My visual quality was as specified - ultra - both in the settings and in what I see with my eyes (sharp textures on terrain/objects etc) using that d3d dll fix. Make sure you have the right file and its in the right place. Also it may only work with NVIDIA graphics cards im not sure.
Make sure you set it on ultra settings and it sticks.... because it does in fact work.
Hmm ok odd. Not sure why but after I was setting it to ultra it was still on medium. Its working fine now.
I find that strange, and also find it strange how I had such a difference in FPS from last night to this morning. Have not had time to see if those flashes are gone. If so I am one happy gamer