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This is always kind of a strange question for me.  I mean, graphical advances often directly impact game-play advances.  FPS games, for example, are highly dependent on effective 3D rendering.  That makes it impossible for me to say, "it doesn't matter," because, clearly, there are instances where it does matter.

They can be a vital ingredient to improving game-play.

That being said, I don't give a rat's ass about "ultra high," and I certainly won't go looking for a new video card just because I have to play on "medium".