How is the state of PDF #accessibility on macOS for #screenReader users? If I gave someone a PDF that was prepared in a fully #accessible way, what would they use to read it with #VoiceOver, and to what extent would the accessibility be retained?

Note that I'm specifically not interested in applications that strip out all of the text to essentially make a plain version. Those can be useful when you just need to read something and don't care how, but the degree to which accessible semantics like headings, tables, lists, etc. are kept at that point is usually zero.

I'm also not asking about applications that reinvent the accessibility for PDFs and ignore what's already there, as many browsers do.