It depends on the pdf.
I'm using a Kindle Dx, so older software but a good big screen. And buttons.
For scanned pdfs, I've found Willus's k2pdfopt helpful. It usually reflows pages for smaller screens, but -mode copy -dev dx avoids that and gets good results with the Kindle Dx.
For pdf-born-pdfs, I've written a script to separate the images from the text, run the images through k2pdfopt -mode copy, and run the text through cpdf -backtext, before splicing everything back together.
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