First hurdle: know your audience

Sighted people often don't realize there is a steep learning curve involved with screen reading software. Web developers need to sit down and watch a student deal with online forms. The converse is also true. A web designer who is blind needs to sit with a low vision person or sighted person to test their website.

Who is the typical screen reader user?

Here is a snippet from the WebAIM survey conducted by the Center for Persons with Disabilities and Utah State University.

"There is no typical screen reader user. JAWS is still the primary screen reader, but usage continues to decrease as usage of NVDA and VoiceOver increases. iOS device usage is significantly increasing and well above that of the standard population. Screen reader users represent a notable portion of the iOS device user market.

The items that cause the most difficulty on the web remain largely unchanged over the last 2.5 years, with inaccessible Flash content and CAPTCHA being the most problematic."

To read the complete survey: http://webaim.org/projects/screenreadersurvey4/