By default, games made with Unity are incompatible with screen readers because Unityʼs UI systems are not accessible to assistive technologies. This means that while the screen reader is on, it is impossible to interact with a Unity game.
This problem can be partially solved by simulating screen reader behavior with the help of text-to-speech. However, screen reader users will still have to turn their screen reader off if they want to play a game made with Unity.
The good news is that starting with Unity 6, games made with Unity can natively support screen readers on Android and iOS by leveraging Unity’s new Accessibility APIs! 
These APIs are independent of the UI, so they can be used regardless of what UI system the game employs. Moreover, Unity 6.3 also brings native screen reader support to Windows and macOS.
Additionally, we added APIs for retrieving certain system accessibility settings so that games made with Unity can adapt their UI according to the settings that users have configured on their devices.
Check out our documentation and sample project!