NVIDIA users heres what I did.

I set the Power Management Mode to Adaptive in the NVcontrol Panel under my tes.exe profile.

I was having problems with random fps, now im pretty consistant at 60 fps.

Not sure if this has anything to do with it either, but I deleted the game cache through steam,validated the game, and started fresh without any ini tweaks.

Also, set AA to FXAA and Multisample in NVcontrol Panel. Looks really good.