Many of our clients are asking about the new ADA website regulations, and while there are no new “regulations”, there were some recently updated “Web Content Accessibility Guidelines”. In this article we will explain what that means for you as an optometrist and business owner with a website.


The Americans with Disabilities Act was passed in 1990. It prohibits discrimination against those with disabilities, ensuring they have the same rights and opportunities as those without disabilities. The act covers all sectors, businesses, and places open to the public. In 2010, the U.S. Department of Justice passed the Americans with Disabilities Act Standards for Accessible Design, mandating all electronic and information technology, like websites, be accessible to those with disabilities, including vision impairment and hearing loss. However, they have never issued specific guidelines as to how websites should comply with the law.

The Purpose of the ADA Standards

Inaccessible web content means that people with disabilities are denied equal access to information and services. An inaccessible website can exclude people just as much as steps at the entrance to your office can exclude wheelchair bound patients. The Department of Justice has made it a priority to ensure that all individuals have equal access to the web. This has become an issue because in recent years most business now offer services through the web and people rely on websites for many aspects of daily living and even eye care. For example, accessing office information, scheduling appointments, requesting records, and even ordering glasses and contacts.

Examples of Website Accessibility Barriers

According to the ADA website, the following are examples of accessibility barriers:

  • Poor color contrast. People with limited vision or color blindness cannot read text if there is not enough contrast between the text and background (for example, light gray text on a light-colored background).
  • Use of color alone to give information. People who are color-blind may not have access to information when that information is conveyed using only color cues because they cannot distinguish certain colors from others. Also, screen readers do not tell the user the color of text on a screen, so a person who is blind would not be able to know that color is meant to convey certain information (for example, using red text alone to show which fields are required on a form).
  • Lack of text alternatives (“alt text”) on images. People who are blind will not be able to understand the content and purpose of images, such as pictures, illustrations, and charts, when no text alternative is provided. Text alternatives convey the purpose of an image, including pictures, illustrations, charts, etc.
  • No captions on videos. People with hearing disabilities may not be able to understand information communicated in a video if the video does not have captions.
  • Inaccessible online forms. People with disabilities may not be able to fill out, understand, and accurately submit forms without things like:
    • Labels that screen readers can convey to their users (such as text that reads “credit card number” where that number should be entered);
    • Clear instructions; and
    • Error indicators (such as alerts telling the user a form field is missing or incorrect).
  • Mouse-only navigation (lack of keyboard navigation). People with disabilities who cannot use a mouse or trackpad will not be able to access web content if they cannot navigate a website using a keyboard.

When the ADA Requires Web Content to be Accessible

The Americans with Disabilities Act applies to state and local governments (Title II) and businesses that are open to the public (Title III). Optometrists would fall under Title III of the ADA, and the ADA website specifically lists “Hospitals and medical offices“, among others, as an example of Title III businesses. Because a website with inaccessible features can limit the ability of people with disabilities to access a public accommodation’s goods, services, the Department of Justice has consistently taken the position that the ADA’s requirements apply to all the goods, services, privileges, or activities offered by public accommodations, including those offered on the web. Although it’s not clear how or even if ADA rules will be applied to any particular website, it’s generally a good idea to try to comply. Also, many states have adopted their own accessibility laws, and the volume of accessibility-related lawsuits filed against websites has grown rapidly in recent years.

How to Make Web Content Accessible to People with Disabilities

The ADA only has general requirements of nondiscrimination and gives businesses flexibility in how they comply with the ADA. The Department of Justice does not have a regulation setting out standards, but the Department’s longstanding interpretation of the general nondiscrimination and effective communication provisions applies to web accessibility. Businesses can currently choose how they will ensure that the programs, services, and goods they provide online are accessible to people with disabilities.
Despite the lack of specific guidelines for the DOJ and the ADA, there are some internationally agreed upon guidelines called The Web Content Accessibility Guidelines (WCAG), which are part of a series of web accessibility guidelines published by the Web Accessibility Initiative (WAI) of the World Wide Web Consortium (W3C). You can view the latest version of the Web Content Accessibility Guidelines (WCAG) here. These guidelines are just that, guidelines. They are not enforceable, but they form the backbone of many online accessibility laws around the world and therefore make a good model for any American organization striving to provide equal access.
Even though businesses have flexibility in how they comply with the ADA’s general requirements of nondiscrimination, they still must ensure that the services and goods that they provide to the public—including those provided online—are accessible to people with disabilities.

Levels of compliance

The WCAG guidelines break accessibility issues down into three levels:

  1. Level A issues are the most urgent and include problems that can severely limit a disabled visitor’s ability to navigate or use the website.
  2. Level AA issues tend to be more rooted in functionality, addressing areas where improvement is needed to give disabled users the full experience of a site. (Level AA is considered the target standard for most commercial websites.)
  3. Level AAA issues are the highest standard, fine-tuning and expanding on issues identified as Level A and AA. While it is an excellent goal, full Level AAA compliance is likely beyond the reach of most websites.

Obviously, level A issues are the ones that should be addressed first with your website.

Areas of focus

The WCAG accessibility issues are categorized in four distinct groups, which can be summed up with the acronym P.O.U.R.

  1. Perceivable issues are those that affect a user’s ability to find and process information on a website (for example, providing audio descriptions for video content).
  2. Operable issues are those that impact a visitor’s ability to navigate and use a website (for example, ensuring that all site functions and navigation can be operated via keyboard-only commands).
  3. Understandable issues concern a user’s ability to discern and comprehend all information and navigation on a website (for example, composing error messages that include a clear explanation of the error and direction for correcting it).
  4. Robust issues involve a website’s ability to adapt and evolve to meet the changing needs of users with disabilities (for instance, testing compatibility with all leading screen readers and ensuring that those capabilities can be upgraded in the future).

Since the Americans with Disabilities Act has no specific guidelines, and since there is no question that equal access is a major concern for the DOJ and the courts, abiding by WCAG accessibility standards remains the best option for most practices. It’s not only a good way to avoid accessibility lawsuits and negative publicity— it’s just the right thing to do.

Common ways businesses can address accessibility of their web content:

  • Create alt tags for all images, videos, and audio files. Alt tags allow users with disabilities to read or hear alternative descriptions of content they might not otherwise be able to view. Alt tags describe the object itself and, generally, its purpose on the site.
  • Create text transcripts for video and audio content. Text transcripts help deaf and hard-of-hearing users understand content that would otherwise be inaccessible to them.
  • Identify the site’s language in the header code. Making it clear what language the site should be read in helps users who utilize text readers. Text readers can identify those codes and function accordingly.
  • Offer alternatives and suggestions when users encounter input errors. If a user with a disability encounters input errors because they must navigate the website differently, your site should automatically offer recommendations on how visitors can better navigate to the content they need.
  • Create a consistent, organized layout. Menus, links and buttons should be organized so that they are clearly delineated from one another and easily navigated throughout the entire site.

For even more in depth information on ADA Website Compliance, review our ADA compliance checklist for websites.

What Are Your Options?

Practices have 4 main options to create an accessible website for users with disabilities:

  1. Do it on your own – You should start by reading the ADA requirements and then you review our ADA compliance checklist for websites and make sure that you complete all the steps (be warned this is a lengthy and time-consuming list).
  2. Consulting with an attorney who specializes in disability law (this will ensure that you are compliant but is usually quite expensive).
  3. Hire a company to do an accessibility audit, which will reveal issues and show you how to make your site more accessible. Companies like Deque Systems offer this service, usually at a cost of $3,000 and $30,000. Most optometry practices websites would be on the lower side of this range. There are also companies that offer monthly ongoing auditing services. AccessibilitySpark offers this service starting at $99/month, which would probably be sufficient for optometry practices.
  4.  Use an AI powered app like UserWay Web to automate website accessibility. This is a very low cost and effective solution (and the solution that PCS uses).

Web Accessibility is a Priority for the DOJ

When Congress enacted the ADA in 1990, it intended for the ADA to keep pace with the rapidly changing technology, and Since 1996, the Department of Justice has consistently taken the position that the ADA applies to web content. In fact, the ADA website even gives an example of a pharmacy as a business that had to reach a settlement with the DOJ because of accessibility issues with their website, so they clearly intend for website accessibility issues to apply to healthcare.

Like most compliance issues, you can’t ignore it, even though it is not something you want to deal with. For legal, financial, and ethical reasons, you should address it through one of the options mentioned above. As always, if you need help or have any questions, please feel free to reach out to us at