The purpose of this study was to compare driving simulator performance of participants with visual field loss (VFL) from optic disc drusen (ODD) with a normally sighted control group and a group of individuals with glaucoma. Data on performance and safety from a traffic simulator test for two participants with VFL from ODD were retrospectively compared with data from 49 male individuals without visual deficits in a cross-sectional study. VFL of the ODD group was also compared with a group of 20 male glaucoma participants who had failed the same simulator test. Four individuals with ODD regained their driving licences after a successful simulator test and were then followed in a national accident database. All participants with ODD passed the test. No significant differences in safety or performance measures were detected between the normally sighted participants and the ODD group despite severe concentric visual field constrictions. Compared with failed glaucoma male participants, the ODD group had even lower mean sensitivity in the peripheral and peripheral inferior field of vision. None of the four participants with a regained licence were involved in a motor vehicle accident during a three-year follow-up period after the simulator test. Despite having severe VFL, participants with ODD had no worse performance or safety than controls. In conclusion, even if the extent of central VFL may predict driver safety, drivers with severe VFL from ODD might also be safe drivers. It therefore seems reasonable to provide an opportunity for individualised assessments of practical fitness to drive in licencing issues. On-road testing by a certified driving examiner is currently considered the clinical gold standard. However, driving simulators may provide a useful adjunct to a road test for evaluation of responses to potential hazards under safe, controlled and repeatable conditions.