of the severely visually impaired will always be at best treated as a "charitable gimme" on the road to tapping government contracts as a revenue stream.

Designing for an effective experience would require too much overhead in the form of actually hiring designers to overhaul outdated and "good enough" visually biased layouts and workflows, as well as a body of experts who are fluent in the world of accessibility solutions, while also avoiding the bias of the unimpaired to adapt a solution that works for them rather than truly designing an experience that increases the productivity of those they are designing for.

Trust me on this one. I've tried.