Figure accessibility for readers with colour vision deficiency: analysis of leading medical journals

Colour vision deficiency (CVD) affects up to 8% of males and 0.5% of females and currently lacks effective treatments. Individuals with CVD require visually accessible environments to flourish, the absence of which can cause unacceptable disparities in academic achievement and career progression. For current and aspiring clinician-scientists with CVD, inaccessible colour figures in scientific publications can hinder understanding of key information and potentially cause patient harm. Therefore, our work characterises the accessibility of major medical journal figures for individuals with CVD using established guidelines and provides recommendations for improving figure accessibility. We observed that among 138 journal figures evaluated from nine leading medical journals, 107 (80%) failed to conform with colour contrast and labelling requirements from the Web Content Accessibility Guidelines (WCAG), indicating that readers with CVD may be unable to perceive displayed information. 215 of 395 (55%) sub-figures within the aforementioned figures were judged to be completely inaccessible to individuals with protan or deutan deficiencies, the commonest CVD subtypes. Despite universal publisher declarations of compliance with WCAG directives, no journals figures were fully compliant with these guidelines. Our findings demonstrate the need for urgent action by authors and publishers to augment the colour contrast of journal figures and add secondary labels to enable their comprehension by audiences with CVD. We believe that these design changes will, too, improve the clarity of figures for general audiences.