Gave the newest patch a try so I'm just going to list some things I've noticed/my thoughts...
Gallery still has the extreme depth of field bug when you zoom in near the girls, performance seems to be worse now in Harem. I was getting 30-40fps at 1080p, 1440, and 4k, on both the orbital station and erotes club so I'm guessing there's some graphical bugs going on there aswell. There are still errors that pop up occasionally when you try to connect to Harem, but it does actually allow you to connect now and link your Patreon/get rewards.
I don't know if I'm just seeing things, but the game overall looks worse to me compared to 0.4.9 I thought maybe it was caused by DLSS but even with it off it still looks less detailed. Also, analyzing cards is really annoying, it reminds me of Star Wars Battlefront 2, and the animation isn't skippable either so you have to sit through it each time. You can also get duplicate animations when analyzing, I thought Helius said they were going to stop that from happening, but maybe I'm missing something?
All in all, after a year + few months worth of waiting, this update is disappointing, and I already had low expectations.
EDIT: It seems hiding other players helps with performance a little, and now I'm wondering what was going on the entire year while they were supposed to be fixing/improving this? It seems to me like they're using DLSS as a crutch to brute force performance rather than actually addressing issues. Also, hiding players only partially works it seems. It looks like when someone leaves an animation they become unhidden. Visuals definitely seem to have taken a hit. I remember being impressed by the quality of the textures/models when you zoomed in close to them, but now it just looks like the same quality you'd see in other unreal engine porn games like Carnal Instinct and Wild Life. Not that those games look bad, but Fallen Doll was a step above them (imo at least) and now it lost that edge. I think my overall opinion now is that there's no reason to play this game seeing as it's just a hassle grinding and there's no visual edge anymore. The girls look nice and the premise is cool, but the execution makes the whole game fall flat when there are other porn games available that actually offer you the porn without having to jump through hoops, and speaking of jumping through hoops I really don't understand what they're going for with the sanity mechanic. I genuinely don't understand, it's like they're punishing people for... playing? Why halt the player from gaining experience and likes? Why incorporate grinding in a porn game just to limit the amount of grinding you can do?