Some of my clients use Nuance.   However,  I'm really not impressed by making it the default handler for PDF's as it is kind of slow pulling up the PDF's when printing to paperless office.

I've been using Foxit Phantom PDF for years now and won't go back. Superior to adobe IMO. And less of a resource hog. I've also switched most workstations to foxit pdf reader. It offers a print to PDF which adobe reader didn't have. No issues with sage, or anything else for that matter.  It's much less of a resource hog than adobe.

And it's more affordable!