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Never do Vista, no dev. programmed for that wreck of an OS.
Turn on OpenGL for this game in GPU Profiles. Add the executable to the profiles if not found in the list.
For those who just want a quick fix, I've found that just turning off "Depth of Field" fixes it.
Now for those who want more details, I've initially tried most of the things already suggested by others(disable steam overlay, disable fullscreen optimizations, compatibility mode, and run as administrator), but nothing ever worked. However I stumbled upon the suggestion to set the config utility's video settings to medium. Which did in fact work. Which got me thinking, if using a different preset works, then surely it must be one of the settings. so I did the following to isolate the culprit:
1. I set the utility to custom, and disabled all the checkboxes, but set all the drop menus and sliders to max.
2. I decided upon a route to follow, in order to test the effects of each change in settings.(I settled upon the following route: Tower, Nordberg, Tower, Burrows, Tower, Forge. And repeat that at least twice over)
3. After each successful run enable half of the checkboxes that were still disabled(This way I don't have to do 10 runs, and can half the number of offending candidates with each run, narrowing it down much faster.)
4. Repeat 2 and 3 until the issue pops back up(Which it did at of course the very last checkbox "Depth of Field". So glad I didn't go one at a time)
5. Revert all prior solutions to make sure it was just this one setting(Turns out it was).
Now full disclosure, I also DID try the GPU profile, but due to some issue with NVIDIA, which is unrelated to this, that didn't work out I'll try to sort that one out later, but I don't expect it to make too big of a difference.
So now I'm successfully running it at max settings sans "Depth of Field".
Hope that helps.