Optic disc drusen (ODD) are an initially symptom-free, usually bilateral, progressive type of optic neuropathy with genetic disposition. We observed visual field loss (VFL) in 64% (49 of 77) of our patients. Vascular complications such as AION are common. Initially, papilledema is often diagnosed and the diagnosis of ODD is confirmed by means of ultrasound examination. We found an average time interval of 7 years between groups of patients with preperimetric stage and onset of VFL. We also observed more advanced stages of VFL, faster progression of visual field loss and greater visibility of ODD with increasing age. VFL frequently results in loss of driving ability according to driving permission regulations. The aim of our therapy concept is to reduce intraocular pressure (IOP). In a pilot study we found that patients who underwent IOP-lowering therapy showed significantly less progression of VFL than patients who did not undergo this therapy. The present article summarizes current knowledge on epidemiology, pathogenesis, clinical presentation, diagnostics and therapy of optic disc drusen.