I have at least one visually impaired Twitter follower (there may be more that I'm unaware of). This is why I don't do clever things with Unicode characters or post those text-picture memes and always type in alt text for my images. I'd like to think that I would be sensitive enough to do so without having him in my followers list, but I suspect that if I'm honest with myself, I probably wouldn't so I'm thankful for his presence to remind me to keep things accessible.
Oh yes, the Cyclopean usernames of titan blocks and sky-flung monoliths, all dripping with green ooze and sinister with latent horror. Definitely not screen-reader friendly.