I see a lot of ancient topics on this with everyone saying "rollback your drivers". They were also pretty much entirely AMD focused. Has anyone actually found a solution to this? I'm on Win10 with an RTX 3090, so rolling drivers back 7+ years (most of the topics were from 2013) is out of the question. It's also definitely not AMD specific despite the fact that every topic I saw was focused on AMD. I guess they broke it first.

Everything seems to work, but the lag caused by the mouse is just unusable IMO. I've tried strong-arming VSync in NVidia Control Panel (say that in one topic). No dice. Tried strong-arming it and a few other options with DgVoodoo2. Nothing. Oddly enough, I had a small period of time where it did just work, but I have no idea why. Nothing changed, really. And then it stopped working while I was testing it out (so my testing was justified, I suppose).

At this point, I'd jokingly suggest you run it in WINE instead.

But more seriously, have you tried capping the framerate and/or adjusting affinity/priority?

Huh, didn't get a notification. but yes, I've capped it to 30hz both via NVidia control panel (force Vsync at 1/2 refresh rate) and dgVoodoo at 30hz. No difference. I doubt affinity and priority are the issues, but I tried it. No difference. Default is normal priority and allowed to run on all CPUs, so I restricted it to 1 CPU and gave it High priority. No change.

It's also always a pain reproing it because on a fresh boot, it doesn't repro for a good 10 minutes or so, but it slowly gets worse until it's just unplayable. Of course, it stays borked across relaunches and only starts working again on fresh boot (maybe?) or just randomly after quite a long time passes.

Edt: Affinity/priority typo. Also, I wanted to reiterate that I forced VSync at 60hz as well. This was in my OP.

I encountered this issue and found that it is due to a larger mouse size. Setting pointer size to 1 in Windows settings fixed the issue completely. If that doesn't do it, try changing the shape and other mouse settings back to the defaults.

With pointer size 2 the game would stop briefly every time I moved the mouse and if I kept moving it fast enough it would effectively be paused. I am playing at 1920x1080 via config file edit, not sure if that makes it worse than usual or not but it was quite annoying.