Data for 1250 articles across 250 journals (five articles per journal) were collected from March 14 to Sept 30, 2023. Articles examined were published between Feb 2, 2021, and April 25, 2023. The most common alt-text practice observed across journals was replication of figure position, such as by listing “Figure 1” or “Figure 2” (150 [60·0%] of 250 journals). It was also common for alt-text to be absent (37 [14·8%] journals) or to contain no meaningful information, such as “Figure” or “Image” (24 [9·6%] journals). In some cases, alt-text replicated the figure title (14 [5·6%] journals) or figure caption (10 [4·0%] journals). Results were similar across clinical, non-clinical, and ophthalmology journals (table). We also noted variation in alt-text practices across journals managed by the same publisher. For example, the publisher with the second highest number of journals in our sample, Elsevier, published 39 journals with alt-text that replicated figure position and four journals that provided no alt-text. We did not observe variability in alt-text practice across different articles within the same journal. Our sample contained three (1·2%) journals that provided alt-text with some context and interpretation without serving the equivalent purpose of the non-text content (ie, limited degree of interpretation), all published by the US Centers for Disease Control and Prevention (CDC).